Non-alcoholic steatohepatitis: an overview including treatments with herbals as alternative therapeutics

Abstract

Non-alcoholic steatohepatitis (NASH), an under-recognized hepatic ailment with increasing prevalence, is fast emerging as the dark horse of hepatic related morbidity and mortality. Though introduced as a hepatic condition as early as 1980, detailed exploration of its causes, underlying mechanisms and therapeutics has largely remained an ignored or neglected field. Only recently, the focus of attention has gravitated towards an understanding of NASH as a pathological manifestation of significance and a search for possible therapeutic interventions. Treatment schedules as of now involve life style management and usage of anti-diabetic or anti-obesity drugs and antioxidants. In the present review, we have focused on the available treatment schedules including herbal agents, plant extracts, polyherbal formulations and isolated phytocompounds. We present here a review of the available literature on pre-clinical and clinical evaluations of herbals including our recent findings on two plant extracts which can be used in mitigating NASH. This review attempts to provide a comprehensive account of NASH and the future of therapeutics and remediation by herbal principles, an aspect of the urgent need to target this important medical condition that contributes to many cases of silent morbidity and mortality.

Therapeutic Roles of Silymarin or/and Taurine on Nonalcoholic Fatty Liver Disease Associated with Metabolic Syndrome in Rats

“…As shown in Table (3), supplementation of silymarin (1g silymarin/kg body weight intragastrically) after induction of NAFLD to rats showed a significant (p<0.05) decrease in the serum lipid profile (cholesterol, triglycerides, free fatty acids & leptin) as well as hepatic total lipids and cholesterol levels associated with a significant increase occurred in the serum adiponectin levels through the whole -02 -experiment periods (One and two months). These results are in agreement with those of Hajiaghamohammadi et al (2012) and Thounaojam et al (2012). They reported that the supplementation of silymarin improves dyslipidemia and decreases oxidative stress.…”

“…These data may be attributed to the powerful of pharma-properties of silymarin which acts against the pro-oxidant products mainly through free radical scavenging and the ability to increase cellular GSH content; its ability to regulate membrane permeability and increase membrane stability in the presence of xenobiotic damage; its capacity to regulate nuclear expression through steroid-like effects and its inhibition of the transformation of stellate hepatocytes into myofibroblasts (which mediate the deposition of collagen fibers, leading to fibrosis and cirrhosis). These results are in agreement with those of Haddad et al Thounaojam et al (2012). Moreover, Saller et al (2007) recorded that insulin sensitivity was restored by silymarin treatment as suggested by normalized insulinemia and HOMA-IR, despite the continued intake of the NAFLDinducing high fructose/fat diet.…”

“…Silymarin acts as cellular guard by changing the outside layer of liver cells and keeping certain harmful chemicals from getting into liver cells. Also, silymarin may also cause the immune system to be more active (Abenavoli et al, 2011;El-Sheikh & Abd El-Fattah, 2011;Haddad et al, 2011;Hajiaghamohammadi et al, 2012;Kim et al, -04 -2012;Thounaojam et al, 2012 andZhu et al, 2013). This hypothesis confirmed in the current work with a considerable decrease in the serum haptoglobin level after the NAFLD rats treated with silymarin (Table 4).…”

“…These data may be also attributed to the corrections in the hypothalamus-pituitary-thyroid axis (HPTA) and the production of neuropeptide hormones (Neuropeptide-Y, orexin-A and orexine-B) dependent on the time of treatment (One & two months). These data were confirmed by several authors (Saller et al, 2007;El-Sheikh & Abd El-Fatta, 2011;Haddad et al, 2011;Hajiaghamohammadi et al, 2012;Kim et al, 2012 andThounaojam et al, 2012).…”

“…With the rising interest in complementary and alternative medicine, notably in the western hemisphere, several natural products have raised interest for their potential beneficial effects in liver disease. Among such attractive novel therapeutic possibilities are silymarin and its major active compounds (El-Sheikh & Abd El-Fattah, 2011;Haddad et al, 2011;Schrieber et al, 2011;Yao et al, 2011;Girish & Pradhan, 2012;Hajiaghamohammadi et al, 2012;Kim et al, 2012;Rahimi et al, 2012 andThounaojam et al, 2012). Also, taurine is a small amino sulfonic acid and aids in numerous physiological processes, including bile salt formation, osmoregulation, central nervous system function and calcium homeostasis (Xiao et al, 2008;Chen et al , 2009;Schaffer et al, 2009;Gupta, 2013 andRashid et al, 2013).…”