Herb-induced autoimmune-like hepatitis associated with Xiang-tian-guo (Swietenia macrophylla seeds)

Shao, Yueming; Yin, Xin; Qin, Tingting; Jin, Qinglong; Wen, Xiaoyu

doi:10.1097/md.0000000000024045

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…Complementary and alternative medicine agents may also trigger autoimmune‐like hepatitis. 15 Both “classical” AIH and IMDILI require the initial administration of prednisolone followed by IST. In our patients, weaning off steroids during follow‐up was more frequent in IMDILI patients compared to those in the classical AIH group, together with a trend toward less IST to maintain biochemical remission.…”

Section: Discussionmentioning

confidence: 99%

“…We suggest the inclusion of the antidepressant trazodone to the list of potentially harmful compounds. Complementary and alternative medicine agents may also trigger autoimmune‐like hepatitis 15 . Both “classical” AIH and IMDILI require the initial administration of prednisolone followed by IST.…”

Section: Discussionmentioning

confidence: 99%

“…within weeks) exposure and suspected as a trigger for IMDILI. Particular attention was paid to drugs 12 , 13 , 14 or complementary alternative medicines (such as natural products) 7 , 15 that have been reported to cause DILI with AI features. 16 Results of human leukocyte antigen (HLA) typing and lymphocyte transform test were not available.…”

Section: Methodsmentioning

confidence: 99%

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Discontinuation of immunosuppression in patients with immune‐mediated drug‐induced liver injury or idiopathic autoimmune hepatitis: A case–control study

et al. 2023

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Background and Aim Drug‐induced liver injury (DILI) may present with autoimmune features and require immunosuppressive therapy (IST) to reach biochemical response. Discontinuation of IST without hepatitis relapse may be more frequent in these patients as compared to patients with classical autoimmune hepatitis (AIH). We aimed to determine baseline characteristics and outcome of patients with immune‐mediated drug induced liver injury (IMDILI) with particular emphasis on IST during follow‐up. Methods We performed a single‐center retrospective study of consecutive patients presenting at a tertiary care center between January 2005 and December 2019 either with IMDILI or with classical AIH, for whom full baseline characteristics and a close follow‐up were available over a 12‐month period. Results Overall, 31 patients (IMDILI n = 16, mean age 59 [34–74] years; AIH n = 15, mean age 47 [15–61] years) were included, showing similar biochemical, serological, and histological characteristics. Incriminating drugs in IMDILI patients were mostly represented by nonsteroidal antiinflammatory drugs and sartans. Initial corticosteroids combined with IST led to biochemical response in all patients. Compared to idiopathic AIH, more patients with IMDILI were weaned off corticosteroids at the end of follow‐up (11/16 [68.7%] vs 4/15 [26.6%], P < 0.02). At 1 year of follow‐up, more patients in the IMDILI group compared to the classical AIH group were off any type of IST (13/16 [81%] vs 15/15 [100%], P = 0.08). Conclusions Although presenting with similar baseline biochemical and histological characteristics as idiopathic AIH, patients with IMDILI may not require long‐term IST.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Discontinuation of immunosuppression in patients with immune‐mediated drug‐induced liver injury or idiopathic autoimmune hepatitis: A case–control study

et al. 2023

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“…HDS can also elicit indirect liver damage after inducing an immune-mediated response which leads to AH. A literature review identified 8 case reports of AIH induced by the Chinese herb Xiang-tian-Guo which contains Swietenia macrophylla seeds, frequently used to treat diabetes and hypertension [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

The Threat of Weight-Loss Over the Counter Supplements: A Case of Camellia Sinensis Autoimmune Hepatitis

Sacoto¹,

Turbay²,

Sandhu³

et al. 2023

Cureus

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Autoimmune hepatitis (AIH) arises as a result of environmental and immunological interactions. Herbal and dietary supplements (HDS) are known triggers, and approximately half of the U.S. adult population consumes them, even though they are restricted. Therefore, the importance of recognizing potential triggers of AIH is considered relevant. The mechanism behind HDS Camellia Sinensis inducing AIH is related to its compounds, catechins, which induce reactive oxygen species leading to a liver immune-mediated response. We present here a challenging case of a middle-aged woman with AIH following the consumption of a weight-loss Mexican green tea containing Camellia Sinensis.

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“…Chronic AIH triggered by the use of herbals has been documented for the Japanese multiherbal Kampo formulation Dai‐Saiko‐to ( 18 ) ; the traditional Chinese medicine, Ma huang, an ephedrine‐type alkaloid often used for weight loss resulting in fulminant exacerbation of subclinical AIH ( 19 ) ; and recently, ingestion of Xiang‐tian‐Guo (Swietenia macrophylla seeds) ingestion for 6 months resulting in HILI with AIH features on biopsy. ( 20 ) Another study showed that immunostimulatory herbal supplements containing Echinacea and algae might exacerbate pre‐existing autoimmune disease or precipitate autoimmune disease in persons genetically predisposed to such disorders. ( 21 ) HILI with AIH features, herb‐induced AIH, and flares of chronic AIH all lead to self‐limiting acute hepatitis, a severe acute liver injury requiring treatment.…”

Section: Discussionmentioning

confidence: 99%

Tinospora Cordifolia (Giloy)–Induced Liver Injury During the COVID‐19 Pandemic—Multicenter Nationwide Study From India

Kulkarni

Hanchanale²,

Prakash³

et al. 2022

Hepatol Commun

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Tinospora cordifolia (Giloy) is an herbal supplement commonly used in the Indian alternative medicine system Ayurveda. This herb has been promoted to the public in India as an immune booster to prevent novel coronavirus disease 2019. However, small reports have recently shown an association between Giloy use and the development of herb‐induced liver injury (HILI) with autoimmune features in some patients. This large retrospective Indian multicenter study spanning 13 centers at nine locations was designed to identify features and outcomes of HILI temporally associated with Giloy use. Chemical and toxicological analyses of retrieved Giloy samples using state‐of‐the‐art methods were also performed. We report 43 patients, of whom more than half were female, with a median time from initial Giloy consumption to symptom onset of 46 days. Patients presented with acute hepatitis, acute worsening of chronic liver disease (CLD, the most common clinical presentation), or acute liver failure. Causality assessment revealed probable liver injury in 67.4%. The most common autoantibody detected was anti‐nuclear antibody. Liver biopsy in a subset revealed HILI associated with autoimmune features and hepatocyte and canalicular cholestasis and neutrophilic and eosinophilic infiltration. Conclusion: Giloy is associated with acute hepatitis with autoimmune features and can unmask autoimmune hepatitis (AIH) in people with silent AIH‐related CLD. Further studies on the safety (and efficacy) of untested but heavily promoted herbals in alternative systems of medicine are an unmet need in the interests of public health and are especially important during this global health emergency.

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Herb-induced autoimmune-like hepatitis associated with Xiang-tian-guo (Swietenia macrophylla seeds)

Cited by 7 publications

References 18 publications

Discontinuation of immunosuppression in patients with immune‐mediated drug‐induced liver injury or idiopathic autoimmune hepatitis: A case–control study

Discontinuation of immunosuppression in patients with immune‐mediated drug‐induced liver injury or idiopathic autoimmune hepatitis: A case–control study

The Threat of Weight-Loss Over the Counter Supplements: A Case of Camellia Sinensis Autoimmune Hepatitis

Tinospora Cordifolia (Giloy)–Induced Liver Injury During the COVID‐19 Pandemic—Multicenter Nationwide Study From India

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