Literature review of liver injury induced by Tinospora crispa associated with two cases of acute fulminant hepatitis. (February 2019)

• Record Type: Journal Article
• Authors: Huang, Wei-Te; Tu, Ching-Yeh; Wang, Fen-Yu; Huang, Sheng-Teng
• Is Part Of: Complementary therapies in medicine. Volume 42(2019)
• Page Start: 286
• Page End: 291
• Publication Date: 2019-02
• Subjects: ACP acidic phosphatase -- AKT protein kinase B -- ALP alkaline phosphatase -- ALT alanine aminotransferase -- AST aspartate aminotransferase -- CAT catalase -- CCl4 carbon tetrachloride -- CT controlled trial -- DBL direct bilirubin -- DEN diethylnitrosamine -- ED emergency department -- GSH glutathione -- GST GSH S-transferase -- HCC hepatocellular carcinoma -- HDL high-density lipoprotein -- HDLC HDL cholesterol -- LDL low-density lipoprotein -- RCT randomized controlled trial -- SOD superoxide dismutase -- T2DM diabetes mellitus type 2 -- TBL total bilirubin -- TCF Tinospora cordifolia -- TCP Tinospora crispa -- TG Triglyceride -- γ-GT gamma-glutamyltransferase; Herbal medicine -- Guduchi -- Tinospora cordifolia -- Tinospora crispa -- Hepatotoxicity -- Chronic liver diseases; Alternative medicine -- Periodicals; Complementary Therapies -- Periodicals; Médecines parallèles -- Périodiques; Thérapeutique -- Périodiques; Alternative medicine; Electronic journals; Periodicals; 615.5
• DOI: 10.1016/j.ctim.2018.11.028
• Languages: English
• ISSNs: 0965-2299

Abstract

Highlights: TCP and TCF are easily misused in clinical application. TCF exerted liver protection, while TCP had a liver cytotoxic effect. The cis -Clerodane-type furano-diterpenoids in TCP to induce hepatotoxicity. Inform and educate patients or general people of the potential hazards of TCM. Abstract: Introduction: Species of Tinospora are used as herbal remedies for the treatment of various diseases with very few toxic effects having been reported. Tinospora cordifolia (TCF) has been reported to effectively prevent hepatotoxicity. However, there are an increasing number of cases revealing that Tinospora crispa (TCP) might have the negative effect of inducing hepatotoxicity. Because of the similar leaves, people may mistake TCP for TCF, and consume it with the purpose of protecting liver function. Objective: Find out the misusing level of TCP and TCF and which chemical compound in TCP might induce hepatotoxicity. Methods: We report two cases of acute fulminant hepatitis associated with chronic use of TCP. Given that the two herbs were misidentified in these two reports, we investigated the frequency of erroneous identification by using three keywords ("Guduchi", "Tinospora cordifolia", "Tinospora crispa") to search images from the Google Images database. To further clarify the influence of liver function between TCP and TCF, we searched PubMed (up to 29 July 2018) for relevant publications on clinical trials or case reports. Results: Based on web review, over 35 percent of websites failed to accurately identify these two herbs. The different effects on liver function between TCP and TCF were compared through literature review. It indicated that TCF exerted liver protection, TCP had a contrary effect, suggesting its cis -Clerodane-type furano-diterpenoids might be an important factor of inducing hepatotoxicity. Conclusions: We concluded that people might cause hepatic injury or even death without correctly identifying these two Tinospora species.