Hepatitis Induced by Noni Juice from Morinda citrifolia: A Rare Cause of Hepatotoxicity or the Tip of the Iceberg?

Department of Internal Medicine II, Ludwig Maximilians University of Munich, Germany.
Digestion (Impact Factor: 2.1). 02/2006; 73(2-3):167-70. DOI: 10.1159/000094524
Source: PubMed


A 24-year-old female patient presented to her community hospital with mild elevations of serum transaminase and bilirubin levels. Because of multiple sclerosis, she was treated with interferon beta-1a for 6 weeks. After exclusion of viral hepatitis due to hepatitis A-E, interferon beta-1a was withdrawn under the suspicion of drug-induced hepatitis. One week later, she was admitted again to her community hospital with severe icterus. The transaminase and bilirubin levels were highly elevated, and a beginning impairment of the liver synthesis was expressed by a reduced prothrombin time. The confinement to our department occurred with a fulminant hepatitis and the suspicion of beginning acute liver failure. There was no evidence for hepatitis due to potentially hepatotoxic viruses, alcoholic hepatitis, Budd-Chiari syndrome, hemochromatosis, and Wilson's disease. In her serum there were high titers of liver-kidney microsomal type 1 autoantibody; the serum gamma globulin levels were in the normal range. Fine-needle aspiration biopsy of the liver ruled out an autoimmune hepatitis but showed signs of drug-induced toxicity. During the interview, she admitted that for 'general immune system stimulation' she had been drinking Noni juice, a Polynesian herbal remedy made from a tropical fruit (Morinda citrifolia), during the past 4 weeks. After cessation of the Noni juice ingestion, her transaminase levels normalized quickly and were in the normal range within 1 month.

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    • "The claimed hepatoprotective properties on noni juice however still remain speculative [6, 7]. Recently, seven cases of Morinda citrifolia-associated liver injury emerged in the literature, emphasizing its possible hepatotoxic effect [8 9 10 11 12 13]. "
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    ABSTRACT: Noni juice is a popular herbal dietary supplement globally used for preventive or therapeutic purposes in a variety of ailments, claiming to exhibit hepatoprotective properties as well. Herein we present the case of a 38-year-old woman who developed acute liver injury associated with noni juice consumption on a long-term (9 months) anticonvulsant therapy. Clinical presentation and liver biopsy were consistent with severe, predominantly hepatocellular type of injury. Both agents were stopped and corticosteroids were initiated. Five months later the patient had fully recovered. Although in the literature the hepatotoxicity of noni juice remains speculative, sporadic but emerging cases of noni juice-associated liver injury address the need to clarify and investigate potential harmful effects associated with this supplement.
    Case Reports in Gastroenterology 01/2013; 7(1):19-24. DOI:10.1159/000343651
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    • "The possibility of TNJ-induced toxicity was assessed in aged mice consuming the equivalent of a recommended dose in women for most of their adult life. Serum levels of the hepatic enzymes, aspartate transferase (AST) and alanine transferase (ALT), were examined in the TNJ-treated mice, since these are considered markers of liver damage in humans and both were elevated in the case reports on hepatotoxicity with noni use [19–22, 36, 37]. In addition, serum blood urea nitrogen (BUN), a marker of renal function, was assessed. "
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    ABSTRACT: Morinda citrifolia (noni) is reported to have many beneficial properties, including on immune, inflammatory, quality of life, and cancer endpoints, but little is known about its ability to prevent or treat breast cancer. To test its anticancer potential, the effects of Tahitian Noni Juice (TNJ) on mammary carcinogenesis were examined in MMTV- neu transgenic mice. Mammary tumor latency, incidence, multiplicity, and metastatic incidence were unaffected by TNJ treatment, which suggests that it would not increase or decrease breast cancer risk in women taking TNJ for its other benefits. However, noni may be useful to enhance treatment responses in women with existing HER2/ neu breast cancer since TNJ resulted in significant reductions in tumor weight and volume and in longer tumor doubling times in mice. Remarkably, its ability to inhibit the growth of this aggressive form of cancer occurred with the mouse equivalent of a recommended dose for humans (
    Evidence-based Complementary and Alternative Medicine 04/2012; 2012(2):487423. DOI:10.1155/2012/487423 · 1.88 Impact Factor
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    • "Treated with liver transplant _____________________ Acute hepatitis diagnosed based on elevated liver enzymes and liver biopsy. Vomiting and diarrhea Condition improved over 1 month and normalized within 9 months Yuce et al., 2006 "
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    ABSTRACT: This review investigated the relationship of noni juice, or its extract (fruit, leaves or root), to anticancer and/or immunostimulant properties. A Medline search was conducted using the key search words ‘Morinda citrifolia’ and ‘Morinda citrifolia and cancer’ (1964 to October, 2011) along with cross-referencing. Botanical and chemical indexes were not included. A total of 304 and 29 (10%) articles, respectively, were found under these key terms. Of the 19 studies actually related to cancer, seven publications were in vitro cancer studies, nine were in vivo animal cancer studies, and three were in vivo human cancer studies. Among the in vitro studies, a ‘concentrated component’ in noni juice and not pure noni juice may (1) stimulate the immune system to ‘possibly’ assist the body fight the cancer, and (2) kill a small percentage (0–36%) of cancer cells depending on the type. The nine animal studies suggest that a concentrated component in noni juice may stimulate the immune system; but only slightly increases the number (about 1/3; 25–45%) of surviving mice. Other than two case studies, only two human clinical studies existed. The first consisted of testing freeze-dried noni fruit, which reduced pain perception, but did not reverse advanced cancer. The second was on smokers ingesting an unknown concentration of noni juice who experienced decreased aromatic DNA adducts, and decreased levels of plasma superoxide anion radicals and lipid hydroperoxide. Factors to consider in the future are clearly defining the substance being tested, and whether or not the juice is pasteurized. Some reports of hepatotoxicity exist, although there were confounding factors in most of the case reports. More importantly, noni juice is high in potassium and needs to be monitored by patients with kidney, liver or heart problems. In conclusion, a few in vitro and in vivo animal studies suggest a possible unidentified substance in unpasteurized noni fruit juice that may have a small degree of anticancer activity. The isolation of the active component warrants further research. Copyright
    Phytotherapy Research 02/2012; 26(10):1427-40. DOI:10.1002/ptr.4595 · 2.66 Impact Factor
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