Concurrent Use of Corticosteroids with Licorice-Containing TCM Preparations in Taiwan: A National Health Insurance Database Study

Liao, Hui-Ling; Ma, Tsochiang; Li, Yi-Chun; Chen, Jin-Tang; Chang, Yuan‐Shiun

doi:10.1089/acm.2009.0267

Cited by 12 publications

(8 citation statements)

References 31 publications

(33 reference statements)

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“…1). GA has been shown to have anti-inflammatory effects in different systems through multiple mechanisms, such as inhibitory effects on reactive oxygen species (ROS) overproduction and NF-κB pathway activation [6,7]. However, little is known about the role of GA in the immunological regulation during viral infection.…”

Section: Introductionmentioning

confidence: 99%

“…HMGB1 also functions as an extracellular signaling molecule during inflammation, cell differentiation, cell migration, and tumor metastasis [9]. GL has been reported to interact with a motif within HMGB1 and inhibit its chemoattractant and mitogenic activities [6,10]. Additionally, GA can also bind selectively to HMGB1 protein and inhibit its cytokine activities by preventing accumulation of HMGB1 protein [11].…”

Section: Introductionmentioning

confidence: 99%

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Glycyrrhetinic acid alleviates hepatic inflammation injury in viral hepatitis disease via a HMGB1-TLR4 signaling pathway

Shi¹,

Yu²,

Zhang³

et al. 2020

International Immunopharmacology

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Various human disorders are cured by the use of licorice, a key ingredient of herbal remedies. Glycyrrhizic acid (GL), a triterpenoid glycoside, is the aqueous extract from licorice root. Glycyrrhetinic acid (GA) has been reported to be a major bioactive hydrolysis product of GL and has been regarded as an anti-inflammatory agent for the treatment of a variety of inflammatory diseases, including hepatitis. However, the mechanism by which GA inhibits viral hepatic inflammatory injury is not completely understood. In this study, we found that, by consecutively treating mice with a traditional herbal recipe, licorice plays an important role in the detoxification of mice. We also employed a murine hepatitis virus (MHV) infection model to illustrate that GA treatment inhibited activation of hepatic inflammatory responses by blocking high-mobility group box 1 (HMGB1) cytokine activity. Furthermore, decreased HMGB1 levels and downstream signaling triggered by injection of a neutralizing HMGB1 antibody or TLR4 gene deficiency, also significantly protected against MHV-induced severe hepatic injury. Thus, our findings characterize GA as a hepatoprotective therapy agent in hepatic infectious disease not only by suppressing HMGB1 release and blocking HMGB1 cytokine activity, but also via an underlying viral-induced HMGB1-TLR4 immunological regulation axis that occurs during the cytokine storm. The present study provides a new therapy strategy for the treatment of acute viral hepatitis in the clinical setting.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Glycyrrhetinic acid alleviates hepatic inflammation injury in viral hepatitis disease via a HMGB1-TLR4 signaling pathway

Shi¹,

Yu²,

Zhang³

et al. 2020

International Immunopharmacology

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“…Glycyrrhizin (GL; Figure 1) is an active compound isolated from the root of licorice (Glycyrrhiza glabra; Glycyrrhiza radix; Chinese name: Gancao). In traditional Chinese medicine, licorice is one of the most commonly used herbs in treating liver disorders [27]. It is also used to reduce toxicity, to improve appetite and enhance the effectiveness of other ingredients in prescriptions [27,28].…”

Section: Introductionmentioning

confidence: 99%

“…In traditional Chinese medicine, licorice is one of the most commonly used herbs in treating liver disorders [27]. It is also used to reduce toxicity, to improve appetite and enhance the effectiveness of other ingredients in prescriptions [27,28]. There is evidence for the therapeutic application of glycyrrhizin for chronic hepatitis induced by viral infections, toxin exposure and ischemic-reperfusion injury [29].…”

Section: Introductionmentioning

confidence: 99%

Glycyrrhizin Represses Total Parenteral Nutrition-Associated Acute Liver Injury in Rats by Suppressing Endoplasmic Reticulum Stress

Tsai

Kuo

Lee

et al. 2013

IJMS

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Total parenteral nutrition (TPN) is an artificial way to support daily nutritional requirements by bypassing the digestive system, but long-term TPN administration may cause severe liver dysfunction. Glycyrrhizin is an active component of licorice root that has been widely used to treat chronic hepatitis. The aim of this study is to investigate the hepatoprotective effect of glycyrrhizin on TPN-associated acute liver injury in vivo. Liver dysfunction was induced by intravenous infusion of TPN at a flow rate of 20 mL/kg/h for three h in Sprague Dawley rats. The rats were pretreated with Glycyrrhizin (1, 3 and 10 mg/kg intravenously). After receiving TPN or saline (control group) for three h, the rats were sacrificed, blood samples were collected for biochemical analyses and liver tissue was removed for histopathological and immunohistochemical examination. We found that aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB) and triglyceride (TG) levels were significantly increased in the TPN group without glycyrrhizin pretreatment and decreased in the glycyrrhizin-pretreated TPN group in a dose-dependent manner. The stained liver sections showed that glycyrrhizin relieved acute liver injury. The upregulation of serum protein biomarkers of reactive nitrogen species, including nitrotyrosine and inducible NO synthase (iNOS), were attenuated by glycyrrhizin pretreatment. Levels of endoplasmic reticulum (ER) stress factors, such as phosphorylation of JNK1/2, p38 MAPK and CHOP, were decreased by glycyrrhizin pretreatment. In summary, our results suggest that glycyrrhizin decreases TPN-associated acute liver injury factors by suppressing endoplasmic reticulum stress and reactive nitrogen stress.

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“…Typical clinical presentation of HDI include the potentiation of the effects of oral corticosteroids in the presence of liquorice ( Glycyrrhiza glabra ; Liao et al, 2010); potentiation of warfarin effects with resultant bleeding in the presence of garlic ( Allium sativum ; Borrelli et al, 2007), dong quai ( Angelica sinensis ; Nutescu et al, 2006), or danshen ( Salvia miltiorrhiza ; Chan, 2001); decreased blood levels of nevirapine, amitriptyline, nifedipine, statins, digoxin, theophylline, cyclosporine, midazolam, and steroids in patients concurrently consuming St John’s wort (SJW; Hypericum perforatum ; De Maat et al, 2001; Henderson et al, 2002; Johne et al, 2002; Mannel, 2004; Borrelli and Izzo, 2009), decreased oral bioavailability of prednisolone in the presence of the Chinese herbal product xiao-chai-hu tang (sho-saiko-to; Fugh-Berman, 2000); ginseng ( Panax ginseng )-induced mania in patients on antidepressants (Engelberg et al, 2001); production of extrapyramidal effects as a result of the combination of neuroleptic drugs with betel nut ( Areca catechu ; Huang et al, 2003; Coppola and Mondola, 2012); increased blood pressure induced by tricyclic antidepressant-yohimbe ( Pausinystalia yohimbe ) combination (Tam et al, 2001), increased phenytoin clearance and frequent seizures when combined with Ayurvedic syrup shankhapushpi (Patsalos and Perucca, 2003), among other clinical manifestations. These clinical presentations depend on the mechanism of HDI.…”

Section: Resultsmentioning

confidence: 99%

An Overview of the Evidence and Mechanisms of Herb–Drug Interactions

Fasinu¹,

Bouic²,

Rosenkranz³

2012

Front. Pharmacol.

206

140

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Despite the lack of sufficient information on the safety of herbal products, their use as alternative and/or complementary medicine is globally popular. There is also an increasing interest in medicinal herbs as precursor for pharmacological actives. Of serious concern is the concurrent consumption of herbal products and conventional drugs. Herb–drug interaction (HDI) is the single most important clinical consequence of this practice. Using a structured assessment procedure, the evidence of HDI presents with varying degree of clinical significance. While the potential for HDI for a number of herbal products is inferred from non-human studies, certain HDIs are well established through human studies and documented case reports. Various mechanisms of pharmacokinetic HDI have been identified and include the alteration in the gastrointestinal functions with consequent effects on drug absorption; induction and inhibition of metabolic enzymes and transport proteins; and alteration of renal excretion of drugs and their metabolites. Due to the intrinsic pharmacologic properties of phytochemicals, pharmacodynamic HDIs are also known to occur. The effects could be synergistic, additive, and/or antagonistic. Poor reporting on the part of patients and the inability to promptly identify HDI by health providers are identified as major factors limiting the extensive compilation of clinically relevant HDIs. A general overview and the significance of pharmacokinetic and pharmacodynamic HDI are provided, detailing basic mechanism, and nature of evidence available. An increased level of awareness of HDI is necessary among health professionals and drug discovery scientists. With the increasing number of plant-sourced pharmacological actives, the potential for HDI should always be assessed in the non-clinical safety assessment phase of drug development process. More clinically relevant research is also required in this area as current information on HDI is insufficient for clinical applications.

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Concurrent Use of Corticosteroids with Licorice-Containing TCM Preparations in Taiwan: A National Health Insurance Database Study

Cited by 12 publications

References 31 publications

Glycyrrhetinic acid alleviates hepatic inflammation injury in viral hepatitis disease via a HMGB1-TLR4 signaling pathway

Glycyrrhetinic acid alleviates hepatic inflammation injury in viral hepatitis disease via a HMGB1-TLR4 signaling pathway

Glycyrrhizin Represses Total Parenteral Nutrition-Associated Acute Liver Injury in Rats by Suppressing Endoplasmic Reticulum Stress

An Overview of the Evidence and Mechanisms of Herb–Drug Interactions

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