Liver and Anti-virals PDF

Phytotherapy for liver diseases and viruses Dr.Kamel Mahmoud Liver Liver Functions: All the blood leaving the stomach and intestines passes through the liver. The liver processes this blood and breaks down, balances, & creates the nutrients & metabolizes drugs into forms t...

Phytotherapy for liver diseases and viruses Dr.Kamel Mahmoud Liver Liver Functions: All the blood leaving the stomach and intestines passes through the liver. The liver processes this blood and breaks down, balances, & creates the nutrients & metabolizes drugs into forms that easier to use by the body or nontoxic products. More than 500 vital functions have been identified with the liver. Some of the more well-known functions include the following: Production of bile, which helps carry away waste and break down fats in the small intestine during digestion. Production of certain proteins for blood plasma. Production of cholesterol and special proteins to help carry fats through the body. Conversion of excess glucose into glycogen for storage (glycogen can later be converted back to glucose for energy) and to balance and make glucose as needed. Regulation of blood levels of amino acids, which form the building blocks of proteins. Processing of hemoglobin for use of its iron content (the liver stores iron). Conversion of poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine). Clearing the blood of drugs and other poisonous substances. Regulating blood clotting.  Types of liver diseases Acute hepatitis is a clinical syndrome characterized by symptoms of impaired biliary excretion, hepatocellular Hepatitis liver damage and systemic effects of liver inflammation. Viral hepatitis Acute viral hepatitis (AVH) is the commonest cause of Non-alcoholic Fatty liver acute hepatitis and infection with hepatitis viruses Cirrhosis / Liver failure ranges from 20–40% in developed countries and 80– Tumors / Cancers 100% in developing countries. Non-Alcoholic Fatty Liver (NAFLD) Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease. NAFLD indicates an extensive spectrum of liver damages, which ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and liver carcinoma. It is projected to be the principal factor for liver transplantation by 2020. NAFLD is more prevalent in patients with metabolic diseases such as obesity and type 2 diabetes mellitus (T2DM) and is recognized as the hepatic manifestation of the metabolic syndrome (MS).  1- Milk thistle: (Silymarin) (Silybum marianum) Silymarin has been used widely in treating acute or chronic hepatitis worldwide for centuries as a “Liver support” in treatment of chronic inflammatory liver conditions and cirrhosis. The seeds of milk thistle are the medicinal parts of the plant. milk thistle has lipophilic nature, usually administered in capsule or tablet rather than herbal tea. Active constituents: The primary active constituent of milk thistle is silymarin, which is composed of four isomers: silybin, isosilybin, silychristin, and silydianin.  A 2009 Egyptian clinical study was done on 103 patients with acute clinical hepatitis and serum alanine aminotransferase (ALT) levels > 2.5 times the upper limit of normal. Treatment: 140 mg of silymarin (Legalon®) 3 times daily for 4 weeks. Results: Patients in silymarin group had quicker resolution of symptoms of biliary retention: dark urine and jaundice; improving symptoms of acute clinical hepatitis. Supposed mechanisms of action: (1) Preventing entry of various toxins, e.g., alcohol, carbon tetracholoride and heavy metals, into hepatocytes. (2) Stimulating protein synthesis with hepatocyte regeneration. (3) Acting as a free-radical scavenger and antioxidant. (4) Modulating the immune response.  2- Dandelion (Taraxacum officinalis) Dandelion has been used as folk medicines in China, India, & Russia for the treatment of chronic liver diseases. In vitro studies showed the hepatoprotective, antioxidant and anti-inflammatory properties of dandelion. In-vivo studies showed promising results against chronic liver diseases induced by various drugs and chemicals in experimental animals. Active constituents: terpenoids and sterols (principally taraxacin and taraxacerin), equally distributed in the roots, leaves, and flowers. Mechanisms of action: 1- Antioxidant activity: decreases marker enzymes of liver toxicity (AST and ALT), lipid peroxidation and oxidative stress. 2- Anti-inflammatory activity: decrease inflammatory mediators, cyclooxygenase (COX)-2, Tumor necrosis factor- α (TNF-α) and interleukin (IL)-1α. 3- Antifibrotic activity.  3- Licorice 2022, Iran, 60 women with NAFLD were selected and randomly assigned into 2 groups to take 1,000 mg/day powder of licorice root extract or placebo for 12 weeks. All the patients were advised to follow a weight loss diet and healthy lifestyle. Results: women who received powder of licorice root experienced a statistically significant improvement in liver function (alanine aminotransferase ALT), insulin, insulin resistance, malondialdehyde serum levels, and ultrasonographic findings of liver steatosis. Mechanism of action: Licorice and its main active constituent glycyrrhizin treats NAFLD through ameliorating insulin resistance and oxidative stress as these two conditions play important role in NAFLD occurrence.  4- Flax seed 2015, trial for NAFLD Participants were assigned to take either: A lifestyle modification (LM), or LM +30 g/day brown milled flaxseed for 12 weeks. At the end of the study, body weight, liver enzymes, insulin resistance and hepatic fibrosis and steatosis decreased significantly in both groups. However, this reduction was significantly greater in flaxseed group. Mechanism of action: Thus, consumption of n-3 fatty acids may improve NAFLD by increasing the n-3:n-6 ratio in cells, resulting in decreased production of arachidonic acid-derived inflammation and inhibiting hepatic fat accumulation. 5- Omega 3 fatty acid 2018, China, Meta analysis and systematic review of 18 studies involving 1424 patients. “We found a significant benefit for ω-3 PUFAs vs control for liver fat, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, triglycerides, insulin resistance, and glucose.” ω-3PUFAs reduce hepatic lipogenesis and inflammation.  6- Artichoke (Cynara cardunculus) 2018, 90 patients (49 TTT and 41 placebo). Artichoke leaf extract treatment compared with placebo: Doppler sonography showed reduced liver size, reduction in serum ALT and AST levels, improvement in AST/ALT ratio and reduction in total bilirubin. ALE supplementation reduced total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non-high- density lipoprotein cholesterol, and triglyceride concentrations. Active constituents: Artichoke has four well-known compounds: (cynarin. cyanidin. luteolin. cynaroside) 7- Turmeric Turmeric (2 gr/day) or placebo for 8 weeks. At the end of the study, the Turmeric group showed a significant reduction in liver enzymes (AST, ALT and GGT) compared with the placebo group. As mentioned before curcumin has potent anti-inflammatory.  8- Roasted COFFEE Coffee is one of the most popular beverages worldwide, and there is growing evidence that it may provide helpful health benefits in a variety of conditions. Recently, a large, prospective study of more than 50,000 participants reported an inverse, dose-dependent association between coffee drinking and overall mortality. Other studies have suggested that coffee drinking associated with decreased risk of developing heart disease and metabolic syndrome compared with non-coffee drinkers. Several studies reported an inverse association between coffee consumption and hepatocellular carcinoma (HCC) in both the presence and absence of chronic hepatitis C virus (HCV) infection. A meta-analysis of 11 studies reported “Regular coffee consumption is significantly associated with a reduced risk of NAFLD. It is also significantly associated with decreased risk of liver fibrosis development in already diagnosed NAFLD patients.”  A 2015 clinical study on 910 patients with chronic HCV infection showed that “Mild fibrosis controls had a higher average daily intake of caffeinated coffee compared with advanced fibrosis cases” & were more likely to drink an average of 1 or more cups of caffeinated coffee daily. The study showed that “Caffeinated coffee overall and caffeinated tea in non–coffee drinkers likely provide the most benefit in liver disease compared with other caffeinated beverages (soda) or decaffeinated coffee”. This suggests that caffeine is considered the corner stone in hepatoprotective effect of coffee. “But not the only” Study found that “an average of 100 mg or more of caffeine daily from sodas and teas does not have the same protective effect as 100 mg or more of caffeine daily from combined sources (coffee, tea, soda) or from coffee alone, suggesting that “caffeine alone may not entirely explain the effect of coffee on liver disease”. Active constituents: other than caffeine, studies supposed that diterpenes, polyphenols, kahweol, and cafestol, which have antioxidant activity, also may be responsible for the particular hepatoprotective effect of coffee.  Antiviral phytotherapy 1- Nigella sativa and ginger A 2013 Egyptian study was done on 60 HCV patients. Treatment: Ethanolic extracts of black seed and ginger were prepared & formulated into gelatinous capsules, each containing 500 mg were administered twice daily for one month. Results: Both extracts & their mixture significantly reduced 1- The viral load 2- Alpha fetoprotein 3- Liver function parameters with more potent effect for the combined therapy. 2- Glycyrrhizin It is metabolized through the gastrointestinal tract to produce glycyrrhetinic acid. Glycyrrhizin exerts inhibitory effects on hepatitis C virus (HCV), herpes simplex type 1 (HSV-1), influenza virus, severe acute respiratory syndrome (SARS)-associated coronaviruses, and human immunodeficiency virus (HIV). 3- Artemisinin It exerts in vitro and in vivo antiviral activity against DNA viruses such as cytomegaloviruses, human herpesvirus, herpes simplex viruses, Epstein-Barr virus and Hepatitis B virus. 4- Green tea catechins: Proved to have anti-viral activity against DNA viruses like hepatitis B virus, Herpes Simplex Virus, Adenovirus and Epstein-Barr virus. And also, against RNA viruses like Influenza Virus, Influenza Virus, human immunodeficiency virus (HIV), Rotaviruses and Enteroviruses and Ebola virus (EBOV)