Hepatotoxicity of NONI juice: Report of two cases

Department of Internal Medicine, Medical University Graz, Austria.
World Journal of Gastroenterology (Impact Factor: 2.37). 09/2005; 11(30):4758-60.
Source: PubMed


NONI juice (Morinda citrifolia) is an increasingly popular wellness drink claimed to be beneficial for many illnesses. No overt toxicity has been reported to date. We present two cases of novel hepatotoxicity of NONI juice. Causality of liver injury by NONI juice was asses-sed. Routine laboratory tests and transjugular or percutaneous liver biopsy were performed. The first patient underwent successful liver transplantation while the second patient recovered spontaneously after cessation of NONI juice. A 29-year-old man with previous toxic hepatitis associated with small doses of paracetamol developed sub-acute hepatic failure following consumption of 1.5 L NONI juice over 3 wk necessitating urgent liver transplantation. A 62-year-old woman without evidence of previous liver disease developed an episode of self-limited acute hepatitis following consumption of 2 L NONI juice for over 3 mo. The most likely hepatotoxic components of Morinda citrifolia were anthraquinones. Physicians should be aware of potential hepatotoxicity of NONI juice.

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Available from: Vanessa Stadlbauer
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    • "Phenolic acids are consistently associated with reduced risk of cardiovascular disease, cancer and other chronic diseases by mechanisms related to the scavenging of free radicals and as prooxidant metals (antioxidant), although there are reports for toxic effects of compounds isolated from the fruit of M. citrifolia (Ee et al., 2009; Nualsanit et al., 2012; Aziz et al., 2014). Earlier reports indicated that fruits (Millonig et al., 2005; Stadlbauer et al., 2005; Yüce et al., 2006), leaves (West et al., 2006; Lopez-Cepero et al., 2007) and juice (Sivagnanam et al., 2011; Mrzljak et al., 2013) of M. citrifolia are hepatotoxic in humans, since preparations for them are rich inanthraquinones and coumarins (scopoletin) (Ee et al., 2009), they induce generation of free radicals derived from oxygen and trigger oxidative stress. Free radicals cause depletion of intracellular reduced glutathione and mitochondrial membrane potential, thus initiating lipid peroxidation and eventually, cell death (Su et al., 2005; Bussmann et al., 2013). "

    Full-text · Article · Jan 2016 · Journal of medicinal plant research
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    • "In contrast to their therapeutic actions, there are reports of toxicity resulting from the consumption of noni products [15], [16], [17], [18]. Secondary metabolites, such as anthraquinones, have been suggested as the causative agents of toxicity. "
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    ABSTRACT: In this study a novel heat-stable lipid transfer protein, designated McLTP1, was purified from noni (Morinda citrifolia L.) seeds, using four purification steps which resulted in a high-purified protein yield (72 mg McLTP1 from 100 g of noni seeds). McLTP1 exhibited molecular masses of 9.450 and 9.466 kDa, determined by electrospray ionisation mass spectrometry. The N-terminal sequence of McLTP1 (AVPCGQVSSALSPCMSYLTGGGDDPEARCCAGV), as analysed by NCBI-BLAST database, revealed a high degree of identity with other reported plant lipid transfer proteins. In addition, this protein proved to be resistant to pepsin, trypsin and chymotrypsin digestion. McLTP1 given intraperitoneally (1, 2, 4 and 8 mg/kg) and orally (8 mg/kg) caused an inhibition of the writhing response induced by acetic acid in mice. This protein displayed thermostability, retaining 100% of its antinociceptive activity after 30 min incubation at 80 °C. Pretreatment of mice with McLTP1 (8 mg/kg, i.p. and p.o.) also decreased neurogenic and inflammatory phases of nociception in the formalin test. Naloxone (2 mg/kg, i.p.) antagonised the antinociceptive effect of McLTP1 suggesting that the opioid mechanisms mediate the analgesic properties of this protein.
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    • "CAM treatments are not without risks, for example, CAM can interact with conventional medication [26]. CAM treatments such as noni juice (Morinda citrifolia) [27,28] or other herbal medicinal products can be toxic to the liver [29], which is important to know, given some IBDs may be associated with disorders in the liver and biliary tract [30-32]. Thus, knowledge of patients’ use of CAM, will allow healthcare professionals to better monitor patients and their responses to treatments. "
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