Hepatotoxicity from Interferon-Beta, Not Noni Juice

Abstract

old female, Stadlbauer et al. [5] report that 2 months elapsed between the time she stopped drinking noni juice and the appearance of symptoms, which was enough time for resolution to be expected. The subject of the first published case report involving a noni drinker did not initially admit any dietary changes or other risk factors, such as heavy drinking [10] . Further questioning revealed that he consumed noni juice, which raises suspicions of other contributing factors not revealed during the interviewing process [11] . Multiple animal toxicity and human clinical studies have demonstrated that high doses of noni juice (up to 750 ml/d), many times greater than those in any of the case reports, have not caused any liver abnormalities [12, 13] . Liver function tests, as well as histology, were unaffected following ingestion of the juice. Further, anthraquinones in noni juice, identified as causative agents in all the case reports, are of the wrong type and quantity ( ! 1 ppm) to be of toxicological relevance [12] . These case reports seem to reveal a regional interest in making a connection between noni juice consumption and hepatitis. No other cases have been reported elsewhere, even though it has been widely consumed since 1996. The available data does not indicate a credible role of noni juice in cases of hepatotoxicity. Dear Sir, In a recent case report published in this journal, Yuce et al. [1] should have focused on reporting another case of interferonbeta (IFN ) toxicity in a patient with multiple sclerosis (MS) rather than implicating noni juice. It is unreasonable to suggest a causal role for noni juice, when the patient was being treated with IFN . Hepatotoxicity from IFN is very well documented, with as many as 2 in every 3 MS patients experiencing some level of alanine aminostransferase (ALT) elevation, 1.4% of these being grade 3 or higher, and more than 30 serious cases reported [2, 3] . Yuce et al. [1] suggested that the continued rise in ALT and bilirubin after cessation of IFN treatment demonstrates the role of noni juice. However, INF toxicity has been observed to persist many days after exposure has stopped [4] . Previous cases of hepatotoxicity in noni juice drinkers have not substantiated a causal role for noni juice. Stadlbauer et al. [5] have recently reported 2 other cases of hepatotoxicity in noni drinkers. In these cases, investigators could not preclude preexisting liver damage in a 29-year-old male, or his acknowledged use of a certain blend of Chinese herbs, as causative factors. Hepatotoxicity from this herbal blend has been reported previously [6–8] , with one of the ingredients, Pinellia ternata , banned in the US due to health concerns [9] . Furthermore, in the case of a 62-yearPublished online: October 26, 2006