Liver Product - Abstracts

Jayaram S; Thyagarajan SP; Sumathi S; Manjula S; Malathi S; Madanagopalan N

Department of Microbiology, Dr ALM Postgraduate Institute of Basic Medical Sciences,
University of Madras, Taramani, Madras-600 113
Efficacy of phyllanthus amarus treatment in acute viral hepatitis A, B and non A non B : an open
clinical trial.
Indian Journal of Virology. 1997 Jan; 13(1): 59-64

ABSTRACT: The efficacy of an Indian medicinal plant, Phyllanthus amarus to treat acute viral
hepatitis (AVH) was evaluated in parallel to another drug essentiale, (an essential phospholipid
extracted from soybean oil) and compared with a group of patients who were treated
symptomatically with vitamins as the controls. Serological profile of 93 sporadic AVH cases of
the study showed that 25.8 percent had an acute infection due to hepatitis A virus (HAV), 52.6
percent suffered due to hepatitis B viral (HBV) infection, while 19.3 percent of cases were
classified as non-A non-B hepatitis (NANB) by exclusion. On followup of the patients at the end
of treatment period of four weeks with respective drug regimen, it was seen that both phyllanthus
amarus and essentiale brought about significant biochemical and clinical normalcy among the
HAV infected patients compared to control group (p<0.001). In acute HBV group, P. amarus
treated patients recovered faster than the essentiale treated group and the controls (p<0.001).
Essentiale was found to help the non-A non-B hepatitis patients to resume earlier biochemical
normalcy than by P.amarus and control treatments. P.amarus seemed to accelerate the clearance
of hepatitis B surface antigen (HBsAg) in 86.9 percent of convalescing AVH-B cases in three
months time as against 48.0 percent in the essentiale treated group and 50.0 percent in the
controls.

JAAPA. 2014 Jun 4. [Epub ahead of print]
An update on nonalcoholic fatty liver disease.
Business Cards Wholesale (www.alibaba.com)
Provencher DM.
Author information
Abstract
Non alcoholic fatty liver disease (NAFLD) is the accumulation of fat (steatosis) in the liver for reasons other than excess alcohol intake. The diagnosis
of NAFLD is becoming more common for a number of reasons, including increased awareness among healthcare providers, improved diagnostic tools,
and a greater prevalence of the disorder. This article provides primary care providers with the current understanding of NAFLD, including evidence-
based recommendations for managing patients with this common condition.
J Ethnopharmacol. 2012 Dec 18;144(3):457-65. doi: 10.1016/j.jep.2012.09.044. Epub 2012 Oct 9.
Herbal medicines for the prevention of alcoholic liver disease: a
review.
Test Drive the Scorpio (MahindraScorpio.com)
Ding RB
1
, Tian K, Huang LL, He CW, Jiang Y, Wang YT, Wan JB.
Author information
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE:
Long-term excess alcohol exposure leads to alcoholic liver disease (ALD)-a global health problem without effective therapeutic approach. ALD is
increasingly considered as a complex and multifaceted pathological process, involving oxidative stress, inflammation and excessive fatty acid
synthesis. Over the past decade, herbal medicines have attracted much attention as potential therapeutic agents in the prevention and treatment of
ALD, due to their multiple targets and less toxic side effects. Several herbs, such as Cnidium monnieri (L.) Cusson (Apiaceae), Curcuma longa L.
(Zingiberaceae) and Pueraria lobata (Willd.) Ohwi (Leguminosae), etc., have been shown to be quite effective and are being widely used in China
today for the treatment of ALD when used alone or in combination.
AIM OF THE REVIEW:
To review current available knowledge on herbal medicines used to prevent or treat ALD and their underlying mechanisms.
MATERIALS AND METHODS:
We used the pre-set searching syntax and inclusion criteria to retrieve available published literature from PUBMED and Web of Science databases,
all herbal medicines and their active compounds tested on ALD induced by both acute and chronic alcohol ingestion were included.
RESULTS:
A total of 40 experimental studies involving 34 herbal medicines and (or) active compounds were retrieved and reviewed. We found that all reported
extracts and individual compounds from herbal medicines/natural plants could be beneficial to ALD, which might be attributed to regulate multiple
critical targets involved in the pathways of oxidation, inflammation and lipid metabolism.
CONCLUSIONS:
Screening chemical candidate from herbal medicine might be a promising approach to drug discovery for the prevention ortreatment of ALD. However,
further studies remain to be done on the systematic assessment of herbal medicines against ALD and the underlying mechanisms, as well as their
quality control studies.

Cochrane Database Syst Rev. 2013 Aug 24;8:CD009059. doi: 10.1002/14651858.CD009059.pub2.
Herbal medicines for fatty liver diseases.
Liu ZL
1
, Xie LZ, Zhu J, Li GQ, Grant SJ, Liu JP.
Author information
Abstract
BACKGROUND:
Fatty liver disease is potentially a reversible condition that may lead to end-stage liver disease. Since herbal medicines such as Crataegus pinnatifida
and Salvia miltiorrhiza have increasingly been used in the management of fatty liver disease, a systematic review on herbal medicine for fatty liver
disease is needed.
OBJECTIVES:
To assess the beneficial and harmful effects of herbal medicines for people with alcoholic or non-alcoholic fatty liver disease.
SEARCH METHODS:
We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3,
2012), MEDLINE, EMBASE, and Science Citation Index Expanded to 1 March 2012. We also searched the Chinese BioMedical Database, Traditional
Chinese Medical Literature Analysis and Retrieval System, China National Knowledge Infrastructure, Chinese VIP Information, Chinese Academic
Conference Papers Database and Chinese Dissertation Database, and the Allied and Complementary Medicine Database to 2 March 2012.
SELECTION CRITERIA:
We included randomised clinical trials comparing herbal medicines with placebo, no treatment, a pharmacological intervention, or a non-
pharmacological intervention such as diet or lifestyle, or Western interventions in participants with fatty liver disease.
DATA COLLECTION AND ANALYSIS:
Two review authors extracted data independently. We used the 'risk of bias' tool to assess the risk of bias of the included trials. We assessed the
following domains: random sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting, and other
sources of bias. We presented the effects estimates as risk ratios (RR) with 95% confidence intervals (CI) or as mean differences (MD) with 95% CI,
depending on the variables of the outcome measures.
MAIN RESULTS:
We included 77 randomised clinical trials, which included 6753 participants with fatty liver disease. The risks of bias (overestimation of benefits and
underestimation of harms) was high in all trials. The mean sample size was 88 participants (ranging from 40 to 200 participants) per trial. Seventy-five
different herbal medicine products were tested. Herbal medicines tested in the randomised trials included single-herb products (Gynostemma
pentaphyllum, Panax notoginseng, and Prunus armeniaca), proprietary herbal medicines commercially available, and combination formulas prescribed
by practitioners. The most commonly used herbs were Crataegus pinnatifida,Salvia miltiorrhiza,Alisma orientalis,Bupleurum Chinense,Cassia
obtusifolia, Astragalus membranaceous, and Rheum palmatum. None of the trials reported death, hepatic-related morbidity, quality of life, or costs. A
large number of trials reported positive effects on putative surrogate outcomes such as serum aspartate aminotransferase, alanine aminotransferase,
glutamyltransferase, alkaline phosphatases, ultrasound, and computed tomography scan. Twenty-seven trials reported adverse effects and found no
significant difference between herbal medicines versus control. However, the risk of bias of the included trials was high.The outcomes were ultrasound
findings in 22 trials, liver computed tomography findings in eight trials, aspartate aminotransferase levels in 64 trials, alanine aminotransferase activity
in 77 trials, and glutamyltransferase activities in 44 trials. Six herbal medicines showed statistically significant beneficial effects on ultrasound, four on
liver computed tomography, 42 on aspartate aminotransferase activity, 49 on alanine aminotransferase activity, three on alkaline phosphatases activity,
and 32 on glutamyltransferase activity compared with control interventions.
AUTHORS' CONCLUSIONS:
Some herbal medicines seemed to have positive effects on aspartate aminotransferase, alanine aminotransferase, ultrasound, and computed
tomography. We found no significant difference on adverse effects between herbal medicine and control groups. The findings are not conclusive due to
the high risk of bias of the included trials and the limited number of trials testing individual herbal medicines. Accordingly, there is also high risk of
random errors.


Clin Gastroenterol Hepatol. 2004 Nov;2(11):947-56.
Use of herbal supplements for chronic liver disease.
Levy C
1
, Seeff LD, Lindor KD.
Author information
Abstract
BACKGROUND & AIMS:
Complementary and alternative medicine (CAM) is becoming popular among patients with liver disease. Although there is a growing body of evidence
regarding potential mechanisms of action of these and other herbs, caution must be used to interpret the results of the few clinical trials available. Our
goal was to discuss the biologic rationale for the use of specific herbs (silymarin, glycyrrhizin, sho-saiko-to, Phyllanthus amarus , Picrorrhiza kurroa ,
Compound 861, CH-100, and LIV.52) in the treatment of chronic liver diseases, as well as the evidence for their efficacy and adverse effects according
to clinical trials.
METHODS:
Because of the relative paucity of clinical studies using herbs, every trial published in English was reviewed.
RESULTS:
Although many trials suggest that these herbs can decrease serum transaminase levels, the effects on hepatic histopathology and long-term survival
are either poorly studied or conflicting. LIV.52 has been withdrawn from the market because of deleterious effects in patients with liver disease.
CONCLUSIONS:
Based on current evidence, we cannot recommend the use of herbal supplements for the routine treatment of any chronic liver disease and further
well-designed clinical trials are necessary.

Dig Liver Dis. 2007 Apr;39(4):293-304. Epub 2007 Feb 28.
Herbal medicine in the treatment of liver diseases.
Stickel F
1
, Schuppan D.
Author information
Abstract
Herbal drugs have become increasingly popular and their use is widespread. Licensing regulations and pharmacovigilance
regarding herbal products are still incomplete and clearcut proof of their efficacy in liver diseases is sparse. Nevertheless, a number
of herbals show promising activity including silymarin for antifibrotic treatment, phyllantus amarus in chronic hepatitis B, glycyrrhizin
to treat chronic viral hepatitis, and a number of herbal combinations from China and Japan that deserve testing in appropriate
studies. Apart from therapeutic properties, reports are accumulating about liver injury after the intake of herbals, including those
advertised for liver diseases. Acute and/or chronic liver damage occurred after ingestion of some Chinese herbs, herbals that
contain pyrrolizidine alkaloids, germander, greater celandine, kava, atractylis gummifera, callilepsis laureola, senna alkaloids,
chaparral and many others. Since the evidence supporting the use of botanicals to treat chronic liver diseases is insufficient and
only few of them are well standardised and free of potential serious side effects, most of these medications are not recommended
outside clinical trials. Particularly with regard to the latter, adequately powered randomised-controlled clinical trials with well-selected
end points are needed to assess the role of herbal therapy for liver diseases.

J Viral Hepat. 2001 Sep;8(5):358-66.
Genus Phyllanthus for chronic hepatitis B virus infection: a
systematic review.
Liu J
1
, Lin H, McIntosh H.
Author information
Abstract
To evaluate the efficacy and safety of genus Phyllanthus for chronic hepatitis B virus (HBV) infection we performed a systematic review of randomized
clinical trials. Randomized trials comparing genus Phyllanthus vs. placebo, no intervention, general nonspecific treatment, other herbal medicine, or
interferon treatment for chronic HBV infection were identified by electronic and manual searches. Trials of Phyllanthus herb plus interferon (IFN) vs.
IFN alone were also included. No blinding and language limitations were applied. The methodological quality of trials was assessed by the Jadad scale
plus allocation concealment. Twenty-two randomized trials (n=1947) were identified. The methodological quality was high in five double-blind trials and
low in the 17 remaining trials. The combined results showed that Phyllanthus species had positive effect on clearance of serum HBsAg (relative risk
5.64, 95% CI 1.85-17.21) compared with placebo or no intervention. There was no significant difference on clearance of serum HBsAg, HBeAg and
HBV DNA between Phyllanthus and IFN. Phyllanthus species were better than nonspecific treatment or other herbal medicines for the clearance of
serum HBsAg, HBeAg, HBV DNA, and liver enzyme normalization. Analyses showed a better effect of the Phyllanthus plus IFN combination on
clearance of serum HBeAg (1.56, 1.06-2.32) and HBV DNA (1.52, 1.05-2.21) than IFN alone. No serious adverse event was reported. Based on this
review Phyllanthus species may have positive effect on antiviral activity and liver biochemistry in chronic HBV infection. However, the evidence is not
strong due to the general low methodological quality and the variations of the herb. Further large trials are needed.

Integr Cancer Ther. 2007 Jun;6(2):146-57.
Review of clinical trials evaluating safety and efficacy of milk
thistle (Silybum marianum [L.] Gaertn.).
Tamayo C
1
, Diamond S.
Author information
Abstract
Milk thistle extracts have been used as traditional herbal remedies for almost 2000 years. The extracts are still widely used to protect the liver against
toxins and to control chronic liver diseases. Recent experimental and clinical studies suggest that milk thistle extracts also have anticancer,
antidiabetic, and cardioprotective effects. This article reviews clinical trials of milk thistle conducted in the past 5 years including pharmacokinetic and
toxicity studies, herb-drug interactions, and other safety issues. Several trials have studied the effects of milk thistle for patients with liver diseases,
cancer, hepatitis C, HIV, diabetes, and hypercholesterolemia. Promising results have been reported in the protective effect of milk thistle in certain
types of cancer, and ongoing trials will provide more evidence about this effect. In addition, new established doses and improvement on the quality and
standardization of this herb will provide the much-awaited evidence about the efficacy of milk thistle in the treatment of liver diseases. Milk thistle
extracts are known to be safe and well tolerated, and toxic or adverse effects observed in the reviewed clinical trials seem to be minimal. The future of
milk thistle research is promising, and high-quality randomized clinical trials on milk thistle versus placebo may be needed to further demonstrate the
safety and efficacy of this herb.

Am J Med. 2002 Oct 15;113(6):506-15.
Milk thistle for the treatment of liver disease: a systematic review
and meta-analysis.
Jacobs BP
1
, Dennehy C, Ramirez G, Sapp J, Lawrence VA.
Author information
Abstract
PURPOSE:
Milk thistle, an herbal compound, is the dietary supplement taken most frequently by patients with chronic liver disease. We performed a systematic
review of the literature to determine the efficacy and safety of this herb for the treatment of liver disease.
METHODS:
We searched English and non-English reports through July 1999 using thirteen databases and reference lists, and contacting manufacturers and
technical experts. Reviewers independently screened all reports to identify randomized placebo-controlled trials that evaluated milk thistle for the
treatment of liver disease. Outcomes of primary interest included mortality, histological findings on liver biopsy specimens, serum aminotransferase
and albumin levels, and prothrombin times.
RESULTS:
Fourteen trials met inclusion criteria. Four trials reported outcomes for mortality among 433 participants. The overall summary odds ratio for mortality in
the milk thistle group compared with placebo was 0.8 (95% confidence interval [CI]: 0.5 to 1.5; P = 0.6). Three trials assessed histology on liver biopsy;
study quality was inversely associated with the likelihood of histological benefit for milk thistle compared with placebo. There were no differences in
serum alanine aminotransferase, aspartate aminotransferase, or albumin levels, or prothrombin times, among participants assigned to milk thistle
compared with those assigned to placebo. The only statistically significant difference was a greater reduction in alanine aminotransferase levels among
patients with chronic liver disease assigned to milk thistle (-9 IU/L, 95% CI: -18 to -1 IU/L; P = 0.05), but this reduction was of negligible clinical
importance and no longer statistically significant after limiting analyses to studies of longer duration or of higher quality. The frequency of adverse
effects was low and, in clinical trials, indistinguishable from placebo.
CONCLUSION:
Treatment with milk thistle appears to be safe and well tolerated. We found no reduction in mortality, in improvements in histology at liver biopsy, or in
biochemical markers of liver function among patients with chronic liver disease. Data are too limited to exclude a substantial benefit or harm of milk
thistle on mortality, and also to support recommending this herbal compound for the treatment of liver disease.

Am J Med. 2002 Oct 15;113(6):506-15.
Milk thistle for the treatment of liver disease: a systematic review
and meta-analysis.
Jacobs BP
1
, Dennehy C, Ramirez G, Sapp J, Lawrence VA.
Author information
Abstract
PURPOSE:
Milk thistle, an herbal compound, is the dietary supplement taken most frequently by patients with chronic liver disease. We performed a systematic
review of the literature to determine the efficacy and safety of this herb for the treatment of liver disease.
METHODS:
We searched English and non-English reports through July 1999 using thirteen databases and reference lists, and contacting manufacturers and
technical experts. Reviewers independently screened all reports to identify randomized placebo-controlled trials that evaluated milk thistle for the
treatment of liver disease. Outcomes of primary interest included mortality, histological findings on liver biopsy specimens, serum aminotransferase
and albumin levels, and prothrombin times.
RESULTS:
Fourteen trials met inclusion criteria. Four trials reported outcomes for mortality among 433 participants. The overall summary odds ratio for mortality in
the milk thistle group compared with placebo was 0.8 (95% confidence interval [CI]: 0.5 to 1.5; P = 0.6). Three trials assessed histology on liver biopsy;
study quality was inversely associated with the likelihood of histological benefit for milk thistle compared with placebo. There were no differences in
serum alanine aminotransferase, aspartate aminotransferase, or albumin levels, or prothrombin times, among participants assigned to milk thistle
compared with those assigned to placebo. The only statistically significant difference was a greater reduction in alanine aminotransferase levels among
patients with chronic liver disease assigned to milk thistle (-9 IU/L, 95% CI: -18 to -1 IU/L; P = 0.05), but this reduction was of negligible clinical
importance and no longer statistically significant after limiting analyses to studies of longer duration or of higher quality. The frequency of adverse
effects was low and, in clinical trials, indistinguishable from placebo.
CONCLUSION:
Treatment with milk thistle appears to be safe and well tolerated. We found no reduction in mortality, in improvements in histology at liver biopsy, or in
biochemical markers of liver function among patients with chronic liver disease. Data are too limited to exclude a substantial benefit or harm of milk
thistle on mortality, and also to support recommending this herbal compound for the treatment of liver disease.

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003620.
Milk thistle for alcoholic and/or hepatitis B or C virus liver
diseases.
Rambaldi A
1
, Jacobs BP, Gluud C.
Author information
Abstract
BACKGROUND:
Alcohol and hepatotoxic viruses cause the majority of liver diseases. Randomised clinical trials have assessed whether extracts of milk thistle, Silybum
marianum (L) Gaertneri, have any effect in patients with alcoholic and/or hepatitis B or C virus liver diseases.
OBJECTIVES:
To assess the beneficial and harmful effects of milk thistle or milk thistle constituents versus placebo or no intervention in patients with alcoholic liver
disease and/or viral liver diseases (hepatitis B and hepatitis C).
SEARCH STRATEGY:
The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and full text
searches were combined (July 2007). Manufacturers and researchers in the field were contacted.
SELECTION CRITERIA:
Only randomised clinical trials in patients with alcoholic and/or hepatitis B or C virus liver diseases (acute and chronic) were included. Interventions
encompassed milk thistle at any dose or duration versus placebo or no intervention. The trials could be double blind, single blind, or unblinded. The
trials could be unpublished or published and no language limitations were applied.
DATA COLLECTION AND ANALYSIS:
The primary outcome measure was mortality. Binary outcomes are reported as relative risks (RR) with 95% confidence interval (CI). Subgroup
analyses were performed with regard to methodological quality.
MAIN RESULTS:
Eighteen randomised clinical trials assessed milk thistle in 1088 patients with alcoholic and/or hepatitis B or C virus liver diseases. The methodological
quality was low: only 28.6% of the trials reported high methodological quality characteristics. Milk thistle versus placebo or no intervention had no
significant effect on mortality (RR 0.78, 95% CI 0.53 to 1.15), complications of liver disease (RR 0.95, 95% CI 0.83 to 1.09), or liver histology. Liver-
related mortality was significantly reduced by milk thistle in all trials (RR 0.50, 95% CI 0.29 to 0.88), but not in high-quality trials (RR 0.57, 95% CI 0.28
to 1.19). Milk thistle was not associated with a significantly increased risk of adverse events (RR 0.83, 95% CI 0.46 to 1.50).
AUTHORS' CONCLUSIONS:
Our results question the beneficial effects of milk thistle for patients with alcoholic and/or hepatitis B or C virus liver diseases and highlight the lack of
high-quality evidence to support this intervention. Adequately conducted and reported randomised clinical trials on milk thistle versus placebo are
needed.

Dig Liver Dis. 2007 Apr;39(4):293-304. Epub 2007 Feb 28.
Herbal medicine in the treatment of liver diseases.
Stickel F
1
, Schuppan D.
Author information
Abstract
Herbal drugs have become increasingly popular and their use is widespread. Licensing regulations and pharmacovigilance
regarding herbal products are still incomplete and clearcut proof of their efficacy in liver diseases is sparse. Nevertheless, a number
of herbals show promising activity including silymarin for antifibrotic treatment, phyllantus amarus in chronic hepatitis B, glycyrrhizin
to treat chronic viral hepatitis, and a number of herbal combinations from China and Japan that deserve testing in appropriate
studies. Apart from therapeutic properties, reports are accumulating about liver injury after the intake of herbals, including those
advertised for liver diseases. Acute and/or chronic liver damage occurred after ingestion of some Chinese herbs, herbals that
contain pyrrolizidine alkaloids, germander, greater celandine, kava, atractylis gummifera, callilepsis laureola, senna alkaloids,
chaparral and many others. Since the evidence supporting the use of botanicals to treat chronic liver diseases is insufficient and
only few of them are well standardised and free of potential serious side effects, most of these medications are not recommended
outside clinical trials. Particularly with regard to the latter, adequately powered randomised-controlled clinical trials with well-selected
end points are needed to assess the role of herbal therapy for liver diseases.

J Gastroenterol Hepatol. 2002 Dec;17 Suppl 3:S370-6.
Herbal medicines for liver diseases in India.
Thyagarajan SP
1
, Jayaram S, Gopalakrishnan V, Hari R, Jeyakumar P, Sripathi MS.
Author information
Abstract
The use of natural remedies for the treatment of liver diseases has a long history, starting with the Ayurvedhic treatment, and extending to the Chinese,
European and other systems of traditional medicines. The 21st century has seen a paradigm shift towards therapeutic evaluation of herbal products in
liver diseases by carefully synergizing the strengths of the traditional systems of medicine with that of the modern concept of evidence-based medicinal
evaluation, standardization of herbal products and randomized placebo controlled clinical trials to support clinical efficacy. The present review provides
the status report on the scientific approaches made to herbal preparations used in Indian systems of medicine for the treatment of liver diseases. In
spite of the availability of more than 300 preparations for the treatment of jaundice and chronic liver diseases in Indian systems of medicine using more
than 87 Indian medicinal plants, only four terrestrial plants have been scientifically elucidated while adhering to the internationally acceptable scientific
protocols. In-depth studies have proved Sylibum marianum to be anti-oxidative, antilipidperoxidative, antifibrotic, anti-inflammatory, immunomodulating
and liver regenerative. Glycyrrhiza glabra has been shown to be hepatoprotective and capable of inducing an indigenous interferon. Picrorhiza kurroa
is proved to be anti-inflammatory, hepatoprotective and immunomodulatory. Extensive studies on Phyllanthus amarus have confirmed this plant
preparation as being anti-viral against hepatitis B and C viruses, hepatoprotective and immunomodulating, as well as possessing anti-inflammatory
properties. For the first time in the Indian systems of medicine, a chemo-biological fingerprinting methodology for standardization of P. amarus
preparation has been patented.

Dig Liver Dis. 2007 May;39(5):397-408. Epub 2007 Mar 26.
Prophylaxis and treatment of hepatitis B in immunocompromised
patients.
How to pay less of your gas bill (TopTipsNews)
Marzano A
1
, Angelucci E, Andreone P, Brunetto M, Bruno R, Burra P, Caraceni P, Daniele B, Di
Marco V, Fabrizi F, Fagiuoli S, Grossi P, Lampertico P,Meliconi R, Mangia A, Puoti
M, Raimondo G, Smedile A; Italian Association for the Study of the Liver.
Author information
Abstract
The literature on hepatitis B virus (HBV) in immunocompromised patients is heterogeneous and referred mainly to the pre-antivirals era. Today a
rational approach to the problem of hepatitis B in these patients provides for: (a) the evaluation of HBV markers and of liver condition in all subjects
starting immunosuppressive therapies (baseline), (b) the treatment with antivirals (therapy) of active carriers, (c) the pre-emptive use of antivirals
(prophylaxis) in inactive carriers, especially if they are undergoing immunosuppressive therapies judged to be at high risk, (d) the biochemical and
hepatitis B surface antigen (HBsAg) monitoring (or universal prophylaxis, in case of high risk immunosuppression) in subjects with markers of previous
contact with HBV (HBsAg negative and anti-HBc positive), in order to prevent reverse seroconversion. Moreover it is suggested a strict adherence to
criteria of allocation based on the virological characteristics of both recipients and donors in the general setting of transplants and
in liver transplantation the universal prophylaxis with nucleos(t)ides analogues (frequently combined with specific anti-HBV immunoglobulins) in HBsAg
positive candidates and in HBsAg negative recipients of anti-HBc positive grafts.

J Med Assoc Thai. 1991 Sep;74(9):381-5.
Efficacy of Phyllanthus amarus for eradication of hepatitis B
virus in chronic carriers.
5 tips to get the best mortgage rates (TopTipsNews)
Thamlikitkul V
1
, Wasuwat S, Kanchanapee P.
Author information
Abstract
Sixty-five adult asymptomatic chronic carriers of hepatitis B virus were enrolled to the randomized controlled efficacy study of Phyllanthus amarus.
Thirty-four received Phyllanthus amarus 600 mg per day for 30 days and 31 received placebo in identical capsules. The conversion rate of HBsAg was
6 per cent in the study group at day 30. When 20 subjects in the Phyllanthus amarus group were given a further 30-day treatment and 22 placebo
recipients given Phyllanthus amarus 1,200 mg per day for 30 days, the conversion was observed in 1 (5%) in the higher dose group. Adverse effects
were not observed in all patients receiving the plant. The results indicated that Phyllanthus amarus, whole plant except root, grown in the central part of
Thailand, given at the studied dosage and duration, had a very minimal effect on eradication of HBsAg from Thai adult asymptomatic chronic carriers.

Antiviral Res. 1993 Mar;20(3):185-92.
Effect of an extract from Phyllanthus amarus on hepatitis B
surface antigen gene expression in human hepatoma cells.
No 1 Air Hostess Course (www.frankfinn.in)
Yeh SF
1
, Hong CY, Huang YL, Liu TY, Choo KB, Chou CK.
Author information
Abstract
It has been suggested that Phyllanthus amarus may be helpful in the treatment of hepatitis B virus infection. We studied the effect of an aqueous
extract of P. amarus on the cultured hepatoma cell line HepA2. This cell line had been transfected with tandemly arranged HBV DNA and continued to
synthesize and secrete both HBsAg and HBeAg. Extract of P. amarus reversibly inhibited cellular proliferation and suppressed HBsAg production but
not HBeAg production in HepA2 cells. We also found that P. amarus suppressed HBsAg gene expression at mRNA level in a time-dependent manner,
and selectively abolished the HBsAg gene promoter driven CAT activity. Our results demonstrate that P. amarus contains some active components
which can suppress the HBsAg gene expression in human hepatoma cells. Such suppression may contribute the antiviral activity of P. amarus in vivo.

1.Genus Phyllanthus for chronic hepatitis B virus infection: a systematic review.
Liu J, Lin H, McIntosh H. J Viral Hepat 2001 Sep;8(5):358-66
Twenty-two randomized trials (n=1947) were identified. The methodological quality
was high in five double-blind trials and low in the 17 remaining trials. The combined
results showed that Phyllanthus species had positive effect on clearance of serum
HBsAg (relative risk 5.64, 95% CI 1.85-17.21) compared with placebo or no
intervention. Phyllanthus species were better than nonspecific treatment or other
herbal medicines for the clearance of serum HBsAg, HBeAg, HBV DNA, and liver
enzyme normalization. No serious adverse event was reported...

2. A comparative study of Phyllanthus amarus compound and interferon in the treatment of chronic viral
hepatitis B.
Xin-Hua W, Chang-Qing L, Xing-Bo G, Lin-Chun F. Southeast Asian J Trop Med Public Health 2001;32(1):140
Fifty-five patients with chronic viral hepatitis B were randomly divided into two groups. Thirty
patients were treated with Phyllanthus amarus compound (PA Co) for three months in the
treatment group, another 25 patients were treated with domestic recombinant human interferon
alpha-1b (IFN-alpha 1b) for three months as controls. The total effective rate in the treatment
group was 83.3%, showing no significant difference from the control (p>0.05). The
normalization rates of ALT, A/G and SB in the treatment group were 73.3%, 80.0% and 78.2%
respectively, which were significantly higher than that in the control (p<0.05). The negative
conversion rates of HBeAg and HBV-DNA in the treatment group were 42.3% and 47.8%,
showing no significant difference from the control (p>0.005). It is indicated that PA Co has
remarkable effect for chronic viral hepatitis B in recovery of liver function and inhibition of the
replication of HBV.

3. Effect of Phyllanthus amarus on chronic carriers of hepatitis B virus.
Thyagarajan SP, Subramanian S, Thirunalasundari T, Venkateswaran PS, Blumberg BS. Lancet 1988 Oct
1;2(8614):764-6
In a preliminary study, carriers of hepatitis B virus were treated with a preparation of the
plant Phyllanthus amarus for 30 days. 22 of 37 (59%) treated patients had lost hepatitis B
surface antigen when tested 15-20 days after the end of the treatment compared with only 1 of 23
(4%) placebo-treated controls. Some subjects have been followed for up to 9 months. In no case
has the surface antigen returned. Clinical observation revealed few or no toxic effects. The
encouraging results of this preliminary study recommend continued evaluation of this plant and
the active principles isolated from it.

4. Phyllanthus combination plus lamivudin in treatment of 40 cases of chronic hepatitis B.
Zhang, JJ, Wang, HJ, Zhang, H. Journal of Shandong University of TCM, China
Phyllanthus niruri has been demonstrated to have inhibition effect on HBV replication, increases immune system,
significantly reduce enzymes levels due to CCl4-induced liver injury, inhibits liver free radical formation and repair
liver cells. Phyllanthus has stronger effect on immune system and liver function but not so effective against HBV
replication. Combination of both treatments can lead to a synergetic effect and result has showed that the PHCo plus
lamivudin has a better effect compared to lamivudin alone

V. IMP.
Indian J Gastroenterol. 1993 Jan;12(1):5-8.
Immunotherapy with Tinospora cordifolia: a new lead in the
management of obstructive jaundice.
Rege N
1
, Bapat RD, Koti R, Desai NK, Dahanukar S.
Author information
Abstract
OBJECTIVE:
Immunosuppression associated with deranged hepatic function and sepsis results in poor surgical outcome in extrahepatic obstructive jaundice. The
effect of an ayurvedic agent, Tinospora cordifolia(TC), which has been shown to have hepatoprotective and immunomodulatory properties in
experimental studies, on surgical outcome in patients with malignant obstructive jaundice was evaluated.
METHODS:
Thirty patients were randomly divided into two groups, matched with respect to clinical features, impairment of hepatic function (as judged by liver
function tests including antipyrine elimination) and immunosuppression (phagocytic and killing capacities of neutrophils). Group I received conventional
management, ie vitamin K, antibiotics and biliary drainage; Group II received Tinospora cordifolia (16 mg/kg/day orally) in addition, during the period of
biliary drainage.
RESULTS:
Hepatic function remained comparable in the two groups after drainage. However, the phagocytic and killing capacities of neutrophils normalized only
in patients receiving Tinospora cordifolia(28.2 +/- 5.5% and 29.47 +/- 6.5% respectively). Post-drainage bactobilia was observed in 8 patients in Group
I and 7 in Group II, but clinical evidence of septicemia was observed in 50% of patients in Group I as against none in Group II (p < 0.05). Post-
operative survival in Groups I and II was 40% and 92.4% respectively (p < 0.01).
CONCLUSION:
Tinospora cordifolia appears to improve surgical outcome by strengthening host defenses.

J Med Food. 2007 Mar;10(1):143-8.
Diuretic, hypotensive, and hypocholesterolemic effects
of Eclipta alba in mild hypertensive subjects: a pilot study.
Top 10 cities to visit in the US (TopTipsNews)
Rangineni V
1
, Sharada D, Saxena S.
Author information
Abstract
The combined effect of dried Eclipta alba leaf powder (3 g/day) in encapsulated form on blood pressure, diuresis, and lipid profile of 60 mildly
hypertensive male subjects in the age group of 40-55 years was studied. The subjects were divided into two groups, i.e., a control (placebo) and
the Eclipta group, and were given six capsules (500 mg each) per day in three equal doses for a period of 60 days. Clinical parameters, viz., blood
pressure, urine volume, electrolytes (Na and K) in serum and urine, lipid profile, and plasma lipid peroxides, were analyzed before and after the feeding
trials. The findings revealed that the Eclipta-supplemented group showed a marked reduction in mean arterial pressure by 15%, total cholesterol
(17%), low-density lipoprotein fraction (24%), triglycerides (14%), very-low-density lipoprotein fraction (14%), and plasma lipid peroxides (18%).
Results also revealed a remarkable increase in urine volume (34%), urine sodium (24%), serum vitamin C (17%), and serum tocopherols (23%) of
the Eclipta group. In conclusion, it would appear that E. albais diuretic, hypotensive, and hypocholesterolemic and helps in the alleviating oxidative
stress-induced complications in hypertensives.

J Postgrad Med. 1996 Oct-Dec;42(4):105-8.
Picrorhiza kurroa (Kutaki) Royle ex Benth as a hepatoprotective
agent--experimental & clinical studies.
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home (ConsumerTips)
Vaidya AB
1
, Antarkar DS, Doshi JC, Bhatt AD, Ramesh V, Vora PV, Perissond D, Baxi AJ, Kale
PM.
Author information
Abstract
Picrorhiza kurroa (Pk), a known hepatoprotective plant, was studied in experimental and clinical situtations. The standardization of active principles--
Picroside 1 and 2 was done with High Performance Liquid Chromatography. Picroside 1 ranged from 2.72 to 2.88 mg/capsule and picroside 2 from
5.50 to 6.00 mg/capsule. In the galactosamine-induced liver injury in rats, Pk at a dose of 200 mg/kg p.o. showed a significant reduction (p < 0.05) in
liver lipid content, GOT and GPT. In a randomised, double-blind placebo controlled trial in patients diagnosed to have acute viral hepatitis (HBsAg
negative), Pk root powder 375 mg three times a day was given for 2 weeks (n = 15) or a matching placebo (n = 18) was given. Difference in values of
bilirubin, SGOT and SGPT was significant between placebo and Pk groups. The time in days required for total serum bilirubin to drop to average value
of 2.5 mg% was 75.9 days in placebo as against 27.44 days in Pk group. The present study has shown a biological plausability of efficacy of Pk as
supported by clinical trial in viral hepatitis, hepatoprotection in animal model and an approach for standardizing extracts based on picroside content.

Immunotherapy with Tinospora cordifolia: a new lead in the management of obstructive jaundice.
(PMID:8330924)
Rege N, Bapat RD, Koti R, Desai NK, Dahanukar S
Department of Pharmacology, Seth G S Medical College, Bombay.
Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology [1993, 12(1):5-8]
Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Comparative Study
Abstract Highlight Terms

OBJECTIVE: Immunosuppression associated with deranged hepatic function and sepsis results in poor surgical
outcome in extrahepatic obstructive jaundice. The effect of an ayurvedic agent, Tinospora cordifolia (TC), which
has been shown to have hepatoprotective and immunomodulatory properties in experimental studies, on surgical
outcome in patients with malignant obstructive jaundice was evaluated.

METHODS: Thirty patients were randomly divided into two groups, matched with respect to clinical features,
impairment of hepatic function (as judged by liver function tests including antipyrineelimination) and
immunosuppression (phagocytic and killing capacities of neutrophils). Group I received conventional management,
ie vitamin K, antibiotics and biliary drainage; Group II received Tinospora cordifolia (16 mg/kg/day orally) in
addition, during the period of biliary drainage.

RESULTS: Hepatic function remained comparable in the two groups after drainage. However, the phagocytic and
killing capacities of neutrophils normalized only in patients receiving Tinospora cordifolia (28.2 +/- 5.5% and 29.47
+/- 6.5% respectively). Post-drainage bactobilia was observed in 8 patients in Group I and 7 in Group II, but clinical
evidence of septicemia was observed in 50% of patients in Group I as against none in Group II (p < 0.05). Post-
operative survival in Groups I and II was 40% and 92.4% respectively (p < 0.01). CONCLUSION: Tinospora
cordifolia appears to improve surgical outcome by strengthening host defenses.