hepatotoxicity associated with the ingestion of centella asiatica hepatotoxicidad asociada al consumo de centella asiática

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ID: 166799
2005
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Ranked #33 of 155 articles by views in chemistry of heterocyclic compounds

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Abstract
Background: hepatotoxicity due to herbal remedies is being increasingly recognized. Centella asiatica (Centella asiatica Linn Urban) is commercialized for multiple conditions. Its active principles are pentacyclic triterpenic saponosides (asiaticoside, madecassoside). Clinical case studies: we present three women (61, 52 and 49 years old) who developed jaundice after taking Centella asiatica for 30, 20 and 60 days. Respective laboratory tests: ALT: 1193, 1694 and 324 U/L; ALP: 503, 472 and 484 U/L; bilirubin: 4.23, 19.89 and 3.9 mg/dl. The first patient also had ASMA 1/160 and AMA 1/320. Respective pathological diagnoses: granulomatous hepatitis with marked necrosis and apoptosis; chronic hepatitis with cirrhotic transformation and intense necroinflammatory activity, and granulomatous hepatitis. All patients improved with Centella asiatica discontinuation, and ursodeoxycholic acid 10 mg/kg/day. The first patient took Centella asiatica again, with recurrence of the damage. The second one had taken this herb a year before. Conclusions: many plants synthesize hepatotoxic compounds. Germander, Skullcap and Glycyrrhizin contain di- or triterpenic active principles, which can produce hepatic injury by promoting apoptosis and altering cell membranes. We hypothesize that these mechanisms may have resulted in injuries associated with Centella asiatica. The presence of autoantibodies and granulomas also favors an immune-mediated mechanism. Ursodeoxycholic acid has anti-apoptotic properties, but we cannot rule out that Centella asiatica discontinuation alone may have resulted in patient improvement.
Introducción: la hepatotoxicidad por hierbas medicinales es reconocida cada vez más frecuentemente. Centella asiática (Centella asiatica Linn Urban) es comercializada para múltiples afecciones. Sus principios activos son saponósidos pentacíclicos triterpénicos (asiaticósido, madecasósido). Casos clínicos: presentamos 3 mujeres (61, 52 y 49 años) que presentaron ictericia después de consumir Centella asiática por 30, 20 y 60 días. Analíticas respectivas: ALT: 1193, 1694 y 324 U/l; FAL: 503, 472 y 484 U/l; bilirrubina: 4,23, 19,89 y 3,9 mg/dl. La primera presentó ASMA 1/160 y AMA 1/320. Diagnósticos anatomopatológicos: respectivamente hepatitis granulomatosa con marcada necrosis y apoptosis; hepatitis crónica con transformación cirrótica e intensa actividad necroinflamatoria y hepatitis granulomatosa. Todas mejoraron al suspender Centella asiática y con ácido ursodeoxicólico 10 mg/kg/día. La primera volvió a ingerir Centella asiática, repitiendo las lesiones. La segunda había ingerido esta sustancia un año antes. Conclusiones: muchos vegetales sintetizan compuestos hepatotóxicos. Camedrio, escutelaria y glicirricina poseen principios activos di- o triterpénicos que pueden lesionar el hígado promoviendo apoptosis y alterando membranas celulares. Hipotetizamos que estos mecanismos pueden haber producido las lesiones asociadas a Centella asiática. La presencia de autoanticuerpos y granulomas también favorecen un mecanismo inmunológico. El ácido ursodeoxicólico posee propiedades antiapoptóticas, aunque no podemos descartar que la sola discontinuación de Centella asiática haya determinado la mejoría de las pacientes.
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jorge2005revistahepatotoxicity Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;O. A. Jorge;A. D. Jorge
Journal chemistry of heterocyclic compounds
Year 2005
DOI
DOI not found
URL
http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082005000200006
Keywords
apoptosis hepatotoxicity Gastroenterology Ácido ursodeoxicólico

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