Efficacy and safety of addition of minor bloodletting (petit phlebotomy) in hepatitis C virus-infected patients receiving regular glycyrrhizin injections

Tanaka, Naoki; Horiuchi, Akira; Yamaura, Takahiro; Komatsu, Michiharu; Yokoyama, Tetsuji; Okaniwa, Shinji; Nagaya, Tadanobu; Yoshizawa, Kaname; Kiyosawa, Kendo; Aoyama, Toshifumi; Tanaka, Eiji

doi:10.1007/s00535-009-0034-x

Cited by 19 publications

(17 citation statements)

References 12 publications

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“…Our study results demonstrated that the levels of aminotransferases were significantly improved in the phlebotomy-treated patients, similar to the reported findings of earlier studies (18)(19)(20). In the present study, the significant improvements in the ALT and AST levels in the phlebotomy group suggest that the effects of phlebotomy augment the benefits of other therapies (Fig.…”

Section: Discussionsupporting

confidence: 82%

“…Another study demonstrated that iron reduction therapy significantly improved the serum levels of aminotransferases and AFP in patients with HCV-related liver cirrhosis who had received UDCA and/or glycyrrhizin injection for more than six months before study entry (19). Similarly, the addition of petit phlebotomy was found to be effective and safe for improving the serum aminotransferase levels in hepatitis C patients receiving regular glycyrrhizin injections (20).…”

Section: Discussionmentioning

confidence: 99%

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Incidence of Hepatocellular Carcinoma Reduced by Phlebotomy Treatment in Patients with Chronic Hepatitis C

et al. 2015

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Objective To determine the impact of phlebotomy on the laboratory values and the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis C. Methods Study patients with chronic hepatitis C were treated with glycyrrhizin injection and oral ursodeoxycholic acid and either with (n=52) or without (n=50) phlebotomy during the period of 2005-2012. Six phlebotomized patients had previously received interferon therapy and were subsequently excluded from the data analysis. The serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase, lactate dehydrogenase, ferritin, iron and albumin, as well as the hemoglobin concentration, platelet count and prothrombin time, were determined. We compared the long-term outcomes based on the incidence of HCC and laboratory values, including the baseline serum ferritin levels, in patients treated with versus without phlebotomy. Results In the phlebotomy group, the mean AST and ALT levels decreased significantly at each one-year interval over five years (p<0.01), whereas the platelet counts did not. The incidence of HCC in the phlebotomized patients was significantly lower than that observed in the patients treated without phlebotomy: 10.3% vs. 43.7%, respectively, during the 8-year observation period (p=0.04). The incidence of HCC was also lower in the phlebotomized patients with a normal baseline ferritin level: 0.0% vs. 36.0% in the matched subgroup treated without phlebotomy at year 8. Phlebotomy offered a risk ratio of 0.13, thus suggesting protection against the development of HCC. Conclusion The incidence of HCC can be reduced by phlebotomy treatment, which should be performed in patients with chronic hepatitis C not receiving or not responding to antiviral therapy.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Incidence of Hepatocellular Carcinoma Reduced by Phlebotomy Treatment in Patients with Chronic Hepatitis C

et al. 2015

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“…Given that the lysosome is the site of most labile iron in the cell (Fakih et al 2008; Gorria et al 2008; Kurz et al 2004,2008a, b; Persson 2005; Tenopoulou et al 2007; Terman et al 2006b; Yu et al 2003), it is also of interest that there is an increased frequency of mutations in the gene encoding GBA among patients with Parkinson’s disease (e.g. Aharon-Peretz et al 2004; Clark et al 2007; Gan-Or et al 2008; Lwin et al 2004), and vice versa (Sidransky et al 2009).…”

Section: Parkinson’s Diseasementioning

confidence: 99%

Towards a unifying, systems biology understanding of large-scale cellular death and destruction caused by poorly liganded iron: Parkinson’s, Huntington’s, Alzheimer’s, prions, bactericides, chemical toxicology and others as examples

2010

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Exposure to a variety of toxins and/or infectious agents leads to disease, degeneration and death, often characterised by circumstances in which cells or tissues do not merely die and cease to function but may be more or less entirely obliterated. It is then legitimate to ask the question as to whether, despite the many kinds of agent involved, there may be at least some unifying mechanisms of such cell death and destruction. I summarise the evidence that in a great many cases, one underlying mechanism, providing major stresses of this type, entails continuing and autocatalytic production (based on positive feedback mechanisms) of hydroxyl radicals via Fenton chemistry involving poorly liganded iron, leading to cell death via apoptosis (probably including via pathways induced by changes in the NF-κB system). While every pathway is in some sense connected to every other one, I highlight the literature evidence suggesting that the degenerative effects of many diseases and toxicological insults converge on iron dysregulation. This highlights specifically the role of iron metabolism, and the detailed speciation of iron, in chemical and other toxicology, and has significant implications for the use of iron chelating substances (probably in partnership with appropriate anti-oxidants) as nutritional or therapeutic agents in inhibiting both the progression of these mainly degenerative diseases and the sequelae of both chronic and acute toxin exposure. The complexity of biochemical networks, especially those involving autocatalytic behaviour and positive feedbacks, means that multiple interventions (e.g. of iron chelators plus antioxidants) are likely to prove most effective. A variety of systems biology approaches, that I summarise, can predict both the mechanisms involved in these cell death pathways and the optimal sites of action for nutritional or pharmacological interventions.

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“…Furthermore, because metabolic factors also fluctuate according to lifestyle and/or medication, a prospective longitudinal study is needed to clarify the association between fluctuations in metabolic factors and those in serum ALT levels. Although we could not determine serum iron and ferritin levels in this retrospective study, many reports have shown that iron overload in HCV infection is associated with higher ALT levels [37,38], and that iron reduction therapy can lower serum ALT levels [39][40][41][42]. Therefore, iron metabolism is an important factor in regard to the serum ALT activity in HCV-infected patients.…”

Section: Discussionmentioning

confidence: 84%

Metabolic factors are associated with serum alanine aminotransferase levels in patients with chronic hepatitis C

Kobayashi

Kawaguchi²,

Mizuta³

et al. 2010

J Gastroenterol

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Efficacy and safety of addition of minor bloodletting (petit phlebotomy) in hepatitis C virus-infected patients receiving regular glycyrrhizin injections

Abstract: Background: Hepatoprotective therapies that include regular glycyrrhizin injection (GI)

Cited by 19 publications

References 12 publications

Incidence of Hepatocellular Carcinoma Reduced by Phlebotomy Treatment in Patients with Chronic Hepatitis C

Incidence of Hepatocellular Carcinoma Reduced by Phlebotomy Treatment in Patients with Chronic Hepatitis C

Towards a unifying, systems biology understanding of large-scale cellular death and destruction caused by poorly liganded iron: Parkinson’s, Huntington’s, Alzheimer’s, prions, bactericides, chemical toxicology and others as examples

Metabolic factors are associated with serum alanine aminotransferase levels in patients with chronic hepatitis C

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