Therapeutic value of combined therapy with Deferiprone and Silymarin as iron chelators in Egyptian Children with Beta Thalassemia major

Hagag, Adel A; Elfaragy, Mohamed S.; Elrifaey, Shaymaa; El-Lateef, Amal Ezzat Abd

doi:10.2174/1871526515666150731113305

Cited by 24 publications

(16 citation statements)

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“…At higher dosages (>1,500 mg/day), silymarin may have gastrointestinal and laxative effects (Luper, ). We utilised silymarin to a total dose of 420 mg, split into three separate doses, similar to several previous studies for evaluation of the iron‐chelating effects in thalassemia patients (Gharagozloo et al, ; A. Hagag, ; Moayedi et al, ). However, we did not assess adherence and compliance to silymarin/placebo in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Effective iron chelation remains one of the vital objectives of clinical management of transfusion‐dependent thalassemia, and recent studies have focused on the use of natural iron chelators (Gharagozloo et al, ; A. Hagag, ; Moayedi et al, ). Safe and effective oral chelators as adjuvants to standard iron chelators are required for transfusion‐dependent thalassemia patients.…”

Section: Introductionmentioning

confidence: 99%

“…Previous in vitro studies demonstrated that silybin has a high affinity for iron ions (Fe 3+ ) and forms an iron–silybin complex (Gharagozloo, Khoshdel, & Amirghofran, ; Hutchinson, Bomford, & Geissler, ). In addition, the iron‐chelating effects of silymarin and silybin have been demonstrated in patients with β‐TM (Gharagozloo et al, ; A. Hagag, ; Moayedi et al, ) and hereditary haemochromatosis (Hutchinson et al, ). The iron‐chelating effect of silymarin was assessed in a combination therapy of DFO plus silymarin (Moayedi et al, ) and DFX plus silymarin (A.…”

Section: Introductionmentioning

confidence: 99%

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Iron‐chelating effect of silymarin in patients with β‐thalassemia major: A crossover randomised control trial

Darvishi‐Khezri

Salehifar

Kosaryan

et al. 2017

Phytotherapy Research

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This study aimed to determine the potential iron-chelating effects of silymarin in patients with β-thalassemia major receiving standard iron-chelation therapy. We evaluated whether addition of silymarin to standard iron-chelation therapy could improve iron burden markers and liver and cardiac function in these patients, via a placebo-controlled, crossover clinical study. Silymarin (140 mg) or placebo were administered thrice daily to all patients (n = 82) for 12 weeks, and after a 2-week washout period, patients were crossed over to the other groups. Silymarin efficacy was assessed by measuring serum iron level, ferritin level, total iron-binding capacity and liver and cardiac function on magnetic resonance imaging. Silymarin treatment resulted in a negative change in the serum iron and ferritin levels and a positive change in the total iron-binding capacity levels (treatment effect, p < .001, p = .06, and p = .05, respectively). Silymarin treatment led to positive changes in cardiac and liver function in both treatment sequences of study; however, this was not statistically significant. There was a negative change in liver iron concentration in both treatment sequences (treatment effect, p = .02). In conclusion, combined iron-chelation and silymarin therapy was effective for improving the iron-burden status in patients with β-thalassemia major.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Iron‐chelating effect of silymarin in patients with β‐thalassemia major: A crossover randomised control trial

Darvishi‐Khezri

Salehifar

Kosaryan

et al. 2017

Phytotherapy Research

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“…In one research on patients with beta thalassemia, oral administration of 140‐mg silymarin three times daily for 6 months in combination with deferiprone (20‐40 mg/kg/day) was without any toxicity. Silymarin also showed iron‐chelating activity, and after the termination of treatment, the level of ferritin and iron were diminished, but no significant changes were observed in serum creatinine, alanine aminotransferase, and aspartate aminotransferase (Hagag, Elfaragy, Elrifaey, & Abd El‐Lateef, ). In another study on patients, they treated with subcutaneous desferrioxamine and oral 140‐mg silymarin three times in a day for 9 months.…”

Section: Safety and Adverse Reactions Of Oral Silymarin In Humansmentioning

confidence: 99%

Safety and toxicity of silymarin, the major constituent of milk thistle extract: An updated review

Soleimani

Delghandi

Moallem

et al. 2019

Phytotherapy Research

155

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Milk thistle (Silybum marianum) is a medicinal plant from the Asteraceae family. Silymarin is the major constituent of milk thistle extract and is a mixture of some flavonolignans such as silybin, which is the most active component of silymarin. It is most commonly known for its hepatoprotective effect. Also, studies have shown other therapeutic effects such as anticancer, anti‐Alzheimer, anti‐Parkinson, and anti‐diabetic, so its safety is very important. It has no major toxicity in animals. Silymarin was mutagen in Salmonella typhimurium strains in the presence of metabolic enzymes. Silybin, silydianin, and silychristin were not cytotoxic and genotoxic at concentration of 100 μM. Silymarin is safe in humans at therapeutic doses and is well tolerated even at a high dose of 700 mg three times a day for 24 weeks. Some gastrointestinal discomforts occurred like nausea and diarrhea. One clinical trial showed silymarin is safe in pregnancy, and there were no anomalies. Consequently, caution should be exercised during pregnancy, and more studies are needed especially in humans. Silymarin has low‐drug interactions, and it does not have major effects on cytochromes P‐450. Some studies demonstrated that the use of silymarin must be with caution when co‐administered with narrow therapeutic window drugs.

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“…Earlier studies observed an additional, positive effect (e.g. reduced serum iron and serum ferritin in 3 out of 4 trials) for silymarin [125,126]. In addition, the role of silymarin in a combined regimen with deferasirox or deferiprone in the treatment of the iron overload in Beta-Thalassemia is currently under investigation in several clinical trials.…”

Section: Iron Overloadmentioning

confidence: 99%

The potential of silymarin for the treatment of hepatic disorders

et al. 2016

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Silymarin has long been used as a hepatoprotective remedy. Chronic toxicity studies in rodents have confirmed that silymarin has a very low toxicity. These data support its history as a safe medication in hepatic diseases. In the last years, several studies expanded our understanding of the pharmacology of silymarin and its molecular mechanisms of action. These new insights may affect the handling of silymarin in clinical studies and daily practice. Additionally, scientific knowledge in hepatology is constantly evolving with, particularly, an increase in the field of non-alcoholic fatty liver disease which is considered today as the most frequent liver disease worldwide. In this review, we will describe scientific evidence for the effectiveness of silymarin in hepatic disorders. We will focus on silymarin's pharmacological effects in non-alcoholic fatty liver disease and on its well described effects in alcoholic liver disease and acute intoxications, e.g. with Amanita species. We will discuss the relevance of pharmacological data as a function of doses or concentrations required for a given effect and of concentrations achieved in the target tissues. Many pharmacological effects of silymarin can be attributed to effects downstream or upstream of its antioxidative and membrane-stabilizing properties. However, despite promising new experimental and clinical data further clinical studies are required including long-term observations and the application of hard clinical endpoints such as survival rates, to further support silymarin's use for the treatment of hepatic diseases.

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Therapeutic value of combined therapy with Deferiprone and Silymarin as iron chelators in Egyptian Children with Beta Thalassemia major

Abstract: 'Extensive multicenter studies in large number of patients with longer follow up period and more advanced methods of assessment of iron status to clarify the exact role of silymarin in reduction of iron over load in thalassemic children'.

Cited by 24 publications

References 0 publications

Iron‐chelating effect of silymarin in patients with β‐thalassemia major: A crossover randomised control trial

Iron‐chelating effect of silymarin in patients with β‐thalassemia major: A crossover randomised control trial

Safety and toxicity of silymarin, the major constituent of milk thistle extract: An updated review

The potential of silymarin for the treatment of hepatic disorders

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