Silymarin treatment of viral hepatitis: A systematic review

Liver Unit, Department of Medicine, University of Calgary, Calgary, Canada.
Journal of Viral Hepatitis (Impact Factor: 3.91). 12/2005; 12(6):559-67. DOI: 10.1111/j.1365-2893.2005.00636.x
Source: PubMed


Silymarin from the milk thistle herb (Silybum marianum) is used by many patients with chronic viral hepatitis, but its efficacy remains unknown. We performed a systematic review of silymarin for the treatment of chronic viral hepatitis B and C. An exhaustive search strategy identified 148 papers that studied silymarin compounds in liver disease. Of these, four trials included patients with hepatitis C, one included hepatitis B patients, and two, unspecified chronic viral hepatitis. However, only one trial exclusively studied patients with hepatitis C, and none involved patients with only hepatitis B. Silymarin treatment resulted in a decrease in serum transaminases compared with baseline in four studies, and compared with placebo in only one study. There is no evidence that silymarin affects viral load or improves liver histology in hepatitis B or C. No studies were found that investigated the use of silymarin concomitantly with interferon, nucleoside analogues, or other conventional treatments for hepatitis B or C. In conclusion, silymarin compounds likely decrease serum transaminases in patients with chronic viral hepatitis, but do not appear to affect viral load or liver histology. Nevertheless it may be worthwhile to determine its effects in conjunction with standard antiviral treatment.

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    • "Interest in complementary and alternative medicine (CAM) is increasing throughout the world probably because there are only few universally effective and available options for the treatment of common liver diseases such as cirrhosis, fatty liver, and chronic hepatitis.[123456] In recent years, researchers have used scientific methods to evaluate the effects of plants used in traditional CAM for the treatment of liver ailments.[78910] In many cases, the mechanisms and modes of action of these plants as well as their therapeutic effectiveness have been confirmed in clinical studies. "
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    ABSTRACT: Various hepatoprotective herbal products from plants are available in Mexico, where up to 85% of patients with liver disease use some form of complementary and alternative medicine. However, only few studies have reported on the biological evaluation of these products. Using a model of carbon tetrachloride (CCl4)-induced hepatotoxicity in rats, we evaluated the effects of commercial herbal extracts used most commonly in the metropolitan area of Monterrey, Mexico. The commercial products were identified through surveys in public areas. The effect of these products given with or without CCl4 in rats was evaluated by measuring the serum concentrations of aspartate amino transferase (AST) and alanine amino transferase (ALT), and histopathological analysis. Legalon(®) was used as the standard drug. The most commonly used herbal products were Hepatisan(®) capsules, Boldo capsules, Hepavida(®) capsules, Boldo infusion, and milk thistle herbal supplement (80% silymarin). None of the products tested was hepatotoxic according to transaminase and histological analyses. AST and ALT activities were significantly lower in the Hepavida+CCl4-treated group as compared with the CCl4-only group. AST and ALT activities in the silymarin, Hepatisan, and Boldo tea groups were similar to those in the CCl4 group. The CCl4 group displayed submassive confluent necrosis and mixed inflammatory infiltration. Both the Hepatisan+CCl4 and Boldo tea+CCl4 groups exhibited ballooning degeneration, inflammatory infiltration, and lytic necrosis. The silymarin+CCl4 group exhibited microvesicular steatosis. The Hepavida+CCl4- and Legalon+CCL4-treated groups had lower percentages of necrotic cells as compared with the CCl4-treated group; this treatment was hepatoprotective against necrosis. Only Hepavida had a hepatoprotective effect.
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    • "Natural silymarin is used in the therapy of liver diseases because of its hepatoprotective effect. The silybins, the major components of silymarin, display highly efficient anti-tumor, anti-inflammatory and anti-fibrotic activity [5] [6] [7] [8] [9]. The qualitative and quantitative analysis of the natural extract is based on liquid chromatography–mass spectrometry (LC–MS) methods with soft ionization e.g., electrospray (ESI) [10]. "
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    ABSTRACT: The fragmentation properties of the major silymarin constituents, including silydianin, silychristin A and B, silybin A and B and isosilybin A and B were studied by energy-dependent collision-induced dissociation (CID) technique. The survival yield (SY) method was applied to compare the fragmentation behavior of the various silymarin components. MS/MS spectra were recorded at collision energies which correspond to about 50% survival yield (CE50) and about 1% survival yield (CE01). The laboratory frame collision energy dependence of the fragmentation was studied on the basis of the breakdown curves, i.e., the relative intensities of fragment ions versus collision energy. The fragmentation of silybins and isosilybins is distinct in spite of the minimal difference between their structures. This phenomenon, which is the basis of their analytical identification, is explained in details for the first time, on the basis of the energy-dependent MS/MS experiments and the conformational analysis.
    Full-text · Article · Mar 2012 · International Journal of Mass Spectrometry
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    • "Dhiman also emphasized protective effects of MT on hepatic disease [22]. Mayer revealed protective and curative effects of MT on viral hepatitis [23]. Rambaldi and colleagues showed these protective and curative effects in viral and alcoholic hepatitis [24]. "
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    ABSTRACT: Extracts of milk thistle (MT), Silybum marianum, have been used as medical remedies since the time of ancient Greece. Methotrexate is a potentially hepatotxic drug. To clarify the hepatoprotective effects of MT on methotrexate. From January 2010 to April 2010, 30 male rats were recruited into three 10-rat subgroups in Tabriz University of Medical Sciences. Normal saline was injected intraperitoneally in the first group (A; the controls); intraperitoneal methotrexate plus oral MT extract were administered to the second group (B) and intraperitoneal methotrexate alone was given to the third group (C). Pre- and post-interventional measuring of serum parameters were carried out every 15 days. After six weeks, the rats were decapitated and histopathological evaluation of liver was done. Serum liver enzymes (AST, ALT), alkaline phosphatase, total and direct bilirubin, creatinine and BUN were measured on days 0, 15, 30, 45. They were significantly higher in the group C, comparing with other two groups. Serum albumin was the least in group C animals as well. There were no significant differences between groups A and B. The mean±SD fibrosis score using semi-quantitative scoring system (SSS) was 1.25±0.46, 1.40±0.52 and 6.70±0.82, in groups A, B and C, respectively (p<0.001). MT extract can effectively prevent methotrexate-induced liver dysfunction and fibrosis in rats.
    Full-text · Article · Jun 2011 · Hepatitis Monthly
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