Herbal products containing aristolochic acids: A call to revisit the context of safety

Abstract

Herbal products are used globally for their perceived health benefits, and as a complement to alternative therapy to Western medicines. Herbal products can be beneficial, although they can also be harmful in several circumstances. Aristolochic acids (AA) are a compound that is abundant in Aristolochia plants. Previous studies have reported that AAs exert several therapeutic effects and have been commonly used to treat a variety of illnesses, such as eczema, pneumonia, stroke, hepatitis, snakebites, arthritis, gout and coronary artery diseases. AAs, thus, are widely used in traditional and local medicines and herbal products. Unfortunately, the intake of AAs has been linked to kidney failure, as well as cancers of the urinary tract. A direct association between use of AAs and hepatocellular carcinomas has been established. According to the International Agency for Research on Cancer (IARC), AAs are classified into Group 1, which indicates there is sufficient evidence that they cause cancer in humans. Given uncontrolled adulteration of herbal products, along with a decreasing trend in clinical investigations into products containing AAs, adverse events due to exposure to Aristolochia herbs should be given much more attention. Even though the latest evidence has concretely proven that exposure to AAs is widespread throughout countries and regions such as China, South Korea, Japan, Southeast Asia, Europe and North America, the public awareness and attention given by physicians and native healers is not very encouraging. The toxicity and adverse drug events associated with AAs should be investigated thoroughly. Further law enforcement to restrict the sale and use of products containing AAs is warranted.