LIVER DISEASES: THERAPY WITH HERBAL MEDICINES

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ABOUT AUTHORS:
Kambham Venkateswarlu1*, N.Devanna2, R.Venu Priya3, P.Bharath Rathna Kumar4
1M.Pharm Scholar, Department Of Pharmaceutics,
2Director Of JNTUA-Otri,
3Faculty Of Pharmacy, Department Of Pharmaceutics,
4Faculty Of Pharmacy, Department Of Pharmaceutical Chemistry,
JNTUA-Oil Technological Research Institute,
Beside Collector Office, Anantapur,
Anantapur District, Andhra Pradesh, India. Pin Code: 515001
k.v.reddy9441701016@gmail.com

ABSTRACT:
Therapies developed along the principles of Western medicine are often limited in efficacy, carry the risk of adverse effects, and are often too costly, especially for the developing world. Therefore, treating liver diseases with plant-derived compounds which are easily accessible and do not require laborious pharmaceutical synthesis seems highly attractive. When compared to allopathic medicines herbal medicines have some less side effects.

REFERENCE ID: PHARMATUTOR-ART-2093

1. INTRODUCTION:
Supporters of herbal medicine claim that herbs may both treat and prevent diseases. This adds to a deep belief that these treatments are safe because they are “natural” and fit into the image of a gentle and, therefore, harmless alternative to conventional medicine. Treating liver diseases with botanical drugs have a long tradition, but evidence for efficacy is sparse. Moreover, there are concerns about the quality of studies testing herbal remedies.[1]

Silymarin
Silybummarianum
(Milk thistle) has been used to treat liver diseases since the 16th century. Its major constituents are the flavonoids silibinin, silidianin, silichristin, and isosilibinin of which silibinin is the biologically most active compound and used for standardisation of pharmaceutical products. The pharmacological profile of silymarin has been well defined and hepatoprotective properties of silymarin were investigated both in vitro and in vivo. Experimental studies demonstrated antioxidant and free radical scavenging properties, improvement of the antioxidative defence by prevention of glutathione depletion, and antifibrotic activity.[2]

Glycyrrhizin
Glycyrrhizin is an aqueous extract of the liquorice root (Glycyrrhizaglabra) and has been used in traditional medicine to alleviate bronchitis, gastritis and jaundice. The major constituents are glycyrrhetic acid, flavonoids, hydroxycoumarins, and beta-sitosterol, the latter with probable glucocorticoid and mineralocorticoid properties.

As regards safety of glycyrrhizin, decrease of potassium, sodium retention, worsening of ascites and hypertension are anticipated adverse effects due to its aldosterone-like activities. However, published data show no increased rate of these side-effects during treatment although documentation of toxicity is poor in most reports. [2]

Phyllanthusamarus
The plants of the genus Phyllanthusare found in most tropical and subtropical countries and have long been used to treat chronic liver diseases. Phyllantins, hypophyllantins and several polyphenoles are major constituents of which chemical and pharmacological properties are well described. Experimental data indicate that some of the active compounds within Phyllanthusmay exert activity against hepatitis B virus infection, possibly through interference with polymerase activity, mRNA transcription and replication.[2]

Clinical evidence for a beneficial activity of Phyllanthuspreparations in the treatment of chronic hepatitis B comes from numerous trials which were recently evaluated in a systematic review.[2]

Future efforts will have to implement extensive methodological improvements to separate the real therapeutic value of these agents from unfounded hopes and mysteries associated with them. Only rigorous scientific testing along the principles of evidence-based medicine will help herbal medicine to become more than a fashionable trend.[2]

2. ANTIFIBROTIC THERAPEUTIC STRATEGIES:

Anti-inflammatories: Prednisone
Colchicine
+ ursodeoxycholic acid
+ methotrexate
Malotilate
Octreotide
IL-1 receptor antagonists[7]

Antioxidants: Vitamin E/C
Silymarin
Dilineolylphosphatidylcholine
N-acetylcysteine
S-adenosyl-L-methionine
Polyenylphosphatidylcholine[3, 4, 5, 6]

Cytokine/signal transduction molecules: TGF-β receptor competitors
Halofuginone
Hepatocyte growth factor
Interferon-α
Interferon-γ
AT receptor inhibitors (losartan, olmesartan)
ACE inhibitors (peridinopril, captopril)
TNP-470
Carbenoxolone[3, 4, 5, 6]
Tyrosine kinase inhibitors (genistein, imatinibmesylate)
Soluble PDGF receptor
Farnesyl-/geranylgeranyltransferase inhibitors
S-farnesylthiosalicyclic acid
PD 98059 (ERK inhibitor)
Y-27632 (ROCK inhibitor)

ECM-Targeted: Antisense TIMP-1
TIMP-1 antibody
MMP gene therapy
Prolyl-4-hydroxylase inhibitors (HOE077, S4682)[1, 3, 4, 5, 6]

Promoters of HSC Apoptosis: Sulfasalazine
Gliotoxin
Anandamide[1, 3, 4, 5, 6]

Herbal medicines: Sho-saiko-to (TJ-9)
Inchin-ko-to (TJ-135)
Glycyrrhizin
Han-dan-gan-le[1, 3, 4, 5, 6]

3. FOODS AND LIVER HEALTH:
The relevance of human nutrition in the maintenance of the healthy status is an ancient issue and in the year 500 BC Hippocrates said that ‘‘Food is medicine, and medicine is food’’.

In the clinical practice, dietary recommendations in the management of chronic diseases often rely on denying patients certain foods, which results in a severe reduction of quality of life. A new perspective based on the development of Food intended for Specific Medical Purposes (FSMP) containing highly bioavailable antioxidant compounds or polyunsaturated-fatty acids, has been highlighted as a tool for preventive and curative medicine, to be associated to pharmacological treatments.[1]

Nowadays human nutrition science and medicine look at food not only for its function of nourishing and satisfying human senses but also as tool to help people to maintain a healthy status preventing the risk of common pathologies and thus reducing the costs of public healthcare. Recent evidence highlight that a dietary approach that is constituted by the increase of fruit and vegetable as well as the reduction of alcoholic beverage and of fat-rich food consumption also for patients with liver diseases may be counselled.[1]

4. CONCLUSION:
Now a days the whole pharmaceutical companies searching for herbal medicines when compared to synthetic medicines because of most adverse effects associated with synthetic drugs.

4. REFERENCES:
1. Harshmohan. The liver, biliary tract and exocrine pancreas. In: Text book of pathology, 4 thEd, Jaypee Brothers Medical Publishers (P) Ltd. New Delhi . 2002; 22-4 and 569-630.
2. A text book of Pharmacogony by Dr. C.K.Kokate, A.P.Purohit, S.B.Gokhale, NiraliPrakashan Publications, vol-II, 45th Edition
3. Shirwaiker A, Sreenivasan KK, Krishnanand BR and Kumar AV. Chemical investigation and anti hepatotoxic activity of the root bark of Caparisspinosa.Fitoterapia.1996; 67 (3): 200-4.
4. Saraswat B, Visen PKS, Dayal R, Agarwal DP and Patnaik GK. Protective action of ursolic acid against chemical induced hepatotoxicity in rats, Ind. J. Pharmacol.1996; 28: 232-39.
5. Sandhir R and Gill KD. Hepatoprotective effects of Liv-52 on ethanol induced liver damage in rats. Ind .J. Expt. Biol. 1999; 37:762-66.
6. Padma VV, Suja V, Shyamala DCS and Prema. Hepatoprotective effect of Liv-52 on  antitubercular drug-induced hepatotoxicity in rats. Fitoterapia.1998; 69(6): 520-22.
7. Iredale .JP.models of liver fibrosis:exploring the dynamic nature of inflammation and repair  in a solid organ.J.Clinical investigation 2007;117;539-48

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