Hepatoprotective potential of ethanolic extract of Ziziphus oenoplia (L.) Mill roots against antitubercular drugs induced hepatotoxicity in experimental models

Medicinal herbs and their metabolites with biological potential to protect and combat liver toxicity and its disorders: A review

The liver is an essential organ that helps the body with immunity, metabolism, and detoxification, among other functions. Worldwide, liver illnesses are a leading cause of mortality and disability. There are few effective treatment choices, but they frequently have unfavorable side effects. Investigating the potential of medicinal plants and their bioactive phytoconstituents in the prevention and treatment of liver disorders has gained more attention in recent years. An assessment of the hepatoprotective potential of medicinal plants and their bioactive secondary metabolites is the goal of this thorough review paper. To determine their hepatoprotective activity, these plants were tested against liver toxicity artificially induced in rats, mice and rabbits by chemical agents such as carbon tetrachloride (CCl4), paracetamol (PCM), thioacetamide (TAA), N-nitrosodiethylamine, d-galactosamine/lipopolysaccharide, antitubercular medicines (rifampin, isoniazid) and alcohol. To find pertinent research publications published between 1989 and 2022, a comprehensive search of electronic bibliographic databases (including Web of Science, SpringerLink, ScienceDirect, Google Scholar, PubMed, Scopus, and others) was carried out. The investigation comprised 203 plant species from 81 families in total. A thorough discussion was mentioned regarding the hepatoprotective qualities of plants belonging to several families, such as Fabaceae, Asteraceae, Lamiaceae, and Euphorbiaceae. The plant groups Asteraceae and Fabaceae were the most frequently shown to have hepatoprotective properties. The phytochemical constituents namely flavonoids, phenolic compounds, and alkaloids exhibited the highest frequency of hepatoprotective action. Also, some possible mechanism of action of some active constituents from medicinal plants was discussed in brief which were found in some studies. In summary, the information on medicinal plants and their potentially hepatoprotective bioactive phytoconstituents has been consolidated in this review which emphasizes the importance of further research to explore the efficacy and safety of these natural remedies for various liver ailments.

The Activity of Purple Sweet Potato Extract on Antituberculosis-Induced Liver Toxicity

BACKGROUND: The proportion of antituberculosis-induced liver injury on tuberculosis patients showed a relatively high incidence in many countries. Hepatic damage induced by antituberculosis drugs might potentially fatal. Isoniazid (INH) and rifampicin (RIF) are two main components of antituberculosis with crucial role for the incidence of liver injury. One of the herbal remedies that pose hepatoprotective action is purple sweet potato. Hepatoprotective action of purple sweet potato extract has been proved to pose antioxidant and anti-inflammatory activity. AIM: This study was designed to analyze the effect of purple sweet potato extract on rat interleukin-6 (IL-6) and tumor necrosis factor-α _(TNF-α) level, as well as liver histopathology feature in hepatic injury induced by INH-RIF. METHODS: This study was a randomized posttest-only control group design. Male Wistar rats (Rattus norvegicus), age 8–12 weeks, weight 180–220 g were included in this research (divided into three groups). Purple sweet potato extract was produced by maceration technique. IL-6 and TNF-α _level was measured by enzyme-linked immunosorbent assay, whereas liver histopathology examination was performed with hematoxylin and eosin staining. Statistical analysis was performed using one-way ANOVA and post hoc test. RESULTS: Liver IL-6 level in the normal, control, and treatment groups was 2.272±0.473, 3.315 ± 0.536, and 2.548 ± 0.304, respectively (p < 0.001). Liver TNF-α _level in the normal, control, and treatment groups was 26.476 ± 1.681, 48.584 ± 1.359, and 32.547 ± 1.528, respectively (p < 0.05). Histopathology feature of the liver in the control group showed significant liver congestion, liver degeneration, liver necrosis, and infiltration of inflammatory cell. Otherwise, histopathology feature of the liver in the treatment group showed minimal lesion. CONCLUSIONS: Purple sweet potato ethanol extract lowered the liver concentration of IL-6 and TNF-α, as well as improving liver damage in Wistar rats induced with isoniazid and rifampicin.

The efficacy of Jujube syrup on the prevention of drug-induced hepatotoxicity in pulmonary tuberculosis patients: A pilot randomized double-blind placebo-controlled clinical trial

Liver injury is the most common complication of anti-tuberculosis drugs that can cause significant problems. The study aimed to determine the effectiveness of Jujube syrup on the prevention of antituberculosis drug-induced hepatotoxicity (DIH). This pilot randomized double-blind study was conducted based on a placebo-controlled design in patients with tuberculosis (TB). The patients were divided into two groups based on the block random allocation method and received 10 cc of jujube or placebo syrup per day. The liver enzyme levels were assessed as primary outcomes, and the severity of cough, anorexia, and nausea along with the quality of life (QOL) was assessed as secondary outcomes. Finally, eight and nine patients in the jujube and placebo groups completed the study, respectively. In the second week of the study, 27.3% of the patients in the placebo group developed hepatotoxicity. Moreover, there was no liver toxicity in the jujube group. This difference between the two groups was statistically significant (p = .037). Furthermore, the severity of cough in patients in the jujube group decreased significantly during weeks 2 and 4. The QOL significantly improved in the jujube group, compared to the placebo group. This study suggested that Jujube syrup could prevent anti-TB DIH. It can also improve the severity of cough and the QOL in pulmonary TB patients.

Ziziphus oenoplia Mill.: A systematic review on ethnopharmacology, phytochemistry and pharmacology of an important traditional medicinal plant

BACKGROUND

Ziziphus oenoplia Mill. (Family- Rhamnaceae) an important shrub, often found throughout the hot regions of tropical Asia and northern Australia, is commonly well known as Jackal Jujube in English. It is a folk herbal medicine used as an abdominal pain killer and anti-diarrhoeal agent,.

OBJECTIVE

The review aims to provide up-to-date information on the vernacular information, botanical characterization, distribution, ethnopharmacological uses, pharmacological activities, and chemical constituents of Z. oenoplia for possible exploitation of treatment for various diseases and to suggest future investigations.

METHOD

This review was performed by studying online resources relating to Z. oenoplia and diverse resources, including scientific journals, books, and worldwide accepted databases from which information was assembled to accumulate significant information and relevant data at one place.

RESULTS

Investigations on Z. oenoplia have been focused on its pharmacological activities, including its antimicrobial, antidiabetic, antihepatotoxic, antiulcer, antiplasmodial, anticancer, wound healing, anthelmintic, antioxidant, analgesic and antinociceptive, hypolipidemic activity, anti-inflammatory, immunomodulatory and antidiarrheal activities. Phytochemical studies resulted in the isolation of fatty acids, flavonoids, phenols, pentacyclic triterpenes, hydroxy carboxylic acids, aliphatic hydroxy ether, and cyclopeptide alkaloids.

CONCLUSIONS

Most of the ethnopharmacological relevance of Z. oenoplia is justified but more need to be studied. Further investigations are necessary to fully understand the mode of action of the active constituents and to exploit its preventive and therapeutic potentials.

Dietary Intake of Vegetables and Cooking Oil Was Associated With Drug-Induced Liver Injury During Tuberculosis Treatment: A Preliminary Cohort Study

Background and Purpose: Drug-induced liver injury is challenging during tuberculosis treatment. There is no epidemiological data investigating the relation between dietary intake and the risk of drug-induced liver injury during tuberculosis treatment. The aim of this study is to investigate the association of food and nutrient intake with the incidence of tuberculosis-drug-induced liver injury.

Methods: A cohort study was conducted in two city-level tuberculosis-specialized hospitals in Linyi City and Qingdao City, China from January 2011 to December 2013. The dietary intake was assessed by a 3-day 24-h food recall survey and a standard food-frequency questionnaire. The liver functions including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were monitored throughout the 6-month tuberculosis therapy. Liver injury was defined as ALT or AST higher than two times of the upper limit of normal (ULN). Liver dysfunction was defined as ALT or AST higher than the ULN. The ULN for ALT and AST is 40 U/L. Multivariate logistic regression analyses were performed to determine the dietary factors associated with the incidence of liver injury and liver dysfunction.

Results: A total of 605 patients were included in the analysis. During the treatment, 8.1% patients exhibited liver injury and 23.3% patients exhibited liver dysfunction. A lower intake of vegetables was associated with a higher risk of liver injury [OR (95% CI): 3.50 (1.52–8.08), P = 0.003) and liver dysfunction [OR (95% CI): 2.37 (1.31–4.29), P = 0.004], while a lower intake of cooking oil was associated with a lower risk of liver injury [OR (95% CI): 0.44 (0.20–0.96), P = 0.040)] and liver dysfunction [OR (95% CI): 0.51 (0.31–0.85), P = 0.009].

Conclusion: The current study indicated that the higher risks of tuberculosis-drug-induced liver injury and liver dysfunction were statistically associated with decreased vegetable intake and increased cooking oil intake.

Hepatoprotective activity of Tamarindus indica Linn stem bark ethanolic extract against hepatic damage induced by co-administration of antitubercular drugs isoniazid and rifampicin in Sprague Dawley rats

Background Development of drug-induced hepatic damage (DIHD) during chemotherapy is the most common reason for interruption in chemotherapy. This study evaluated the hepatoprotective activity of the ethanolic extract of Tamarindus indica stem bark (EETI) against the induced DIHD in Sprague Dawley rats. Methods The rats were divided into five groups (n=5). Group I, group III, group IV, and group V rats received 1 mL 1% carboxymethyl cellulose, EETI 100 mg/kg body weight (b.wt), EETI 200 mg/kg b.wt, and silymarin 100 mg/kg b.wt, respectively, orally once every day for 28 days. After 1 h-group II, group III, group IV, and group V rats were administered with isoniazid (INH) and rifampicin (RIF) 50 mg/kg b.wt each orally once every day for 28 days. Then, 24 h after the last dosing, blood was withdrawn from the rats and analyzed for liver specific enzymes and biochemical markers. They were examined for histopathology. Results Co-administration of INH and RIF in group II significantly increased alanine transaminase, aspartate transaminase, alkaline phosphatase, lactate dehydrogenase, serum bilirubin, and cholesterol levels while reduced the total protein and albumin levels compared to that of group I. EETI in group III and group IV rats significantly restored the liver specific enzymes and biochemical markers altered due to co-administration of INH and RIF to normal in a dose-dependent manner. EETI 200 mg/kg b.wt showed better protection to liver than EETI 100 mg/kg b.wt and was comparable to silymarin 100 mg/kg b.wt. It was well supported with histopathology of liver tissues. Conclusions EETI possesses hepatoprotective activity against DIHD in rats. It may have a substantial impact on developing clinical strategies to treat patients with hepatic damage.

Prominence of Oxidative Stress in the Management of Anti-tuberculosis Drugs Related Hepatotoxicity

Advanced medical services and treatments are available for treating Tuberculosis. Related prevalence has increased in recent times. Unfortunately, the continuous consumption of related drugs is also known for inducing hepatotoxicity which is a critical condition and cannot be overlooked. The present review article has focused on the pathways causing these toxicities and also the role of enzyme CYP2E1, hepatic glutathione, Nrf2-ARE signaling pathway, and Membrane Permeability Transition as possible targets which may help in preventing the hepatotoxicity induced by the drugs used in the treatment of tuberculosis.

Clinical and experimental research in antituberculosis drug-induced hepatotoxicity: a review

Drug-induced liver injury is the common adverse effect seen in patients receiving antituberculosis drugs (ATDs). There are several risk factors associated with the development of hepatotoxicity in such patients. Though there have been appreciable efforts taken by carrying out studies investigating the efficacy of several natural and synthetic compounds in minimising this effect, the only choice available for clinicians is withdrawal of drugs. This review would give a precise idea of ATD-induced hepatotoxicity, its underlying mechanisms and alternative therapies for the same.

Dexamethasone Pretreatment Alleviates Isoniazid/Lipopolysaccharide Hepatotoxicity: Inhibition of Inflammatory and Oxidative Stress

Isoniazid (INH) remains a cornerstone key constitute of the current tuberculosis management strategy, but its hepatotoxic potentiality remains a significant clinical problem. Our previous findings succeed to establish a rat model of INH hepatotoxicity employing the inflammatory stress theory in which non-injurious doses of inflammatory-mediating agent bacterial lipopolysaccharides (LPS) augmented the toxicity of INH that assist to uncover the mechanisms behind INH hepatotoxicity. Following LPS exposure, several inflammatory cells are activated and it is likely that the consequences of this activation rather than direct hepatocellular effects of LPS underlie the ability of LPS to augment toxic responses. In this study, we investigated the potential protective role of the anti-inflammatory agent dexamethasone (DEX), a potent synthetic glucocorticoid, in INH/LPS hepatotoxic rat model. DEX pre-treatment successfully eliminates the components of the inflammatory stress as shown through analysis of blood biochemistry and liver histopathology. DEX potentiated hepatic anti-oxidant mechanisms while serum and hepatic lipid profiles were reduced. However, DEX administration was not able to revoke the principal effects of cytochrome P450 2E1 (CYP2E1) in INH/LPS-induced liver damage. In conclusion, this study illustrated the DEX-preventive capabilities on INH/LPS-induced hepatotoxicity model through DEX-induced potent anti-inflammatory activity whereas the partial toxicity seen in the model could be attributed to the expression of hepatic CYP2E1. These findings potentiate the clinical applications of DEX co-administration with INH therapy in order to reduce the potential incidences of hepatotoxicity.

Preliminary phytochemical analysis and evaluation of antioxidant, cytotoxic and inhibition of lipopolysaccaride - induced NOS (iNOS) expression in BALB/c mice liver by Ziziphus oenoplia Mill. fruit

BACKGROUND

Ziziphus oenoplia Mill. is an ethnomedicinal plant and its fruit has been traditionally used by Puliar tribes of Anamalai Hills, Tamil Nadu, India to treat various ailments. Phytochemical analysis, antioxidant, cytotoxic and inducible nitric oxide synthase (iNOS) gene downregulation activities of Z. oenoplia fruit (ZOF) were studied.

METHODS

To explore bioactive compounds present in the ripened fruits, high-performance thin-layer chromatography (HPTLC) and gas chromatography/mass spectrometry (GC-MS) analysis were done. Free radical scavenging, hepatoprotective, inhibition of iNOS gene expression and cytotoxic activities of ethanol extract of fruit were also studied.

RESULTS

Total flavonoid content of ZOFwas estimated as 69 µg/mg catechin equivalent. HPTLC densitogram confirmed the presence of quercetin and GC-MS analysis showed a total of 16 compounds of 87.66 % with quinic acid as a major compound which accounted for 22.29 %. Free radical-scavenging activity of ethanolic fruit extract was ranged from 160.12 to 650.23 µg/mL. An amount of 1.5 µg lipopolysaccharide (LPS)- induced severe inflammation in BALB/c mice liver, followed by treatment with ethanolic fruit extract of 100 µg concentration, exhibited significant hepatoprotection and reverse transcriptase polymerase (RT-PCR) analysis showed downregulation of iNOS gene expression in hepatocytes at transcriptional level. ZOF also showed significant cytotoxicity and propidium iodide staining confirmed the induction of apoptosis in cervical cancer cells (HeLa).

CONCLUSIONS

Findings of the present study prove that ZOF is a rich source of bioactive compounds with a wide range of pharmacological activities. Hence, consumption of this wild edible fruit will be a cost-effective and easily available natural nutritional source for health protection.

Role of Inflammatory and Oxidative Stress, Cytochrome P450 2E1, and Bile Acid Disturbance in Rat Liver Injury Induced by Isoniazid and Lipopolysaccharide Cotreatment

Isoniazid (INH) remains the core drug in tuberculosis management, but serious hepatotoxicity and potentially fatal liver injury continue to accompany INH consumption. Among numerous theories that have been established to explain INH-induced liver injury, an inflammatory stress theory has recently been widely used to explain the idiosyncrasy. Inflammatory stress usually sensitizes tissues to a drug's toxic consequences. Therefore, the present study was conducted to verify whether bacterial lipopolysaccharide (LPS)-induced inflammation may have a role in enhancing INH hepatotoxicity. While single INH or LPS administration showed no major toxicity signs, INH-LPS cotreatment intensified liver toxicity. Both blood biomarkers and histological evaluations clearly showed positive signs of severe liver damage accompanied by massive necrosis, inflammatory infiltration, and hepatic steatosis. Furthermore, elevated serum levels of bile acid associated with the repression of bile acid synthesis and transport regulatory parameters were observed. Moreover, the principal impact of cytochrome P450 2E1 (CYP2E1) on INH toxicity could be anticipated, as its protein expression showed enormous increases in INH-LPS-cotreated animals. Furthermore, the crucial role of CYP2E1 in the production of reactive oxygen species (ROS) was clearly obvious in the repression of hepatic antioxidant parameters. In summary, these results confirmed that this LPS-induced inflammation model might prove valuable in revealing the hepatotoxic mechanisms of INH and the crucial role played by CYP2E1 in the initiation and propagation of INH-induced liver damage, information which could be very useful to clinicians in understanding the pathogenesis of drug-induced liver injury.

Emerging CAM Ziziphus nummularia with in vivo sedative-hypnotic, antipyretic and analgesic attributes

Ziziphus nummularia from Rhamnaceae family is traditionally used for sedative-hypnotic, antipyretic and analgesic purposes; however, scientific validations are lacking. This in vivo study was undertaken to verify the above ameliorative properties of Z. nummularia root methanolic extract. Various fractions of the extract were assayed on Balb/c mice by open field, Brewer’s yeast-induced hyperthermia and acetic acid-induced writhing experiments. The significance of the outcomes was analyzed with statistical tests. Various fractions of the extract exhibited marked dose-dependent (p < 0.05) sedative-hypnotic and antipyretic activities. The biological efficacies were most pronounced between 50 and 100 mg/kg. Further, the acetic acid-induced abdominal constrictions were significantly (p < 0.05) attenuated by the extract. Chloroform fraction of the extract was most dominant followed by ethyl acetate. The demonstrated therapeutic attributes of Z. nummularia extract can be exploited to isolate pharmaceutically relevant compounds.

Hepatoprotective agent tethered isoniazid for the treatment of drug-induced hepatotoxicity: Synthesis, biochemical and histopathological evaluation

The aim of the study was to investigate the protective effect of isoniazid–curcumin conjugate (INH–CRM) in INH-induced hepatic injury by biochemical analysis and histology examination of liver in Wistar rats. The biochemical analysis included determination of the levels of plasma cholesterol, triglycerides (TG), albumin content, and lipid peroxidation (MDA). INH–CRM administration resulted in a significant decrease in plasma cholesterol, TG, and MDA levels in the liver tissue homogenate with an elevation in albumin level indicating its hepatoprotective activity. Histology of the liver further confirmed the reduction in hepatic injury. The hepatoprotective with INH–CRM can be attributed to the antioxidant activity of curcumin. The conjugate probably stabilizes the curcumin molecule, preventing its presystemic metabolism thereby enhancing its bioavailability and therefore, its hepatoprotective activity. Thus, the novel INH–CRM has the potential to alleviate INH-induced liver toxicity in antitubercular treatment.