Evaluating the Safety and Efficacy of Silymarin inβ-Thalassemia Patients: A Review

Abstract

β-Thalassemia (β-thal) is a type of hereditary anemia affecting hemoglobin (Hb) synthesis causing severe chronic anemia in homozygous patients. Regular blood transfusions are the mainstay treatment for this type of anemia. In turn, this leads to iron overload which is responsible for the formation of reactive oxygen species (ROS), oxidative stress and organ damage. Deferoxamine (DFO) is the standard of treatment for iron overload but regular painful subcutaneous administration of this medication prevents optimal compliance. Oral chelators, such as deferasirox (DFX) and deferiprone (DFP), are also effective and safe. Deferiprone is most effective in combination therapy with DFO rather than monotherapy; however, DFX is very expensive and the cost is a significant new burden for patients. Recently, researchers have proposed an iron chelating effect for silymarin that is a flavonoid extract from the milk thistle plant. This extract has different properties and has long been used for its antioxidant and hepatoprotective effects. In this review we assess different aspects of silymarin's potential effects and compare them to the profile of thalassemic patients.

The potential of silymarin for the treatment of hepatic disorders

“…Earlier studies observed an additional, positive effect (e.g. reduced serum iron and serum ferritin in 3 out of 4 trials) for silymarin [125,126]. In addition, the role of silymarin in a combined regimen with deferasirox or deferiprone in the treatment of the iron overload in Beta-Thalassemia is currently under investigation in several clinical trials.…”

Iron‐chelating effect of silymarin in patients with β‐thalassemia major: A crossover randomised control trial

“…Standard iron chelators, such as deferoxamine (DFO), deferasirox (DFX), and deferiprone (DFP), can attenuate excess iron in the body and prevent complications in patients with β‐TM (Darvishi Khezri et al, ). DFO is the standard treatment for iron overload, but regular painful subcutaneous administration of this drug prevents optimal compliance (Moayedi Esfahani, Reisi, & Mirmoghtadaei, ). Although DFO is available in most countries, one third of all patients worldwide experience iron load because of compliance issues with the self‐administered subcutaneous infusions, 5–6 times/week.…”

“…DFP is an effective oral chelator in combination with DFO, but not as a monotherapy (Poggiali, Cassinerio, Zanaboni, & Cappellini, ). DFX is expensive and has several side effects, such as increased risk of gastrointestinal and liver complications (Moayedi Esfahani et al, ; Poggiali et al, ).…”

Oxidative Stress and Iron Overload in β-Thalassemia: An Overview

“…It reduces inflammation induced by ethanol and oxidative stress in mice [82] and, similar to quercetin, increases HAMP promoter activity in both zebrafish and human hepatocytes via Stat3-and Smad4-dependent process [83]. Silymarin, another flavonoid, is present in milk thistle plant extract and may have iron-chelating properties [84]. It is safe, well tolerated, cost-effective alternative to currently available iron chelation therapies for treating patients with β-thalassemia [84].…”

“…Silymarin, another flavonoid, is present in milk thistle plant extract and may have iron-chelating properties [84]. It is safe, well tolerated, cost-effective alternative to currently available iron chelation therapies for treating patients with β-thalassemia [84]. Ferulic acid is present in a wide variety of plants, and the antioxidant effects are believed to be mediated via the neutralization of free radicals [85].…”