Abstract
Herb induced liver injury (HILI) and drug induced liver injury (DILI) share the common characteristic of chemical compounds as their causative agents, which were either produced by the plant or synthetic processes. Both, natural and synthetic chemicals are foreign products to the body and need metabolic degradation to be eliminated. During this process, hepatotoxic metabolites may be generated causing liver injury in susceptible patients. There is uncertainty, whether risk factors such as high lipophilicity or high daily and cumulative doses play a pathogenetic role for HILI, as these are under discussion for DILI. It is also often unclear, whether a HILI case has an idiosyncratic or an intrinsic background. Treatment with herbs of Western medicine or traditional Chinese medicine (TCM) rarely causes elevated liver tests (LT). However, HILI can develop to acute liver failure requiring liver transplantation in single cases. HILI is a diagnosis of exclusion, because clinical features of HILI are not specific as they are also found in many other liver diseases unrelated to herbal use. In strikingly increased liver tests signifying severe liver injury, herbal use has to be stopped. To establish HILI as the cause of liver damage, RUCAM (Roussel Uclaf Causality Assessment Method) is a useful tool. Diagnostic problems may emerge when alternative causes were not carefully excluded and the correct therapy is withheld. Future strategies should focus on RUCAM based causality assessment in suspected HILI cases and more regulatory efforts to provide all herbal medicines and herbal dietary supplements used as medicine with strict regulatory surveillance, considering them as herbal drugs and ascertaining an appropriate risk benefit balance.
Highlights
IntroductionThere are worldwide efforts aiming to develop drugs from natural proTdhuercetasr.e Swuocrlhdwsiudeccefefsorstfsualiming to develop drugs drug developments were recently honored by awarding the Nobel Prize fodrruMg eddeivceilnopemaenntds Pwheryesiroecloengtlyy honored by awardin
There are worldwide efforts aiming to develop drugs from natural proTdhuercetasr.e Swuocrlhdwsiudeccefefsorstfsualiming to develop drugs drug developments were recently honored by awarding the Nobel Prize fodrruMg eddeivceilnopemaenntds Pwheryesiroecloengtlyy honored by awardin2015 for the discovery of two natural products that brought breakthroughPshyinsiotlhogeyth20e1r5afpoyr tohfe tdrioscpoivcearyl of two natural produ therapy of tropical parasitic diseases affecting millions parasitic diseases affecting millions of individuals worldwide
Other intrinsic herb induced liver injury (HILI) are caused by plants such as Germander [72], Radix bupleuri [97,98], Polygonum multiflorum [99], and green tea extracts (GTE) [13,22,23,24,100]
Summary
There are worldwide efforts aiming to develop drugs from natural proTdhuercetasr.e Swuocrlhdwsiudeccefefsorstfsualiming to develop drugs drug developments were recently honored by awarding the Nobel Prize fodrruMg eddeivceilnopemaenntds Pwheryesiroecloengtlyy honored by awardin. Many other drugs have been developed from herbs of traditional or modern medicine [4]. Key issues of presently available and newly developed herbal medicines will have to focus on questions as to whether the benefit risk balance is appropriate [7] and on monitoring safety [6]. This should be associated with mandatory causality assessment of adverse reactions [6,7,8], especially related to the liver as the target organ [8,9,10,11].
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