Abstract
The last few decades have seen a rise in the use of herbal supplements, natural products, and traditional medicines. However, there are growing concerns related to the safety and toxicities of these medicines. These herbal medicines are associated with complications such as liver damage with a high incidence of mortalities and morbidities. Clinical manifestations range from asymptomatic cases with abnormal liver functions tests to sudden and severe liver failure necessitating liver transplantation. This work aimed to review the etiology, risk factors, diagnosis, clinical manifestations and selected clinical case reports of herbal hepatotoxicity in developing nations. PubMed and Google Scholar searches were undertaken to identify relevant literature. Furthermore, we scanned the reference lists of the primary and review articles to identify publications not retrieved by electronic searches. Little data exists on clinical cases of herb-induced liver injury in some developing countries such as Nigeria, as most incidences are either not reported to health care providers or reports from hospitals go unpublished. Studies in Nigeria have highlighted a possible correlation between use of herbs and liver disease. In Uganda, and association between the use of traditional herbal medicine with liver fibrosis in HIV-infected and non-HIV patients was demonstrated. Reports from China have revealed incidences of acute liver failure as a result of herbal medicine use. The actual incidence and prevalence of HILI in developing nations remain largely unknown due to both poor pharmacovigilance programs and non-application of emerging technologies. Improving education and public awareness of the potential risks of herbals and herbal products is desirable to ensure that suspected adverse effects are formally reported. There is need for stricter regulations and pre-clinical studies necessary for efficacy and safety.
Highlights
The liver is one of the vital organs in the human body, and is highly susceptible to a wide array of metabolic, toxic, microbial, circulatory, and neoplastic injury
Liver injury associated with the consumption of herbal medicines is referred to as ‘herb-induced liver injury’ (HILI), which occurs rarely in only a few susceptible individuals [4,5]
After screening titles and abstracts, we excluded 13 articles, leaving 79 articles for full text review. These articles were excluded on the basis of being irrelevant (n = 9), no copy available in English (n = 1), and duplicates (n = 3)
Summary
The liver is one of the vital organs in the human body, and is highly susceptible to a wide array of metabolic, toxic, microbial, circulatory, and neoplastic injury. Liver diseases start as a gradual and subtle process in which clinical detection and manifestation could occur weeks, months, or even many years following onset of injury. Liver injury associated with the consumption of herbal medicines is referred to as ‘herb-induced liver injury’ (HILI), which occurs rarely in only a few susceptible individuals [4,5]. HILI and DILI share common features, as both cases are caused by chemical components that can be produced either by natural or synthetic processes. These natural and synthetic chemicals are foreign to Toxics 2018, 6, 24; doi:10.3390/toxics6020024 www.mdpi.com/journal/toxics
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