Fatal hepatitis after herbal tea

Mostefa-Kara, N; Pauwels, Arnaud; Pines, E; Biour, M; Lévy, V. G.

doi:10.1016/0140-6736(92)92209-x

Cited by 119 publications

(46 citation statements)

References 4 publications

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“…Ingestion of tea in great quantity or capsules caused an epidemic of cytolytic hepatitis. Thirty cases of hepatotoxicity were first reported, including cases with positive rechallenge (Castot and Larrey, 1992;Larrey et al, 1992;Ben Yahia et al, 1993;Dao et al, 1993) and a fatality due to fulminant hepatic necrosis (Mostefa-Kara et al, 1992). Recently, two other cases, with one positive rechallenge were reported in Canada (Laliberte and Villeneuve, 1996).…”

mentioning

confidence: 96%

Human Microsomal Epoxide Hydrolase Is the Target of Germander-Induced Autoantibodies on the Surface of Human Hepatocytes

Berardinis

Moulis²,

Maurice³

et al. 2000

Mol Pharmacol

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Germander, a plant used in folk medicine, caused an epidemic of cytolytic hepatitis in France. In about half of these patients, a rechallenge caused early recurrence, suggesting an immunoallergic type of hepatitis. Teucrin A (TA) was found responsible for the hepatotoxicity via metabolic activation by CYP3A. In this study, we describe the presence of anti-microsomal epoxide hydrolase (EH) autoantibodies in the sera of patients who drank germander teas for a long period of time. By Western blotting and immunocytochemistry, human microsomal EH was shown to be present in purified plasma membranes of both human hepatocytes and transformed spheroplasts and to be exposed on the cell surface where affinity-purified germander autoantibodies recognized it as their autoantigen. Immunoprecipitation of EH activity by germander-induced autoantibodies confirmed this finding. These autoantibodies were not immunoinhibitory. The plasma membrane-located EH was catalytically competent and may act as target for reactive metabolites from TA. To test this hypothesis CYP3A4 and EH were expressed with human cytochrome P450 reductase and cytochrome b 5 in a "humanized" yeast strain. In the absence of EH only one metabolite was formed. In the presence of EH, two additional metabolites were formed, and a time-dependent inactivation of EH was detected, suggesting that a reactive oxide derived from TA could alkylate the enzyme and trigger an immune response. Antibodies were found to recognize TA-alkykated EH. Recognition of EH present at the surface of human hepatocytes could suggest an (auto)antibody participation in an immune cell destruction.

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mentioning

confidence: 96%

Human Microsomal Epoxide Hydrolase Is the Target of Germander-Induced Autoantibodies on the Surface of Human Hepatocytes

Berardinis

Moulis²,

Maurice³

et al. 2000

Mol Pharmacol

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“…The usual methods of ingestion were capsules and tea bags but germander was also added to liquors and vermouths. Large-scale use resulted in a number of reports in 1992 to the French Regional Centers of Pharmacovigilance about numerous cases of germander-associated acute, chronic and even fulminant hepatitis 54,55 . Most affected individuals were women attempting to lose weight, which most probably re¯ected the high rate of women taking germander rather than gender-speci®c susceptibility.…”

Section: Germandermentioning

confidence: 99%

Hepatotoxicity of botanicals

Stickel

Egerer

Seitz

2000

Public Health Nutr.

133

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Objective: Hepatic impairment resulting from the use of conventional drugs is widely acknowledged, but there is less awareness of the potential hepatotoxicity of herbal preparations and other botanicals, many of which are believed to be harmless and are commonly used for self-medication without supervision. The aim of this paper is to examine the evidence for hepatotoxicity of botanicals and draw conclusions regarding their pathology, safety and applications. Design: Current literature on the hepatotoxicity of herbal drugs and other botanicals is reviewed. The aetiology, clinical picture and treatment of mushroom (Amanita) poisoning are described.

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“…It should be emphasized, however, that, although no serious adverse effects were noted in this study, careful monitoring of complete blood cell count and liver function is recommended, as reports of liver failure and even death have been reported when baseline laboratory values were not followed up. [46][47][48] It is known that specific herbs used in these studies have anti-inflammatory, antibacterial, antifungal, antihistaminic, immunosuppressant, and corticosteroidlike effects. A few ingredients also are smooth muscle relaxants and inhibit platelet activating factor.…”

Section: Chinese Herbal Medicinementioning

confidence: 99%