Spirulina platensis versus silymarin in the treatment of chronic hepatitis C virus infection. A pilot randomized, comparative clinical trial

Green Clinic and Research Centre, Alexandria 21121, Egypt.
BMC Gastroenterology (Impact Factor: 2.37). 04/2012; 12(1):32. DOI: 10.1186/1471-230X-12-32
Source: PubMed


Spirulina platensis, a cynobacterium used frequently as a dietary supplement had been found to exhibit many immune-stimulating and antiviral activities. It had been found to activate macrophages, NK cells, T cells, B cells, and to stimulate the production of Interferon gamma (IFN-γ) and other cytokines. Natural substances isolated from Spirulina platensis had been found to be potent inhibitors against several enveloped viruses by blocking viral absorption/penetration and some replication stages of progeny viruses after penetration into cells. We aimed to study whether this dietary supplement possesses any therapeutically feasible activity worthy of further larger controlled clinical evaluation.
Sixty six patients with chronic hepatitis C virus infection and eligible for inclusion had been randomized to either Spirulina or Silymarin treated groups for a period of six months treatment.The two groups were followed up and blindly compared for early (after 3 months) and end of 6 months treatment virological response. The effects of both treatments on each of alanine aminotransferase (ALT), Chronic Liver Disease Questionnaire scores (CLDQ), Arizona Sexual Experience Scale scores (ASEX) and the occurrence of any attributable adverse events were also compared.
Among the 30 patients who had been treated with Spirulina and completed the 6 months protocol, 4 patients (13.3%) had a complete end of treatment virological response and 2 patients (6.7%) had a partial end of treatment response defined as significant decrease of virus load of at least 2-logs10. Though the proportion of responders in Spirulina group was greater than in the Silymarin group, the difference was not statistically significant at the end of both 6 months (p = 0.12) and 3 months treatment (p = 0.22) by Exact test. Alanine aminotransferase as well as CLDQ and ASEX scores were found to be more significantly improved in Spirulina than in Silymarin treated group.
Our results could suggest a therapeutically feasible potential for Spirulina platensis in chronic HCV patients, worthy to conduct a larger sized and longer study to confirm these safety and efficacy encouraging results.
WHO Clinical Trial Registration ID: ACTRN12610000958088

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Available from: Mostafa Yakoot, Oct 05, 2015
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    • "A total of 1,035 abstracts were reviewed; among these articles, 55 were retrieved, including 12 RCTs [8–12, 22–28] that are closely related to the current subject. However, two [22, 23] were excluded because these articles were basic research, two [24, 25] were excluded because these articles did not use placebo as a control, two [26, 27] were excluded because of duplication, and one [28] was excluded because of unavailable inclusion outcomes; hence, five RCTs [8–12] were selected on the basis of our inclusion criteria (Table 1). "
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    ABSTRACT: Objective: This study aimed to evaluate the efficacy and safety of silymarin on chronic hepatitis C virus- (HCV-) infected patients. Methods: Randomized controlled trials (RCTs) of silymarin in chronic HCV-infected patients up to April 1, 2014 were systematically identified in PubMed, Ovid, Web of Science, and Cochrane Library databases. Results: A total of 222 and 167 patients in five RCTs were randomly treated with silymarin (or intravenous silibinin) and placebo, respectively. Serum HCV RNA relatively decreased in patients treated with silymarin compared with those administered with placebo, but no significance was found (P = 0.09). Meta-analysis of patients orally treated with silymarin indicated that the changes of HCV RNA are similar in the two groups (P = 0.19). The effect on alanine aminotransferase (ALT) of oral silymarin is not different from that of placebo (P = 0.45). Improvements in quality-of-life (Short Form-36) in both silymarin and placebo recipients were impressive but relatively identical (P = 0.09). Conclusion: Silymarin is well tolerated in chronic HCV-infected patients. However, no evidence of salutary effects of oral silymarin has yet been reported based on intermediate endpoints (ALT and HCV RNA) in this population. Moreover, intravenous administration of silymarin should be further studied.
    BioMed Research International 08/2014; 2014:941085. DOI:10.1155/2014/941085 · 2.71 Impact Factor
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    • "Rechter et al. (2006) have analyzed polysaccharide fractions isolated from Arthrospira platensis. These fractions containing spirulan-like molecules showed a pronounced antiviral activity against human cytomegalovirus , herpes simplex virus type 1. Yakoot and Salem (2012) "
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    Antonie van Leeuwenhoek 03/2013; 103(5). DOI:10.1007/s10482-013-9898-0 · 1.81 Impact Factor
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    ABSTRACT: The key role of antiviral therapy of patients with chronic HCV is the sustained eradication of HCV. Different therapeutic plans such as herbal formulations against hepatitis symptoms were put forward for hundreds of years. However, lesser efficacy and, adverse effects constrained the large scale use of herbal medicines. The modern approach, thrived after the discovery of HCV made use of ''interferon-based'' regimens in different dose, duration of treatment and combination. After, ribavirin used in combination with interferon alpha became the centerpiece, pegylation of interferon alpha also aided in enhancing the efficacy of therapeutic plans. Keeping in view the genotype of HCV, viral load and virologic response to treatment, pegylated interferon alpha in combination with ribavirin soon became the standard of care for treating hepatitis C. Adverse effects and lower sustained virologic response rates associated with ''interferon-based'' regimen made indispensable the search for novel HCV therapies. The direct interference of some drugs in the HCV life cycle opened new gates to the treatment strategies beyond interferon. HCV NS3/4A protease inhibitors, the first developed class of Direct Acting Antivirals provided the modern world with Telaprevir and Boceprevir like drugs, that increased the SVR rates up to twice or thrice as that of Standard of Care alone. Many other important direct acting antivirals including polymerase inhibitors, alpha-glucosidase and cyclophilin inhibitors, Nitazoxanide and immuno-modulatory therapies proved effective in increasing the upshot rates of HCV therapies. Recent advancement saw the upstart of direct acting antiviral combination therapies and more direct acting drugs under different phases of clinical trials.
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