Green tea extract and the risk of drug-induced liver injury

Teschke, Rolf; Zhang, Li; Melzer, Lena; Schulze, Johannes; Eickhoff, Axel

doi:10.1517/17425255.2014.971011

Cited by 44 publications

(47 citation statements)

References 65 publications

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“…Inhibition of human hepatic and intestinal microsomal CYP2C8, CYP2B6, CYP3A4, CYP2D6 and CYP2C19 by GTE catechins was observed in vitro; however, a clinical study of bioavailability highlighted a small risk of increased plasma drug levels only for substrates metabolized by CYP3A4, without clinical relevance (Teschke et al 2014). …”

Section: Discussionmentioning

confidence: 99%

Hepatotoxicity of green tea: an update

2015

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Green tea (GT), obtained from the leaves of Camellia sinensis (L.) Kuntze (Fam. Theaceae), is largely used for its potential health benefits such as reduction in risk of cardiovascular diseases and weight loss. Nevertheless, it is suspected to induce liver damage. Present work reviews the hepatic adverse reactions associated with GT-based herbal supplements, published by the end of 2008 to March 2015. A systematic research was carried out on PubMed, MedlinePlus, Scopus and Google Scholar databases, without any language restriction. Moreover, some accessible databases on pharmacovigilance or phytovigilance were consulted. The causality assessment was performed using the CIOMS/RUCAM score. Nineteen cases of hepatotoxicity related to the consumption of herbal products containing GT were identified. The hepatic reactions involved mostly women (16/19); the kind of liver damage was generally classified as hepatocellular (16/19). The causality assessment between consumption of herbal preparation and hepatic reaction resulted as probable in eight cases and as possible in eleven cases. In seven cases, patients used preparations containing only GT, while twelve reactions involved patients who took multicomponent preparations (MC). The reactions induced by GT had a generally long latency (179.1 ± 58.95 days), and the outcome was always resolution, with recovery time of 64.6 ± 17.78 days. On the contrary, liver injury associated with MC had a shorter latency (44.7 ± 13.85 days) and was more serious in four cases that required liver transplantation and, when resolution occurred, the recovery time was longer (118.9 ± 38.79). MC preparations contained numerous other components, many of which are suspected to induce liver damage, so it is difficult to ascribe the toxicity to one specific component, e.g., GT. Present data confirm a certain safety concern with GT, even if the number of hepatic reactions reported is low considering the great extent of use of this supplement. The mechanism of GT hepatotoxicity remains unclear, but factors related to the patient are becoming predominant. A major safety concern exists when GT is associated with other ingredients that can interact between them and with GT, enhancing the risk of liver damage. Patients should be discouraged from using herbal or dietary supplements containing complex mixtures and should be encouraged to use herbal and dietary supplement possibly under supervision of healthcare professionals.

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Section: Discussionmentioning

confidence: 99%

Hepatotoxicity of green tea: an update

2015

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“…Information on the amounts of green tea in these two products was not provided. At least as extract, Camellia sinensis is a potent weight loss aid with potentially hepatotoxic effects, as thoroughly discussed first in 2004 [131,132,133] and in subsequent years as shown for many cases [134,135,136,137,138,139,140,141,142,143,144]. Therefore, hepatotoxicity of green tea as extracts was not yet clearly established in 2003 when the case reports were published [93].…”

Section: Narratives Of Tcm Hili Casesmentioning

confidence: 99%

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

et al. 2016

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Background: Traditional Chinese Medicine (TCM) with its focus on herbal use is popular and appreciated worldwide with increased tendency, although its therapeutic efficacy is poorly established for most herbal TCM products. Treatment was perceived as fairly safe but discussions emerged more recently as to whether herb induced liver injury (HILI) from herbal TCM is a major issue; Methods: To analyze clinical and case characteristics of HILI caused by herbal TCM, we undertook a selective literature search in the PubMed database with the search items Traditional Chinese Medicine, TCM, alone and combined with the terms herbal hepatotoxicity or herb induced liver injury; Results: HILI caused by herbal TCM is rare and similarly to drugs can be caused by an unpredictable idiosyncratic or a predictable intrinsic reaction. Clinical features of liver injury from herbal TCM products are variable, and specific diagnostic biomarkers such as microsomal epoxide hydrolase, pyrrole-protein adducts, metabolomics, and microRNAs are available for only a few TCM herbs. The diagnosis is ascertained if alternative causes are validly excluded and causality levels of probable or highly probable are achieved applying the liver specific RUCAM (Roussel Uclaf Causality Assessment Method) as the most commonly used diagnostic tool worldwide. Case evaluation may be confounded by inappropriate or lacking causality assessment, poor herbal product quality, insufficiently documented cases, and failing to exclude alternative causes such as infections by hepatotropic viruses including hepatitis E virus infections; Conclusion: Suspected cases of liver injury from herbal TCM represent major challenges that deserve special clinical and regulatory attention to improve the quality of case evaluations and ascertain patients’ safety and benefit.

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“…Similar criteria were used in causality assessments [23,65] and have been used in prior reviews [65,66]; they allow the comparison of evidence from variable sources, different diagnostic and outcome criteria or different study layouts.…”

Section: Methodsmentioning

confidence: 99%

“…Beginning as early as 1973 [15] modulation of CYP450 activity was studied to explain chemical carcinogenesis and chemoprevention [16][17][18][19][20]. Xenobiotic metabolism is mainly catalyzed by CYP450 isoenzymes, its modulation by tea extracts has been summarized previously [21][22][23][24][25]. However, no direct link between changes in carcinogen metabolism by GT and cancer incidence has been found.…”

Section: Cancer Initiation and Developmentmentioning

confidence: 99%

Green Tea and Its Extracts in Cancer Prevention and Treatment

et al. 2017

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Green tea (GT) and green tea extracts (GTE) have been postulated to decrease cancer incidence. In vitro results indicate a possible effect; however, epidemiological data do not support cancer chemoprevention. We have performed a PubMED literature search for green tea consumption and the correlation to the common tumor types lung, colorectal, breast, prostate, esophageal and gastric cancer, with cohorts from both Western and Asian countries. We additionally included selected mechanistical studies for a possible mode of action. The comparability between studies was limited due to major differences in study outlines; a meta analysis was thus not possible and studies were evaluated individually. Only for breast cancer could a possible small protective effect be seen in Asian and Western cohorts, whereas for esophagus and stomach cancer, green tea increased the cancer incidence, possibly due to heat stress. No effect was found for colonic/colorectal and prostatic cancer in any country, for lung cancer Chinese studies found a protective effect, but not studies from outside China. Epidemiological studies thus do not support a cancer protective effect. GT as an indicator of as yet undefined parameters in lifestyle, environment and/or ethnicity may explain some of the observed differences between China and other countries.

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Green tea extract and the risk of drug-induced liver injury

Cited by 44 publications

References 65 publications

Hepatotoxicity of green tea: an update

Hepatotoxicity of green tea: an update

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

Green Tea and Its Extracts in Cancer Prevention and Treatment

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