Tinospora Cordifolia (Giloy)–Induced Liver Injury During the COVID‐19 Pandemic—Multicenter Nationwide Study From India

Abstract

Tinospora cordifolia (Giloy) is an herbal supplement commonly used in the Indian alternative medicine system Ayurveda. This herb has been promoted to the public in India as an immune booster to prevent novel coronavirus disease 2019. However, small reports have recently shown an association between Giloy use and the development of herb‐induced liver injury (HILI) with autoimmune features in some patients. This large retrospective Indian multicenter study spanning 13 centers at nine locations was designed to identify features and outcomes of HILI temporally associated with Giloy use. Chemical and toxicological analyses of retrieved Giloy samples using state‐of‐the‐art methods were also performed. We report 43 patients, of whom more than half were female, with a median time from initial Giloy consumption to symptom onset of 46 days. Patients presented with acute hepatitis, acute worsening of chronic liver disease (CLD, the most common clinical presentation), or acute liver failure. Causality assessment revealed probable liver injury in 67.4%. The most common autoantibody detected was anti‐nuclear antibody. Liver biopsy in a subset revealed HILI associated with autoimmune features and hepatocyte and canalicular cholestasis and neutrophilic and eosinophilic infiltration. Conclusion: Giloy is associated with acute hepatitis with autoimmune features and can unmask autoimmune hepatitis (AIH) in people with silent AIH‐related CLD. Further studies on the safety (and efficacy) of untested but heavily promoted herbals in alternative systems of medicine are an unmet need in the interests of public health and are especially important during this global health emergency.

Heavy Metals, Halogenated Hydrocarbons, Phthalates, Glyphosate, Cordycepin, Alcohol, Drugs, and Herbs, Assessed for Liver Injury and Mechanistic Steps

“…A major challenge is related to the hundreds of herbs as potential culprits of HILI as no uniform pathogenetic concept for all herbs can be provided, but a number of excellent publications [319][320][321][322][323][324][325] has well covered mechanistic topics. This allows now to focus the discussion of mechanistic steps on HILI by Polygonum multiflorum [326][327][328] and herbs containing PAs [329][330][331][332][333][334][335][336][337][338][339][340][341][342][343][344][345].…”

Tinospora cordifolia‐associated hepatotoxicity has been scientifically misconstrued, in haste

“…Interestingly, the median T. cordifolia consumption of 40 mL/day presented in the study is much higher than the permitted limit ( https://tinyurl.com/5n6cn25u ). Kulkarni et al [ 1 ] have attributed the apparent hepatotoxicity to plant alkaloids, terpenoids, and polysaccharides, without mentioning their quantities. Precise quantities and identities of phytocompounds are important for evidence‐based toxicity reporting of traditional herbal medicines.…”

Letter to the editor: Concerning the paper entitled “TC (Giloy) induced liver injury…” by Anand Kulkarni et al.

“…Concerning the paper entitled “TC (Giloy) induced liver injury…” by Anand Kulkarni et al, [ 1 ] the paper is built on a completely unscientific foundation. There is insufficient data to rule out other causes: There were 43 patients in the study with 79 distinct comorbidities among them; median age of 54 years indicates older patients on polypharmacy over longer durations.…”

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Concerning the paper entitled "TC (Giloy) induced liver injury…" by Anand Kulkarni et al, [1] the paper is built on a completely unscientific foundation.

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