Inchin-ko-to prevents medium-term liver fibrosis in postoperative biliary atresia patients

Abstract

The oriental herbal formulation inchin-ko-to (ICKT) inhibits liver cell apoptosis induced by transforming growth factor-beta 1 (TGF-beta1). This study evaluated the effect of ICKT on serum markers of liver function and liver fibrosis in postoperative biliary atresia (BA) patients. Twenty-one postoperative BA patients with elevated GOT, GPT and gamma-GTP, but normal serum total bilirubin levels, were divided into two groups arbitrarily; an ICKT group (n = 12), and a no-ICKT group (n = 9). Serum markers of liver function [GOT, GPT, gamma-GTP, total bile acids (TBA)], and serum markers of liver fibrosis [hyaluronic acid (HA), type IV collagen (C-IV)], were measured in both groups at the beginning of the study, and at 1, and 3 years after the beginning of the study and the results compared statistically. All patients tolerated ICKT well, and there were no side effects. In the ICKT group, mean serum HA levels were significantly decreased at 1 year (P < 0.012), and at 3 years, both mean serum HA and C-IV were significantly decreased (P < 0.001 and P < 0.003, respectively). However, mean serum levels of GOT, GPT, gamma-GTP, and TBA did not change significantly following ICKT use for any length of time (all P > 0.05). Administration of ICKT in postoperative BA patients appears to lower the serum levels of markers of fibrosis in the medium-term. Whether this in fact correlates with prevention cannot be determined from this paper, but ICKT would appear to protect against liver fibrosis. Long-term studies are required to determine the exact role ICKT plays in prognosis of BA patients.

Efficacy of Inchinkoto for Liver Cirrhosis in an Infant with Down Syndrome Complicated by Transient Myeloproliferative Disorder

“…Inchinkoto has long been used to treat various liver disorders in eastern Asia such as Japan and China [5] [6] [7] [8] [9]. Iinuma, et al reported that Inchinkoto might have a protective and antifibrotic effect for the liver of children with biliary atresia [6] [7].…”

“…Iinuma, et al reported that Inchinkoto might have a protective and antifibrotic effect for the liver of children with biliary atresia [6] [7]. Though the precise mechanisms of its action on the liver diseases remain unknown, it can be speculated as following: 1) inhibition of hepatocyte apoptosis induced by transforming growth factor-β1 [10]; 2) inhibition of the production of inflammatory cytokines and inducible nitric oxide synthase [11] [12]; and 3) direct suppression of liver fibrosis [13].…”

“…Considering its reported efficacy on liver fibrosis in children with postoperative biliary atresia [6] [7], the Japanese herbal medicine, Inchinkoto (Tsumura & Co., Tokyo, Japan) was orally administered at the dose of 0.15 g/kg•per•day) since PD 100. In parallel with the commencement of Inchinkoto, both D-bil and HA gradually decreased to 18.3 mg/dL and 1280 ng/mL, respectively on PD 144 (Figure 1).…”

“…Several authors have claimed that Inchinkoto improves liver function and suppresses liver fibrosis in children with postoperative biliary atresia without serious side effects [6] [7]. However, efficacy of How to cite this paper: Washio, R., Takahashi, M., Yamanouchi, S., Hirabayashi, M., Mine, K., Noda, Y., Kanda, E., Ohashi, A., Kawasaki …”

Maximizing Kasai portoenterostomy in the treatment of biliary atresia: Medical and surgical options

“…31 Modulation of this biological process would have immense benefit, but seems elusive and far distant. Asian centres routinely prescribe the Chinese herb Inchinko-to; claimed benefits include inhibition of apoptosis and liver fibrosis, 32 but real evidence of benefit remains unpublished.…”