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Review

Potential Hepatotoxins Found in Herbal Medicinal Products: A Systematic Review

1
Transdisciplinary Science and Engineering Program, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima 739-8529, Japan
2
Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, 63450 Hanau, Germany
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2020, 21(14), 5011; https://doi.org/10.3390/ijms21145011
Received: 12 June 2020 / Revised: 7 July 2020 / Accepted: 8 July 2020 / Published: 16 July 2020
(This article belongs to the Section Molecular Toxicology)
The risk of liver injury associated with the use of herbal medicinal products (HMPs) is well known among physicians caring for patients under a HMP therapy, as documented in case reports or case series and evidenced by using the Roussel Uclaf Causality Assessment Method (RUCAM) to verify a causal relationship. In many cases, however, the quality of HMPs has rarely been considered regarding potential culprits such as contaminants and toxins possibly incriminated as causes for the liver injury. This review aims to comprehensively assemble details of tentative hepatotoxic contaminants and toxins found in HMPs. Based on the origin, harmful agents may be divided according two main sources, namely the phyto-hepatotoxin and the nonphyto-hepatotoxin groups. More specifically, phyto-hepatotoxins are phytochemicals or their metabolites naturally produced by plants or internally in response to plant stress conditions. In contrast, nonphyto-hepatotoxic elements may include contaminants or adulterants occurring during collection, processing and production, are the result of accumulation of toxic heavy metals by the plant itself due to soil pollutions, or represent mycotoxins, herbicidal and pesticidal residues. The phyto-hepatotoxins detected in HMPs are classified into eight major groups consisting of volatile compounds, phytotoxic proteins, glycosides, terpenoid lactones, terpenoids, alkaloids, anthraquinones, and phenolic acids. Nonphyto-hepatotoxins including metals, mycotoxins, and pesticidal and herbicidal residues and tentative mechanisms of toxicity are discussed. In conclusion, although a variety of potential toxic substances may enter the human body through HMP use, the ability of these toxins to trigger human liver injury remains largely unclear. View Full-Text
Keywords: contaminants; hepatotoxicity; herbal medicinal products; liver injury; herb induced liver injury; RUCAM; nonphyto-hepatotoxins; phyto-hepatotoxins contaminants; hepatotoxicity; herbal medicinal products; liver injury; herb induced liver injury; RUCAM; nonphyto-hepatotoxins; phyto-hepatotoxins
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MDPI and ACS Style

Quan, N.V.; Dang Xuan, T.; Teschke, R. Potential Hepatotoxins Found in Herbal Medicinal Products: A Systematic Review. Int. J. Mol. Sci. 2020, 21, 5011. https://doi.org/10.3390/ijms21145011

AMA Style

Quan NV, Dang Xuan T, Teschke R. Potential Hepatotoxins Found in Herbal Medicinal Products: A Systematic Review. International Journal of Molecular Sciences. 2020; 21(14):5011. https://doi.org/10.3390/ijms21145011

Chicago/Turabian Style

Quan, Nguyen V., Tran Dang Xuan, and Rolf Teschke. 2020. "Potential Hepatotoxins Found in Herbal Medicinal Products: A Systematic Review" International Journal of Molecular Sciences 21, no. 14: 5011. https://doi.org/10.3390/ijms21145011

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