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The Effect of Artichoke Leaf Extract on Alanine Aminotransferase and Aspartate Aminotransferase in the Patients with Nonalcoholic Steatohepatitis

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. Based on recent basic and clinical investigations, the extract of artichoke ( Cynara scolymus ) leaf has been revealed to be used for hepatoprotective and cholesterol reducing purposes. We aimed to assess the therapeutic effects of artichoke on biochemical and liver biomarkers in patients with nonalcoholic steatohepatitis (NASH). Methods . In a randomized double blind clinical trial, 60 consecutive patients suffering NASH were randomly assigned to receive Cynara scolymus extract (as 6 tablets per day consisting of 2700 mg extract of the herb) as the intervention group or placebo as the control group for two months. Results . Comparing changes in study markers following interventions showed improvement in liver enzymes. The levels of triglycerides and cholesterol were significantly reduced in the group treated with Cynara scolymus when compared to placebo group. To compare the role of Cynara scolymus use with placebo in changes in study parameters, multivariate linear regression models were employed indicating higher improvement in liver enzymes and also lipid profile particularly triglycerides and total cholesterol following administration of Cynara scolymus in comparison with placebo use. Conclusion . This study sheds light on the potential hepatoprotective activity and hypolipidemic effect of Cynara scolymus in management of NASH. This clinical trial is registered in the IRCT, Iranian Registry of Clinical Trials, by number IRCT2014070218321N1 .
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Clinical Study
The Effect of Artichoke Leaf Extract on Alanine
Aminotransferase and Aspartate Aminotransferase in
the Patients with Nonalcoholic Steatohepatitis
Vajiheh Rangboo,1Mostafa Noroozi,2Roza Zavoshy,3
Seyed Amirmansoor Rezadoost,4and Asghar Mohammadpoorasl5
1Department of Nutrition, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran
2Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
3Department of Nutrition, Faculty of Nutrition, Qazvin University of Medical Sciences, Qazvin, Iran
4Shahid Chamran Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5Department of Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
Correspondence should be addressed to Mostafa Noroozi; mnoroozi@ymail.com
Received  October ; Revised  February ; Accepted  March 
Academic Editor: Roberto Lupi
Copyright ©  Vajiheh Rangboo et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Background. Based on recent basic and clinical investigations, the extract of artichoke (Cynara scolymus) leaf has been revealed to be
used for hepatoprotective and cholesterol reducing purposes. We aimed to assess the therapeutic eects of artichoke on biochemical
and liver biomarkers in patients with nonalcoholic steatohepatitis (NASH). Methods. In a randomized double blind clinical trial,
 consecutive patients suering NASH were randomly assigned to receive Cynara scolymus extract (as  tablets per day consisting
of  mg extract of the herb) as the intervention group or placebo as the control group for two months. Results.Comparing
changes in study markers following interventions showed improvement in liver enzymes. e levels of triglycerides and cholesterol
were signicantly reduced in the group treated with Cynara scolymus when compared to placebo group. To compare the role of
Cynara scoly mus use with placebo in changes in study parameters, multivariate linear regression models were employed indicating
higher improvement in liver enzymes and also lipid prole particularly triglycerides and total cholesterol following administration
of Cynara scolymus in comparison with placebo use. Conclusion. is study sheds light on the potential hepatoprotective activity
and hypolipidemic eect of Cynara scolymus in management of NASH. is clinical trial is registered in the IRCT, Iranian Registry
of Clinical Trials, by number IRCTN.
1. Introduction
Nonalcoholic fatty liver disease (NAFLD) refers to a wide
spectrum of disorders characterized by fatty inltration in
theliverandsteatosis[].Bydevelopingoxidativestress,
hepatocellular inammation, and steatosis, the term was
replaced by nonalcoholic steatohepatitis (NASH) that may
culminate in cirrhosis and hepatocellular carcinoma [, ].
Within the last decade, prevalence of NASH has interestingly
doubled especially in the Middle East, Far East, Africa, the
Caribbean, and Latin America due to its close association
with lifestyle disorders such as diabetes and obesity [].
In this regard, the best treatment approaches for this phe-
nomenon include weight loss, changes in dietary regimens,
and lifestyle modications. Also, in cases with documented
hyperlipidemia or diabetes, use of insulin sensitizing and
lipid lowering drugs can be also considered []. However,
since NASH is a multifactorial disorder, single target based
therapy has limited implications. Hence, the use of herbal
medicine approach can be a promising alternative due to its
multipronged mechanisms of action [–].
Artichoke (Cynara scolymus) is a plant frequently grown
in Mediterranean countries that is rich in natural antioxidants
andthusisusedasaherbaldrug[].Basedonrecent
Hindawi Publishing Corporation
International Journal of Hepatology
Volume 2016, Article ID 4030476, 6 pages
http://dx.doi.org/10.1155/2016/4030476
International Journal of Hepatology
basic and clinical investigations, the extract of artichoke
leaf has been revealed to be used for hepatoprotective [–
], antimicrobial [], and cholesterol reducing purposes
[].
Artichoke has been found to decrease the production of
reactive oxygen species, the oxidation of low-density lipopro-
teins [], lipid peroxidation [], and protein oxidation and
increase the activity of glutathione peroxidase []. In this
regard, it seems that the use of this herb may be promising to
treat NASH. e present study aimed to assess the therapeutic
eects of artichoke on biochemical and liver biomarkers in
patients with NASH.
2. Subjects and Methods
2.1. Study Population. In a randomized double blind clinical
trial,  consecutive patients who suered NASH (based on
changes in liver enzymes and sonographic evidences) were
included in the study. e main inclusion criteria were ele-
vation of liver enzymes (> 𝜇/L), any evidences of fatty liver
in abdominal sonography, and the existence of at least one
of these characteristics: total cholesterol > mg/dL, high
density lipoprotein (HDL) < mg/dL for men and < mg/
dL for women, serum triglycerides level > mg/dL, fasting
blood sugar > mg/dL, obesity dened as body mass index
> kg/m2, or blood pressure >/ mmHg. In this regard,
the main exclusion criteria were daily alcohol consumption,
diabetes mellitus type I, the existence of concomitant liver
diseases such as hepatitis B or C, autoimmune hepatitis,
Wilson, hemochromatosis, alpha- antitrypsin deciency, or
biliary obstruction, the use of vitamin C, livergol, hepatotoxic
drugs, NASH inducing drugs such as amiodarone, calcium-
channel blockers, or tamoxifen, pregnancy or breastfeeding,
sensitivity to artichoke species, or any life-threatening disor-
ders.
e two groups were matched in terms of sex distribution
(maleandfemaleinbothgroups)andmeanage(47.27 ±
8.12 years in intervention group and 49.83 ± 12.79 years in
placebo group, 𝑃 = 0.357). e two groups were also similar
in other baseline characteristics including weight, levels of
liver enzymes, lipid prole, and fasting blood sugar on initial
assessment.
2.2. Study Intervention. e baseline characteristics of
patients were collected by interviewing and the study ques-
tionnaires were recorded. e patients were then randomly
assigned to receive Cynara scolymus extract (as  tablets per
day consisting of mg extract of the herb prepared in
Dineh company, Qazvin, Iran) as the intervention group
or placebo as the control group for two months (placebo
was prepared from the same ingredient as treatment except
Cynara scolymus extract). e randomization was done
using computer generated random number tables. Both
groups were advised to maintain regular physical activity
( min walking within  days a week) and an appropriate
dietary regimen (calculated based on patients’ weight, height,
age, and percentage of activity using the Miin formula to
gradually reduce body weight).
2.3. Measurement of Biomarkers. Serum alanine transam-
inase (ALT) and aspartate transaminase (AST) activity
was estimated colorimetrically using an especial kit (Pars
Azmoon company, Iran) according to the method of Reitman
and Frankel []. Serum cholesterol (Chol) concentration
was determined colorimetrically using an especial kit (Pars
Man company, Iran) according to the method of Allain et
al. []. Serum LDL-cholesterol (LDL) concentration was
assayed colorimetrically using an especial kit (Pars Azmoon
company, Iran) according to the method of Assmann et
al. []. Serum HDL-cholesterol (HDL) concentration was
measured colorimetrically using an especial kit (Pars Man
company, Iran) according to the method of Lopez-Virella
et al. []. Serum triglycerides (TG) level was determined
colorimetrically using an especial kit (Pars Azmoon com-
pany, Iran) according to the method of Fassati and Prencipe
[]. e biomarkers were measured at the two time points:
admission time and  months aer the initial assessment
(completing treatment protocols).
2.4. Statistical Analysis. Results were presented as mean ±
standard deviation (SD). Continuous variables were com-
pared using 𝑡-test or nonparametric Mann-Whitney 𝑈test.
e changes in study biomarkers aer interventions were
assessed using the Paired 𝑡-test or nonparametric Wilcoxon
test. e multivariate linear regression analysis was used
for assessing study outcomes following dierent employed
protocols as follows. First, the baseline variables as probable
confounders with a 𝑃value <. in univariate analyses
were taken in a multivariate logistic regression model to
assess the dierence between the treatment groups receiving
Cynara scolymus extract or placebo with the presence of
these confounders. For the statistical analysis, the statistical
soware SPSS version . for windows (SPSS Inc., Chicago,
IL) was used.
3. Results
As shown in Table , following administration of Cynara
scolymus, signicant reduction was observed in mean weight,
as well as in serum levels of ALT, AST, blood sugar, total
cholesterol, LDL, and triglycerides. Also, mean systolic blood
pressure was signicantly reduced using Cynara scolymus.In
contrast, using placebo resulted in signicant reduction in
meanweight,aswellasinserumlevelsofALTandAST;
however, among other biomarkers, blood sugar and lipid
prole remained unchanged. Comparing changes in study
markers following interventions showed the changes in liver
enzymes, and also levels of triglycerides and cholesterol were
signicantly more in group treated with Cynara scolymus
when compared to placebo group (Table ). To compare
the role of Cynara scolymus use with placebo in changes
in study parameters, multivariate linear regression models
were employed (Table ) indicating higher improvement in
liver enzymes and also lipid proles of triglycerides and total
cholesterol following administration of Cynara scolymus in
comparison with placebo use.
International Journal of Hepatology
T : Changes in study biomarkers in intervention and placebo groups.
Marker Intervention group Placebo group Intergroup dierence
Before Aer 𝑃value Before Aer 𝑃value
Weight (kg) . ±. . ±. <. . ±. . ±. <. .
ALT (mg/dL) . ±. . ±. <. . ±. . ±. <. <.
AST (mg/dL) . ±. . ±.   <. . ±. . ±. <. <.
FBS (mg/dL) . ±. . ±. . . ±. . ±. . .
Chol (mg/dL) . ±. . ±. . . ±. . ±. . .
LDL (mg/dL) . ±. . ±. . .±. . ±. . .
HDL (mg/dL) . ±. . ±. . . ±. . ±. . .
TG (mg/dL) . ±. . ±. . . ±. . ±. . .
SBP (mg/dL) . ±. . ±. . . ±. . ±. . .
DBP (mg/dL) . ±. .±. . . ±. . ±. . .
T : Multivariate linear regression models for determining the role of Cynara scolymus use on changes in liver enzymes and lipid prole.
Marker Variable Beta % condence interval 𝑃value
ALT change
Artichoke use . . to . <.
Male sex . . to . .
Age . . to . .
AST change
Artichoke use . . to . <.
Male sex . . to . .
Age . . to . .
Chol change
Artichoke use . . to . .
Male sex . . to . .
Age . . to . .
TG change
Artichoke use . . to . .
Male sex . . to . .
Age . . to . .
4. Discussion
Our study aimed to assess the benecial eects of Cynara
scolymus, a herb with antioxidant compounds, on liver
function and also lipid prole and fasting blood glucose.
On the other hand, we aimed to demonstrate therapeutic
eects of this herb on liver functional biomarkers and also
hemodynamicparametersinpatientswithNASH.Inthis
double blind clinical trial, patients in intervention group
received Cynara scolymus extract for two months and changes
in study biomarkers were reassessed.
Serum ALT and AST are eective biomarkers in the
diagnosis of hepatic damage. Sever liver damage was demon-
stratedbyremarkableelevationofserumALTandAST
levels. is elevation may be attributed to the release of these
enzymes from the cytoplasm in to the blood circulation aer
rupture of the plasma membrane and cellular damage [].
e result of the present study showed signicant changes
in serum ALT and AST levels in intervention group in com-
parison with the placebo group (𝑃 < 0.001). is eect could
be attributed to the antioxidant ingredients in Cynara scoly-
mus extract such as mono- and dicaeoylquinic acid (cynarin
and chlorogenic acid), caeic acid and avonoids includ-
ing the glycosides luteolin--𝛽-rutinoside (scolymoside),
luteolin--𝛽-D-glucoside, and luteolin--𝛽-D-glucoside that
are mainly compounds in Cynara scoly mus extract [–].
And chlorogenic acid is the most active antioxidant in Cynara
scolymus extract []. Antioxidants are components that
prevent oxidative reactions oen by scavenging free radicals
beforetheycandamagecells[,].Severalinvitroand
animal studies assessed the antioxidative and free radical
scavenging potential of artichoke extracts in protection hep-
atocytes from oxidative stress [–], but there are a few
human and clinical studies in this regard. e result of the
present study in reduction of serum ALT and AST levels is
in agreement with Saa et al. ey investigate the ecacy
of Cynara scolymus total methanolic extract (CSM) and its
fraction (CSF) in rat. eir result showed that CSF is more
activeincomparisonwithCSM.Perhapsitisbecauseof
high concentration of monocaeoylquinic acid derivatives
(chlorogenic acid) in CSF []. In Huber’s study although the
used doses of Cynara scolymus extract and duration of study
were more than the present study, remarkable reduction in
serum ALT and AST levels was not seen in patients with
hepatitis C, which is not in agreement with our study. It
appears that because of microbial agent and sever damage
of hepatocytes uneectiveness of Cynara scolymus extract
on ALT and AST was caused []. Also, in present study,
International Journal of Hepatology
improvement of lipid prole was signicantly observed in
the group receiving Cynara scolymus extract not in placebo
group. ese eects could be attributed to active ingredi-
ents in Cynara scolymus extract which are known as caf-
feoylquinic acid derivatives (cynarin and chlorogenic acid).
Some previous studies showed that these compounds can
reduce cholesterol by inhibiting HMG-COA reductase and
having a hypolipidemic inuence lowering blood cholesterol
[].
Our result on hypocholesterolemic eect of Cynara scoly-
mus extract is in agreement with Pittler et al. []. Some
studies suggest that Cynara scolymus extract reduces blood
lipids by directly inuencing biosynthesis of cholesterol and
also by production and secretion of bi le from the liver [, ].
Reduction in triglycerides level is attributed to improvement
in glycemic control and reduction of glucose instead of
fat. Acetyl COA yield from pyruvic acid enters Krebs cycle
and leads to metabolism of glucose completely instead of
triglycerides biosynthesis.
In present study improvement in fasting blood sugar was
signicantly observed in group receiving Cynara scolymus
extract not in placebo group. is benecial eect could be
attributed to high antioxidant capacity of this herb. Phenolic
compounds, specially, such as caeic acid and avonoids, are
representative of this eect.
Another mechanism for reducing glucose level by Cynara
scolymus extract is aecting glucose absorption. Antioxidant
compounds delay depletion of stomach and bowels and
they inhibited 𝛼-amylase and 𝛼-glucosidase enzymes in
bowelsandblockedglucosetransportationtoblood.Onthe
other hand antioxidants have insulin-like eect and increase
glucose absorption in peripheral tissue. Another probable
mechanism is inuencing 𝛽-cells, repairing damage cells, and
stimulating these cells to secrete insulin. Studies show that
chlorogenic acid has antidiabetic eect [, ] and reduction
glucose by reason of this compound.
Another point of this study was the parallel improvement
in liver enzymes and also lipid prole by administrating
Cynara scolymus that was not simultaneously in placebo
group. Cholesterol metabolism is associated with liver fat
content independent of body weight, implying that the
more the fat the liver contains, the higher the cholesterol
synthesis is []. Cellular cholesterol synthesis is regulated
by activation of membrane bound transcription factors, des-
ignated sterol regulatory element-binding proteins (SREBPs)
which are the most abundant in the liver [], and the
excess of cellular cholesterol is esteried by the acyl CoA-
cholesterol acyltransferase (ACAT) []. e high level of
cholesterol synthesis and the increased SREBP- activity have
paradoxically been shown in subjects with NASH []. It is
thus suggested that the eects of Cynara scolymus may appear
by inducing and involving these metabolic pathways in the
liver.
e main strength of the study was to shed light on
the potential role of artichoke on biochemical and liver
biomarkers in patients with NASH in a controlled trial.
Although, in previous studies, the role of this herb to treat
NASH has been assessed, a few studies focused directly on the
improvement of liver enzymes via administrating this herbal
drug. Another strength of the current study was to assess the
simultaneous changes in liver enzymes, blood sugar, and lipid
prole. is concomitant assessment is important because the
central role of liver leads to metabolic pathways regulating
the level of these metabolic biomarkers. However, our study
had some potential limitations including small sample size
leading to partially low study power as well as ignoring other
baseline clinical and pharmacological confounders aecting
the employed regression models used for assessing the eects
of artichoke on biochemical and liver biomarkers in NASH.
5. Conclusion
In conclusion, the current study sheds light on the potential
role of Cynara scolymus in management of NASH. e active
constituents of this herb such as avonoids and caeoylquinic
acid may be responsible for this eect. ese compounds
have been proven to have hepatoprotective activity and
hypolipidemic eect.
Ethical Approval
e protocol was approved by the Research Council and
Ethical Committee of Qazvin University of Medical Sciences,
no. D//.
Consent
Consent was obtained from each patient. ey could quit
the study freely. All participants provided informed written
consent.
Competing Interests
e authors have no competing interests.
Acknowledgments
e authors would like to thank Children Growth Research
Center, Qazvin University of Medical Sciences, Qazvin, Iran,
and Deputy of Research, Qazvin University of Medical and
Health Sciences, Qazvin, Iran, for nancial support (Grant
no. D..). anks are due to the mothers who partic-
ipatedintheirstudy.eywouldalsoliketothankthehealth
care sta for cooperation in collecting the data and thank
Dineh company for providing the extract of artichoke leaf and
placebo.
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... The p values less than 0.05 were considered to be statistically significant. [27] 2000 L L L L L L 2. Roghani-Dehkordi and Kamkhah [30] 2009 L L L L L L 3. Fallah Huseini et al. [19] 2012 L L L L S L 4. Rangboo et al. [29] 2016 L L S L L L 5. Panahi et al. [17] 2018 L L L L L L 6. Musolino et a. [28] 2020 L L L L L L 7. Rondanelli et al. [31] 2020 L L L L L L L, Low risk of bias; H, High risk of bias; S, Some concerns. ...
... We also excluded another study with complex intervention. Finally, seven studies were included in the systematic review and meta-analysis [27][28][29][30][31][32][33]. Figure 1 shows a flow diagram of study selection. ...
... The mean age of participants ranged from 42.5 to 51.5 years. The studies on hypercholesterolemia [27,30], NAFLD [17,28], type 2 diabetes [19], NASH [29] and overweight patients [31] were included. The clinical trials were released in the period from 2000 to 2020. ...
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Studies examining the effect of artichoke on liver enzymes have reported inconsistent results. This systematic review and meta-analysis aimed to assess the effects of artichoke administration on the liver enzymes. PubMed, Embase, the Cochrane Library, and Scopus databases were searched for articles published up to January 2022. Standardized mean difference (Hedges' g) were analyzed using a random-effects model. Heterogeneity, publication bias, and sensitivity analysis were assessed for the liver enzymes. Pooled analysis of seven randomized controlled trials (RCTs) suggested that the artichoke administration has an effect on both alanine aminotransferase (ALT) (Hedges' g, -1.08; 95% confidence interval [CI], -1.76 to -0.40; p = 0.002), and aspartate aminotransferase (AST) (Hedges' g, -1.02; 95% CI, -1.76 to -0.28; p = 0.007). Greater effects on ALT were detected in trials that lasted ≤8 weeks. Also, greater effects on AST were detected in trials using > 500 mg artichoke. Overall, this meta-analysis demonstrated artichoke supplementation decreased ALT and AST.
... As long-term use of medications could exert adverse effects comprising dizziness, dehydration, constipation, and drowsiness [7] adopting effective alternative therapies in particular dietary management, which could prevent future complications would be very valuable [8]. One of the therapeutic plants with a beneficial impact on HTN [9][10][11][12] is the Cynara scolymus L. (commonly known as artichoke). Lately, artichoke and its products have gained attention in scientific society. ...
... Based on an experimental study, artichoke leaf extract also increases endothelial nitric oxide synthase (eNOS) gene expression and nitric oxide (NO) production in cultured human vascular endothelial cells and enhances endothelium-dependent vasodilation in mice aorta [15]. The current evidence is relatively limited and non-conclusive and only a few studies have reported that the supplementation of artichoke and artichoke products have a promising effect on controlling blood pressure [9][10][11][12]. While these findings are not supported by other studies [14,16,17]. ...
... Of these articles, 10 were excluded because of the following reasons: irrelevant (n = 3), has no placebo-controlled group (n = 1), complex intervention (n = 1), without sufficient data for outcomes (n = 2), and conference abstracts (n = 3). Finally, 7 studies met all our inclusion criteria [9][10][11][12]14,16,17]. ...
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Despite controversies, no earlier study has systematically summarized findings from earlier studies on the effect of artichoke supplementation on blood pressure. Therefore, current systematic review and meta-analysis was done on the effect of artichoke supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults. Five databases were searched from inception to January 2022 using relevant keywords. All randomized clinical trials investigating the impact of oral artichoke supplementation on any of the blood pressure parameters including SBP or/and DBP were included. Out of 1,507 citations, 7 trials that enrolled 472 subjects were included. Artichoke supplementation resulted in significant reduction in SBP (weighted mean difference [WMD], −2.01 mmHg; 95% confidence interval [CI], −3.78, −0.24; p = 0.026) and DBP (WMD, −1.45 mmHg; 95% CI, −2.81, −0.08; p = 0.038). Greater effects on SBP were detected in trials using ≤ 500 mg artichoke, lasted > 8 weeks, participants aged < 50 years' old and sample size ≤ 70. There was also a similar impact of artichoke on DBP. However, significant non-linear associations were found between artichoke supplementation dosage and study duration with both SBP (for dosage: p non-linearity = 0.002, for duration: p non-linearity = 0.016) and DBP (for dosage: p non-linearity = 0.005, for duration: p non-linearity = 0.003). We found a significant reduction in both SBP and DBP following artichoke supplementation in adults. It could be proposed as a hypotensive supplement in hypertension management.
... For this reason, one of the mechanisms of action underlying the hepatoprotective activity might be related to the suppression of the TLR 4 and NF-κB pathway, which can ultimately hinder the release of proinflammatory cytokines and subsequently prevent the damage of the cell membrane, thus avoiding the leakage of AST and ALT into the bloodstream [139]. The bioactive compounds of Cynara that might be responsible for this hepatoprotective activity are caffeic acid and its derivates (chlorogenic acid and cynarine), as well as luteolin [139][140][141], mainly attributed to the antioxidant properties of the above-stated components [141]. The aqueous infusion of separate flower heads of C. scolymus, fruit of Ficus carica L., and fruit of Morus nigra L. presented reduced levels of liver enzymes and a higher level of antioxidant enzymes. ...
... For this reason, one of the mechanisms of action underlying the hepatoprotective activity might be related to the suppression of the TLR 4 and NF-κB pathway, which can ultimately hinder the release of proinflammatory cytokines and subsequently prevent the damage of the cell membrane, thus avoiding the leakage of AST and ALT into the bloodstream [139]. The bioactive compounds of Cynara that might be responsible for this hepatoprotective activity are caffeic acid and its derivates (chlorogenic acid and cynarine), as well as luteolin [139][140][141], mainly attributed to the antioxidant properties of the above-stated components [141]. The aqueous infusion of separate flower heads of C. scolymus, fruit of Ficus carica L., and fruit of Morus nigra L. presented reduced levels of liver enzymes and a higher level of antioxidant enzymes. ...
... -Clinical trial Patients with nonalcoholic steatohepatitis After the treatment with C. scolymus L. extract, there was a decrease in ALT and AST, while it also reduced the serum lipid profile. [141] -, there are no data. ...
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Cardoon (Cynara cardunculus L.) is a Mediterranean plant and member of the Asteraceae family that includes three botanical taxa, the wild perennial cardoon (C. cardunculus L. var. sylvestris (Lamk) Fiori), globe artichoke (C. cardunculus L. var. scolymus L. Fiori), and domesticated cardoon (C. cardunculus L. var. altilis DC.). Cardoon has been widely used in the Mediterranean diet and folk medicine since ancient times. Today, cardoon is recognized as a plant with great industrial potential and is considered as a functional food, with important nutritional value, being an interesting source of bioactive compounds, such as phenolics, minerals, inulin, fiber, and sesquiterpene lactones. These bioactive compounds have been vastly described in the literature, exhibiting a wide range of beneficial effects, such as antimicrobial, anti-inflammatory, anticancer, antioxidant, lipid-lowering, cytotoxic, antidiabetic, antihemorrhoidal, cardiotonic, and choleretic activity. In this review, an overview of the cardoon nutritional and phytochemical composition, as well as its biological potential, is provided, highlighting the main therapeutic effects of the different parts of the cardoon plant on metabolic disorders, specifically associated with hepatoprotective, hypolipidemic, and antidiabetic activity.
... According to the instructions, the indicators determined by using the kit were as follows: aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total serum bilirubin (TSB), total protein (TP), albumin (ALB) content [22], aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (Zhongsheng North Control Biotechnology Co. Ltd., China). Repeat each sample 3 times to prevent system errors. ...
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In order to explore the effect and mechanism of Aornia mealnocarpa Elliot anthocyanins (AMA) at the cellular level on hepatic fibrosis (HF), molecular docking, RT-PCR and Western Blotting were used to explore the molecular mechanism and the effects of different doses AMA on HSC-T6 cells by TGF-β1 induction. The results showed that the binding energy of anthocyanins on TGF-β1 (PDB ID: 3KFD) was in the range of −9.5 to 8.6 kcal/mol, with good low energy parameters and binding positions. AMA could effectively inhibit the expressions of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total serum bilirubin (TSB), and improved the expressions of total protein (TP) and albumin (ALB). RT-PCR and Western bloting results showed that AMA could inhibited the secretion of inflammatory cytokines IL-1, IL-6, TNF-α and COX-2, and inhibit the expression of TGF-β1, P-Smad2, α-SMA and Collagen I in TGF-β /Smad signaling pathway. This study revealed the AMA’s inhibition effects and mechanism of malignant biological behavior of HSC-T6 cells, in order to provide theoretical basis for the prevention and treatment of HF by Aronia melanocarpa Elliot.
... In 44 reviewed studies with a sample size of 1298 participants, patients had nonalcoholic Steatohepatitis (NASH) only in four studies, [58,[71][72][73] and in other studies, the patients were inflicted with NAFLD. In these studies, the standardized effect size of natural products on the reduction of AST, ALT, GGT levels was statistically significant. ...
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Background: Nonalcoholic fatty liver is the most common chronic liver disease. Regarding the side effects of synthetic medicines and the variety of natural products in Iran climate, the present study aimed to investigate the effect of medicinal plants and natural products on liver enzymes in patients with non-alcoholic fatty liver disease in Iran using meta-analysis. Methods: To extract the intended studies, internal and external databases, including SID, Magiran, IranDoc, PubMed, Scopus, Web of Science, Embase, Cochrane, and Clinical Trial Registration System of Clinical trial.gov, the ISRCTN system, as well as Clinical Trial Registration System affiliated to the World Health Organization were searched. The obtained data were analyzed in STATA.14 software. A P value less than 0.05 was considered statistically significant. Results: A total of 44 rstudies were reviewed with a sample size of 1298 participant; they were published in the period from 2009 to 2018, silymarin had the highest effect on the reduction of AST (SMD = -2.68), cinnamon excreted the most profound effect on ALT (SMD = -2.69). In addition, cinnamon had the highest effect on gamma-glutamyl transferase (GGT) (SMD:-3.17), and curcumin had the highest effect on alkaline phosphatase (ALP) (SMD = -1.88). In the lipid profile, the effect of medicinal herbs and natural products on lowering total cholesterol and LDL was statistically significant. In the glycemic profile, the effect of medicinal plants and natural products on the reduction of fasting blood sugar, insulin, and hemoglobin A1c levels was statistically significant. Conclusions: As evidenced by the obtained results, the highest effect of using natural products was observed in the reduction of GGT, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels, respectively; nonetheless, the effect of natural products on ALP reduction was not statistically significant.
Chapter
Artichoke (Cynara scolymus L., Asteraceae) is a prevalent cultivated plant frequently consumed in the Mediterranean Regions, the USA, and Africa. C. scolymus is used in folkloric medicine to treat hepatitis and hyperlipidemia and its diuretic and choleretic effects. Artichoke includes vitamins, minerals, phenolic components, prebiotics, and terpenoids. It has several biological activities, especially antihyperlipidemic, antispasmodic, antiaging, antioxidant, antimicrobial, hepatoprotective, choleretic, hypoglycemic, and anticancer features. In recent years, C. scolymus has been designed and used in various pharmaceutical forms. Clinical analyses have stated that extracts from artichokes may have recuperating characteristics to treat a variety of diseases.KeywordsCynara scolymusGlobe artichokeAsteraceaeHepatoprotective
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Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease that can lead to liver cirrhosis, liver cancer, and death. Artichoke leaf extract (ALE) is well known in folk medicine for its hepatoprotective effect. Till recent times, no sufficient data from randomized clinical trials (RCTs) exist to support such use. This meta-analysis summarizes evidence from recent RCTs that evaluated ALE in NAFLD patients. Electronic databases were searched for RCTs that used ALE in NAFLD patients. The random-effects model was used to pool effect sizes (standardized change score). Data synthesis from five RCTs (333 patients) showed that ALE resulted in a significant reduction in alanine aminotransferase (standardized mean difference [SMD]: 1.1; 95% confidence interval [CI], 0.79-1.73; P < .001) and aspartate aminotransferase levels (SMD: 1.01; 95% CI, 0.52-1.51; P < .001) compared with the control group. ALE also resulted in a significant reduction in total cholesterol (SMD: 0.98; 95% CI, 0.53-1.43; P = .004), low-density lipoprotein (SMD: 0.96; 95% CI, 0.3-1.62; P < .001) and triglycerides (SMD: 0.95; 95% CI, 0.58-1.32; P < .001). The current review provides evidence from RCTs to support the use of ALE as a hepatoprotective agent in NAFLD patients. The study was registered on the PROSPERO database with the Registration No. CRD42020182502 (https://www.crd.york.ac.uk/prospero).
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Macaranga barteri is a plant used in traditional medicine to treat non-alcoholic fatty liver disease. However, its potential against hepatic steatosis has not been scientifically proven yet. This work aimed to investigate the preventive effect of the aqueous extract of Macaranga barteri leaves (AEMb) on hepatic steatosis experimentally induced with amiodarone in rats. 36 rats were divided into 6 groups of 6 rats each. Group 1, the non-intoxicated group and Group 2, used as controls were pretreated with distilled water (10 ml/kg b.w.). Group 3 received silymarin at 100 mg/kg b.w. while Groups 4, 5 and 6 were pretreated with AEMb at doses of 125, 250 and 500 mg/kg b.w. respectively. The weights of the rats were monitored during the experimentation. After 7 days of daily pretreatment with the different substances, rats of groups 2 to 6 were administered intraperitoneally amiodarone (200 mg/kg bw) three times daily for seven other consecutive days. At the end of the experiments, blood samples were collected on fasted and anesthetized rats kept in dried and EDTA tubes in order to assess some hematological and biochemical parameters and also rats livers were removed for gross observation and hepatic triglyceride assessment. The results revealed that AEMb and silymarin inhibited the weight loss induced by amiodarone and even favored weight gain. The reduction of heamatological indices (leukocytes and leukocyte indices, erythrocytes and erythrocyte indices (MCV, MCH and MCHC), hemoglobin, hematocrit and thrombocytes) by amiodarone was impeded in AEMb treated rats. AEMb significantly reduced (p <0.001) lipid profile parameters (plasma triglycerides, cholesterols (LDL, HDL and total)) augmented by amiodarone. Increased hepatic parameters (alkaline phosphatase, bilirubins (total and conjugated), transaminases (AST and ALT)) elicited by amiodarone were restored by AEMb pretreatment while decreased HDL values were normalized as well. Silymarin and AEMb also restored livers appearance and hepatic triglyceride. In conclusion, AEMb have a real preventive potential against amiodarone induced-hepatic steatosis in rats.
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Non-alcoholic fatty liver disease (NAFLD) is the most frequent cause of liver disease in the Western world. Furthermore, it is increasing worldwide, paralleling the obesity pandemic. Though highly frequent, only about one fifth of affected subjects are at risk of developing the progressive form of the disease, non-alcoholic steatohepatitis with fibrosis. Even in the latter, liver disease is slowly progressive, though, since it is so prevalent, it is already the third cause of liver transplantation in the United States, and it is predicted to get to the top of the ranking in few years. Of relevance, fatty liver is also associated with increased overall mortality and particularly increased cardiovascular mortality. The literature and amount of published papers on NAFLD is increasing as fast as its prevalence, which makes it difficult to keep updated in this topic. This review aims to summarize the latest knowledge on NAFLD, in order to help clinicians understanding its pathogenesis and advances on diagnosis and treatment.
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