Therapeutic Value of Black Seed Oil in Methotrexate Hepatotoxicity in Egyptian Children with Acute Lymphoblastic Leukemia

Hagag, Adel A; Abdelaal, Ahmed M.; Elfaragy, Mohamed S.; Hassan, Syed Moin; El-Zamarany, Enas A.

doi:10.2174/1871526515666150320161440

Cited by 24 publications

(22 citation statements)

References 25 publications

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“…In ALL, which is the most common childhood malignancy [108], increased numbers of lymphoblasts are present in the circulating blood and in different tissues and organs [48]. A study by Hagag et al reported that NS oil (80 mg/kg/day) administered for one week after each methotrexate treatment could reduce hepatotoxicity and improve the survival rate in ALL children undergoing that treatment [108]. Table 3.…”

Section: Resultsmentioning

confidence: 99%

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Review on Clinical Trials of Black Seed (Nigella sativa ) and Its Active Constituent, Thymoquinone

Mahdian²,

et al. 2017

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ObjectivesNigella sativa (black seed or black cumin), which belongs to the Ranunculacea family, is an annual herb with many pharmacological properties. Among its many active constituents, thymoquinone (TQ) is the most abundant constituent of the volatile oil of Nigella sativa (N. sativa) seeds, and it is the constituent to which most properties of this herb are attributed.MethodsPubMed-Medline, Scopus, and Web of Science databases were searched to identify randomized control trials (RCTs) investigating the therapeutic effects of N. sativa and/or TQ. In this review, we investigated the clinical uses of N. sativa and TQ in the prevention and the treatment of different diseases and morbidity conditions in humans.ResultsBlack seed and TQ are shown to possess multiple useful effects for the treatment of patients with several diseases, such as inflammatory and auto-immune disorders, as well as metabolic syndrome. Also, other advantages, including antimicrobial, anti-nociceptive and anti-epileptic properties, have been documented. The side effects of this herbal medicine appear not to be serious, so it can be applied in clinical trials because of its many advantages.ConclusionSome effects of N. sativa, such as its hypoglycemic, hypolipidemic and bronchodilatory effects, have been sufficiently studied and are sufficiently understood to allow for the next phase of clinical trials or drug developments. However, most of its other effects and applications require further clinical and animal studies.

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Section: Resultsmentioning

confidence: 99%

“…Thus, herbal medicines, such as NS, can be useful alternatives; however, before such herbal medicines are used extensively, many RCTs should be conducted in order to evaluate and confirm the effects of herbal medicines [46, 48, 108]. One obvious example is sero-reversion in HIV-infected patients.…”

Section: Discussionmentioning

confidence: 99%

Review on Clinical Trials of Black Seed (Nigella sativa ) and Its Active Constituent, Thymoquinone

Mahdian²,

et al. 2017

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“…They were treated with methotrexate-based treatment protocol14–18 and delayed Ca leucovorin rescue according to methotrexate levels 19. Silymarin 420 mg/day, (In the form of Legalon- MEDA Pharma GmbH- tablets 140 mg per tablet one hour before each meal (3 times daily) or Hepaticum syrup (Medical Union Pharmaceuticals, Egypt) in case of inability to swallow the tablet form; (each 5 ml of Hepaticum contains 50 mg Silymarin) was added in 3 divided doses one hour before each meal for one week after each MTX dose 7,20…”

Section: Methodsmentioning

confidence: 99%

Protective Role of Sylimarin on Methotrexate induced Hepato-nephrotoxicity in Children with Acute Lymphoblastic Leukemia

Hagag

2016

Mediterr J Hematol Infect Dis

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BackgroundALL is the most common childhood malignancy. The children with ALL are treated with methotrexate (MTX) based chemotherapy protocols. MTX causes unpredictable serious hepatic and renal side effects. Silymarin has antioxidant and anti-inflammatory activities and stimulates tissue regeneration. This study aims to evaluate the protective effects of Silymarin on MTX-based chemotherapy-induced Hepatic and renal toxicity in children with ALL.Patients and Methods80 children with newly diagnosed ALL were enrolled in the study. They were randomly divided into two groups. Group I included 40 children with ages ranging from 4–13 years and the mean age of 6.85± 2.89 years, who received Silymarin 420 mg/day in 3 divided doses for one week after each MTX dose. Group II included 40 children, with ages ranging from 4–12 years and the mean age of 7.30±2.6 years, who received placebo for one week after MTX therapy. For all patients liver functions including serum bilirubin, total proteins, albumin, globulin and albumin-globulin ratio, alkaline phosphatase, ALT and AST, prothrombin time and activity and renal functions including blood urea and serum creatinine, serum cystatin C and urinary N-acetyl-beta-D-glucosaminidase were done to assess hepatic and renal toxicity before and after chemotherapy.ResultsThere were no significant differences between group I and II as regard liver and renal functions before chemotherapy. After chemotherapy, there were significantly higher values of ALT and AST and alkaline phosphatase, and significantly lower Prothrombin activity in group II compared with group I. No significant differences between group I and II were found in total bilirubin, serum protein, and albumin levels. There was significantly lower blood urea, serum creatinine, and cystatin C and urinary N-acetyl-beta-D-glucosaminidase in group I compared with group II.ConclusionSilymarin improved some hepatic and renal functions in children with ALL who received MTX-based chemotherapy protocols. Recommendations: Extensive multicenter studies could be recommended to prove the hepatic and renal protective effects of Silymarin in patients with ALL who received MTX-based chemotherapy protocols.

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“…Nálunk 1991 után csak vírusinfekciókra szűrt vérkészítményeket használunk, egy betegünk sem fertőződött C-hepatitisvírussal a kezelés alatt. [11], feketeköménymag-kivonattal [12,13], silymarinnal [14], valamint ursodeoxycholsavval [15], amelyek biztonságosnak tűnnek, és nem befolyásolják a citosztatikumok metabolizmusát, hatását. Kedvezőtlen prognózist írtak le olyan toxikus májártalmakban, ahol a normálérték háromszorosát meghaladó ALT-érték a normálérték kétszeresét meghaladó összbilirubin-szinttel társul [16,17].…”

Section: Megbeszélésunclassified

Chemotherapy induced liver toxicity in children with malignant diseases

Horváth

Erzsébet

2018

Bulletin of Medical Sciences

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A broad spectrum of chemotherapy is being used in the therapy of childhood cancers, which may induce liver injury, impairing quality of life and efficacy of the treatment. History of, especially viral, liver diseases may increase toxicity. The aim of the paper is to assess the incidence, type and grade, predisposing factors and treatment options of drug-induced liver injury in children with malignant diseases under cytostatic therapy at the Hemato-Oncology Department of the Pediatric Clinic 2 from Targu-Mures, over a time period spanning from 2012 to 2017. The results of the study may serve as a foundation for such treatment strategies which would enable optimal outcomes with fewer cases of liver toxicity. During this period, we treated 26 patients with acute lymphoblastic leukemia (ALL), two patients with acute myeloblastic leukemia (AML), one patient with lymphoma and seven with solid tumors. We found liver toxicity in 77% of the patients treated for ALL, mainly during the maintenance therapy (65%) with oral 6-mercaptopurine and methotrexate. The most common clinical signs were anorexia, nausea, vomiting, abdominal pain and faltering weight gain. Cholestasis developed in two patients, while hepatocytolysis was the most common observed event (n = 24). Liver fibrosis, hypersplenism, portal hypertension and esophageal varices were found in two patients. One patient required endoscopic ligation of esophageal varices. Elevation of serum bilirubin appeared in two patients, while hypoproteinemia was observed in nine patients. None of the patients developed acute liver failure. We treated liver toxicity with hydration, alkalinization, i.v. Aspatofort, Aminosteril-N Hepa 8%, oral acetylcysteine, silymarin, ursodeoxycholic acid, Liv-52, Sargenor, and Essentiale forte. We found hepatotoxicity in 77% of the ALL patients undergoing chemotherapy, similar results have been published by other authors. Hepatotoxicity may develop through direct hepatic effects of cytostatics, or a preexisting liver disease impairs the metabolism and excretion of the drug, increasing its toxic effects. In our patients hepatotoxicity can be explained mainly by direct liver-injury, previous infections with hepatotropic viruses, such as cytomegalovirus, were detected only in three patients. Liver injury appeared in 77% of our ALL patients; 65% occurred during maintenance therapy with oral 6-mercaptopurine and methotrexate. Close followup of liver function during chemotherapy is mandatory for optimal results.

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Therapeutic Value of Black Seed Oil in Methotrexate Hepatotoxicity in Egyptian Children with Acute Lymphoblastic Leukemia

Abstract: Black cumin seeds decreased MTX hepatotoxicity and improved survival in children with ALL and can be recommended as adjuvant drug in patients with ALL under methotrexate therapy.

Cited by 24 publications

References 25 publications

Review on Clinical Trials of Black Seed (Nigella sativa ) and Its Active Constituent, Thymoquinone

Review on Clinical Trials of Black Seed (Nigella sativa ) and Its Active Constituent, Thymoquinone

Protective Role of Sylimarin on Methotrexate induced Hepato-nephrotoxicity in Children with Acute Lymphoblastic Leukemia

Chemotherapy induced liver toxicity in children with malignant diseases

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