Hepatotoxicity associated with the ingestion of Centella asiatica
Jorge, O.A.; Jorge, A.D.
Revista Espanola de Enfermedades Digestivas Organo Oficial de la Sociedad Espanola de Patologia Digestiva 97(2): 115-124
2005
ISSN/ISBN: 1130-0108 PMID: 15801887 Document Number: 590739
Background: Hepatotoxicity due to herbal remedies is being increasingly recognized. C. asiatica is commercialized for multiple conditions. Its active principles are pentacyclic triterpenic saponosides (asiaticoside, madecassoside). Clinical case studies: We present three women (61, 52 and 49 years old) who developed jaundice after taking C. asiatica for 30, 20 and 60 days. Respective laboratory tests: 1193, 1694 and 324 U alanine aminotransferase/l; 503, 472 and 484 U alkaline phosphatase/l; and 4.23, 19.89 and 3.9 mg bilirubin/dl. The first patient also had ASMA 1/160 and AMA 1/320. Respective pathological diagnoses: granulomatous hepatitis with marked necrosis and apoptosis; chronic hepatitis with cirrhotic transformation and intense necroinflammatory activity, and granulomatous hepatitis. All patients improved with C. asiatica discontinuation and ursodeoxycholic acid 10 mg kg-1 day-1. The first patient took C. asiatica again with recurrence of the damage. The second one had taken this herb a year before. Conclusions: Many plants synthesize hepatotoxic compounds. Germander, Skullcap and Glycyrrhizin contain di- or triterpenic active principles, which can produce hepatic injury by promoting apoptosis and altering cell membranes. We hypothesize that these mechanisms may have resulted in injuries associated with C. asiatica. The presence of autoantibodies and granulomas also favours an immune-mediated mechanism. Ursodeoxycholic acid has anti-apoptotic properties, but we cannot rule out that C. asiatica discontinuation alone may have resulted in patient improvement.