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J Gastroenterol Dig Dis 2017 | Volume 2, Issue 3
World Gastroenterological &
Gastroenterology and Endoscopy
October 30-31, 2017 | Toronto, Canada
World Congress on
Phytotherapy-induced hepatocytotoxicity
Manuela Neuman, Yaacov Maor, Marius Braun, Ana Tobar, Ehud Melzer and Stephen Malnick
University of Toronto, Canada
Background & Aims: Herbal medicine is frequently
integrated with conventional medicine. We report a case of
severe-herbal-induced liver injury (HILI) due to Herbalife tea
and protein-shake. We present both clinical and laboratory
evidence implicating an immune response leading to a
hypersensitivity reaction.
Methods: A 65 year old lady was hospitalized due to
progressive jaundice and hepatocellular injury. 6 months
previously she noted lassitude and disturbed liver enzymes
were detected. Due to the appearance of deep jaundice
she was hospitalized. On repeated history ingestion of
Herbalife tea and protein-shake was noted. Liver biopsy
revealed necrotizing granulomatous hepatitis, apoptotic
cells. PAS diastase stain was showing cluster of foamy
macrophages with ceroid pigment, characteristic of toxicity.
Immunohistochemistry demonstrated and bile duct loss
(attached). Discontinuation of the Herbalife, and treatment
with both prednisone and urso-deoxycholic acid resulted
in slow resolution of her complaints (the ALT decreased
from 1096 U/L to 69U/L and the GGT decreased from 899
to 218 U/L, but relapsed on 10 mg daily of prednisone (ALT
increased to 246). Retreatment with both prednisone and
azathioprine resulted in remission (ALT 41 and GGT 49 U/L).
A lymphocyte toxicity assay (LTA) was performed. LTA %
toxicity was: protein alone 20; tea alone 44; protein+ tea 66.
The proinflammatory cytokines and chemokine (x control)
in serum were elevated as follow: TNF (tumor necrosis
factor alpha) x40; IL1 (interleukin) 12; IL6-x1.2; IL13-x3;
IL8-x5. Vascular endothelial growth factor was 5106 pg/
mL (x46). Mitochondrial markers M30 and M65 revealed
a predominant level of necrosis process versus apoptosis.
The severe HILI resulting from the protein and herbal tea is
consistent with a cholestatic picture. This is the first report
of the cytokine disturbances associated with HILI from the
combination of tea and shake protein (Herbalife). Moreover
this is a clear demonstration of hypersensitivity-induced
lymphocyte death linked to the same product combination.
Conclusions: In susceptible individuals protein and herbal
tea might produce a strong T1 response leading to HILI. This
finding is consistent with the majority of reports of Herbalife
toxicity in the literature being due to the combination of
protein shake and tea consumption.
Speaker Biography
Manuela Neuman teaches clinical and experiment al toxicology and pharmacology
at the University of Toronto, Medical School, Canada. Dr. Neuman supervised
several ., and Ph.D. theses as well as post-doc fellows and research projects for
Medical Physicians. She is also in charge with Ph.D. international students (Cuba,
Israel, Romania, France, Australia, South Africa) as well with Pharmacy and Medicine
exchange ., international students from France and Medical fellows from Israel,
Brazil, Cuba, Romania and Argentina.She is the founder of the In Vitro Drug Safety
and Biotechnology. She is the head of In Vitro and of the biomarkers platforms at
the University of Toronto.The role of micro quantitative liver function based upon
mitochondrial activities; non-invasive biomarkers of fibrosis, inflammation and repair,
immuno-pharmaco-genetics are subject of her research. She also explores biomarkers
such as immuno-genomics and metabolomics as individual variation in personalized
medicine approaches. Neuman studies the role of microbiota in the development of
non-alcoholic liver disease as well as in severity of inflammation and its possible repair.
This includes translational research that characterize, obesity, non-alcoholic fatty liver
disease and non-alcoholic steatohepatitis. The recognition of the key role played by
lipotoxicity in cellular injury and stimulation of the inflammatory responses leading to
fibrogenesis is key for therapies.
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