Does the control of alanine aminotransferase levels lead to a regression of liver fibrosis in chronic hepatitis C patients?

Hepatoprotective Effects of Chinese Medicinal Herbs: A Focus on Anti-Inflammatory and Anti-Oxidative Activities

The liver is intimately connected to inflammation, which is the innate defense system of the body for removing harmful stimuli and participates in the hepatic wound-healing response. Sustained inflammation and the corresponding regenerative wound-healing response can induce the development of fibrosis, cirrhosis and eventually hepatocellular carcinoma. Oxidative stress is associated with the activation of inflammatory pathways, while chronic inflammation is found associated with some human cancers. Inflammation and cancer may be connected by the effect of the inflammation-fibrosis-cancer (IFC) axis. Chinese medicinal herbs display abilities in protecting the liver compared to conventional therapies, as many herbal medicines have been shown as effective anti-inflammatory and anti-oxidative agents. We review the relationship between oxidative stress and inflammation, the development of hepatic diseases, and the hepatoprotective effects of Chinese medicinal herbs via anti-inflammatory and anti-oxidative mechanisms. Moreover, several Chinese medicinal herbs and composite formulae, which have been commonly used for preventing and treating hepatic diseases, including Andrographis Herba, Glycyrrhizae Radix et Rhizoma, Ginseng Radix et Rhizoma, Lycii Fructus, Coptidis Rhizoma, curcumin, xiao-cha-hu-tang and shi-quan-da-bu-tang, were selected for reviewing their hepatoprotective effects with focus on their anti-oxidative and ant-inflammatory activities. This review aims to provide new insight into how Chinese medicinal herbs work in therapeutic strategies for liver diseases.

Does herbal medicine reduce the risk of hepatocellular carcinoma?

Many herbal medicines are effective anti-inflammatory agents and may therefore suppress the development of hepatocellular carcinoma (HCC). Recently, treatment with a single-tablet regimen containing ledipasvir and sofosbuvir resulted in high rates of sustained virologic response among patients with hepatitis C virus genotype 1 infection who did not respond to prior interferon-based treatment. Patients with chronic hepatitis C are expected to receive this treatment worldwide. However, many patients have hepatitis-like fatty liver and nonalcoholic steatohepatitis. A strategy to prevent the development of HCC in this subgroup of patients is urgently required. Whether herbal medicines can suppress the development of HCC remains to be established. However, herbal medicines are effective anti-inflammatory agents and may inhibit the development of HCC. Clinical trials exploring the effectiveness of herbal medicines in the prevention and treatment of HCC are therefore warranted. The current lack of knowledge and of educational programs is a barrier to increasing the use of potentially effective herbal medicines and performing prospective clinical trials.

Ultrasound-assisted extraction methodology as a tool to improve the antioxidant properties of herbal drug Xiao-chia-hu-tang

Xiao-chai-hu-tang (XCHT) is an important Chinese herbal prescription for curing many types of liver diseases. The contents of bioactive constituents (saikosaponins a, c and d, baicalin, baicalein, and glycyrrhizic acid), and antioxidant properties of XCHT extracts prepared with ultrasound-assisted (US) extraction in combination with ethanol (up to 95%) as extraction modifier were studied. The results showed that the US extraction significantly increased the bioactive constituents concentrations and antioxidant properties of XCHT extracts when compared with the XCHT prepared with traditional boiling-water extraction. Among the XCHT extracts made with US extraction, the sample prepared with 95% ethanol showed the highest bioactive constituent concentrations and the best antioxidant functionalities. The results suggest that US extraction of XCHT is feasible to replace the traditional time-consuming and low efficiency preparation procedure in the future modernized and commercialized manufacture of this highly valuable Chinese herbal medicine.

Effects of different herb compatibilities of XCHT on a hepatocytic injury model induced by CCl4in vitro

AIM: To explore the effects of drug-contained serum of different herb compatibilities of Xiao Chaihu Tang (XCHT) on a hepatocytic injury model.

METHODS: The hepatocytic injury model was induced by CCl₄ (10 mmoL/L-1), The injured hepatocytes were incubated with CCl₄ and drug-contained serum of different herb compatibilities of XCHT for 24 h. The cells were observed under microscope with Giemsa and TUNEL staining. The apoptosis rate was measured by flow cytometry.

RESULTS: Different herb compatibilities of XCHT could improve the hepatocytic proliferation rate, which was injured by CCl₄ significantly (1.22±1.00, 1.11±0.09, 1.12±0.18, 1.10±0.08, vs 0.78±0.07, P < 0.01), decrease ALT concentration in cell culture solution (948±162,748±278, 1 081±226, 1 148±163, vs 2 110±377, P < 0.01). There were obvious necrosis and apoptosis in the model group cell observed under the convert microscope and Giemsa and TUNEL staining. CCl₄ induced the apoptosis of cells in model group (2.9 467±1.0 007 vs 16.3 175±4.5 358, P < 0.01). The original recipe of XCHT group (G), bupleurum root-scutellaria root group (A) resisted the apoptosis induced by CCl₄ (4.2 117±2.3 733, 6.4 800±2.4 052, 5.6 200±2.0 573, 4.6 440±0.8 825, vs 16.3 175±4.5 358, P < 0.01).

CONCLUSION: Drug-contained serum of different herb compatibilities of XCHT can protect hepatocytic injury induced by CCl₄in vitro. There are obvious apoptosis and necrosis when CCl₄ injures the hepatocyte. The different herb compatibilities of XCHT are of the effects of resisting hepatocytic apoptosis induced by CCl₄.