Herbal medicines and veno-occlusive disease in India

Abstract

Summary Six cases are described of veno-occlusive disease (VOD) after medicinal herb ingestion. The herb Heliotropium eichwaldii, taken by three patients, was found to contain the toxic pyrrolizidine alkaloid, heliotrine. Two patients presented with fulminant hepatic failure while the other four patients had a clinical picture suggestive of decompensated cirrhosis. The medical use of this herb may possibly be responsible for a significant proportion of acute and chronic liver disease in India, making it of public health importance.

Toxicity of pyrrolizidine alkaloids to humans and ruminants

“…Krishnamachari et al (1977) China, 1973 2 Adults VOD Gynura segetum Hou et al (1980) India, 1974 6 People VOD Heliotropium eichwaldii Datta et al (1978) Martinique In 1975 sheep were individually fed with 100 g dried Senecio jacobaea plant material for 20 weeks. Mortality was observed after 11, 18 and 46 weeks (Mortimer and White 1975).…”

Herbal hepatotoxicity

“…The Crotalaria species in tea leaves were identified as the causative herbs [29]. Later, a series of pyrrolizidine alkaloid poisonings occurred in India [30] and Afghanistan [31], where 'Gondli' cereal contaminated with Heliotropium alkaloids was responsible for numerous cases of venoocclusive disease (VOD), the typical liver injury evoked by pyrrolizidine alkaloids. Incidents of liver damage from pyrrolizidine alkaloid intoxication were noticed in Arizona, such as in two infants exposed to herbal tea containing Senecio longilobus [32,33].…”

Hepatotoxicity of botanicals

“…Liver disease was related to the large content of Crotalaria species in tea leaves 32 . Later, epidemics of pyrrolizidine alkaloid poisoning took place in India 33 and Afghanistan 34 . In the latter, cereal contaminated with Heliotropium alkaloids had caused an endemic outbreak of herb-associated liver disease.…”