Acute liver failure caused by Amanita verna: a case series and review of the literature

Background Amanita verna is one of the most harmful wild fungi in China. Amanita verna poisoning occurs every year, and the mortality is as high as 50%. However, its clinical manifestations are complex and diverse. Case presentation In March 2019, three patients took a large amount of Amanita, and one of them received liver transplantation in Zhongshan hospital, Sun Yat-sen University. All patients had vomiting and diarrhea 8–12 h after eating wild mushrooms (Amanita). The patients were initially diagnosed with Amanita poisoning. One case (case 3) was complicated and diagnosed as mushroom poisoning (fatal Amanita), toxic hepatitis, acute liver failure, toxic encephalopathy, hemorrhagic colitis, toxic myocarditis, disseminated intravascular coagulation (DIC) and pregnancy. The general clinical data of all patients were recorded, who received early treatment such as hemodialysis, artificial liver plasma exchange, hormone shock and anti-infection. One case (case 1) recovered smoothly after liver transplantation, and the indexes of liver, kidney, coagulation function and infection were improved. The other two cases died of intracerebral hemorrhage. Conclusion Liver transplantation is an effective method for the treatment of acute liver failure caused by mushroom poisoning and can improve the survival rate of patients with toxic liver failure.

Evaluation of the hepatoprotective and antioxidant properties of an aqueous extract of plant polyphenols (helichrysum maracandicum)

This study investigated in vivo and in vitro the effects of helmar 2 polyphenol extracts isolated from the plant Helichrysum maracandicum in the conditions of toxic hepatitis poisoned by carbon dioxide (CCl4) in rats. The experiments were performed on healthy male rats and grouped hepatitis model animals with CCl4. In toxic hepatitis, helmar 2 polyphenol extracts at a dose of 20 mg/kg showed an inhibitory effect on hepatic mitochondrial lipid peroxidation. Evidently, the inhibitory effect of polyphenol extracts on the peroxidation of hepatic mitochondrial lipids was very close to that of the hepatoprotective drug silymarin.

Thyrotoxicosis treatment with lithium corbanate. Cases reported

Treatment of thyrotoxicosis caused by Graves’ disease or multinodular toxic goiter, is not difficult, in most cases, since the prescription of thionamides allows to normalize the level of thyroid hormones quickly and safety. But in a number of cases this therapy might be associated with serious side effects (agranulocytosis, toxic hepatitis, cholestasis), severe allergic reactions and also individual intolerance on thionamides. In such cases lithium carbonate is used, especially in severe thyrotoxic syndrome. It is known, that lithium can accumulate in the thyroid gland at a concentration 3–4 times higher than in the plasma. Perhaps, lithium uses Na+/I- ions. It can inhibit the synthesis and secretion thyroid hormones of thyroid gland. The article presents the cases reported the use of lithium carbonate in thyrotoxicosis treatment before thyroidectomy. Administering low doses of carbonate lithium (900 mg/ per day) renders significant decrease or normalization of thyroid hormones concentration within 7–14 days, thus it let perform thyroidectomy on the patients. No side effects have been identified with such a short course of lithium carbonate treatment.

Phenolic Compounds and Hepatoprotective Activity of Chicory Herb Extract

Introduction. Chicory (Cichorium intybus L.) is widely applied for liver disease treatment by traditional medicine of different countries; as well, it is the object for pharmacological research of hepatoprotective activity. In this regard, the method for obtaining dry extract of wild chicory herb (WCHE) is developed in the All-Russian Research Institute of Medicinal and Aromatic Plants.Aim. Aim of the research is determination of the qualitative composition of phenolic compounds, identification of the substances prevailing in WCHE and conducting pharmacological screening of the extract.Materials and methods. WCHE chemical composition has been explored with HPLC-MS/MS method; the main components were determined quantitatively with HPLC-UF method using single compounds that were isolated by us earlier and identified by NMR spectroscopy. WCHE pharmacological screening of hepatoprotective activity research was involving 50 male rats. Acute toxic hepatitis in animals was induced by a single subcutaneous injection of 50 % oily solution of tetrachloromethane (TCM) at a dosage of 0.4 ml per 100 g body weight. One hour before administration TCM, animals received WCHE at the doses of 100 or 500 mg/kg. 48 hours after TCM administration, the activity of serum enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), as well as the content of total bilirubin were determined for preliminary establishment of pharmacological activity. Pathomorphological studies of rat liver were carried out using histological methods. The liver histological structure was inspected using liver sections stained with hematoxylin and eosin.Results and discussion. The component composition of WCHE is represented by oxycoumarins, hydroxycinnamic acids and flavonoids. The dominant phenolic compounds are esculetin, chicoriin, chicoric, chlorogenic and caftaric acids. It was found under acute experimental toxic hepatitis, that preliminary WCHE administration reduces the toxic TCM effect on liver cells. In animals treated with WCHE at doses both 100 mg/kg and 500 mg/kg body weight, it was observed decreases in ALT activity by 35 % and 45 %, AST by 15 % and 28 %, alkaline phosphatase by 15 % and 21 %; the content of total bilirubin by 20 % and 29 %, respectively, in comparison with similar indicators in the group of animals that were not treated with the extract. The histological study showed that WCHE administration to animals at the doses of 100 and 500 mg/kg reduces dystrophic changes in hepatocytes, this effect is more pronounced at the extract dosage of 500 mg/kg.Conclusion. Main WCHE components are oxycoumarins (esculetin, chicoriin), hydroxycinnamic acids (chicoric, chlorogenic and caftaric). According to the results of screening studies, it was established that WCHE in doses of 100 mg/kg and 500 mg/kg is a promising object for further pharmacological research.

INFLUENCE OF THICK EXTRACT FROM MAITAKE MUSHROOMS ON SIGNS OF INFLAMMATORY PROCESS IN EXPERIMENTAL TOXIC HEPATITIS

Background. The priority of the contemporary pharmaceutical industry is to create effective, safe and inexpensive drugs to ensure the highest quality of care and optimal use of available raw materials. Objective. The aim of our study was to investigate anti-inflammatory properties of the Maitake mushrooms thick extract in the experiment on rats with paracetamol(acetaminophen)-induced hepatitis. Methods. 60 white male rats, weighing 180-210 g, randomized into 10 groups of 6 animals in each, were used for the experiment. Paracetamol hepatitis was simulated by acetaminophen intragastric administering in a dose of 1250 mg/kg 1 time per day (for 2 days) as a suspension in 2% starch gel solution. Maitake mushrooms thick extract, which was administered intragastrically 2 hours before the administration of acetaminophen and daily after the lesion in a dose of 150 mg/kg of the animal’s body weight, was used for the toxic lesion correction. “Silibor” was selected as the comparison drug, which was administered according to the same scheme as the investigated extract in a dose of 20 mg/kg of the animal’s body weight. Euthanasia was conducted on the 3rd, 7th and 10th day of the experiment with sodium barbamyl. Liver homogenate and animal serum were used for the studies. The development of inflammatory processes was studied by the content of pro-inflammatory and anti-inflammatory cytokines, as well as C-reactive protein in the serum of rats with toxic hepatitis and after the application of Maitake mushroom extract and the comparison drug. Results. It was found that the introduction of acetaminophen to animals for the acute hepatitis simulation is accompanied by changes in the cytokine profile, i.e. an increase in the level of IL-6 and a decrease in the level of IL-4 in the serum of rats. Inflammatory development is evidenced by the content of C-reactive protein increase in the blood of the affected animals. The application of Maitake mushroom extract facilitated bringing the studied indicators almost to the level of intact control. Conclusions. Reduction of inflammation signs in rats with the simulated paracetamol hepatitis under the influence of Maitake mushrooms thick extract confirms its anti-inflammatory properties. Objective. The aim of our study was to investigate anti-inflammatory properties of the Maitake mushrooms thick extract in the experiment on rats with paracetamol(acetaminophen)-induced hepatitis. Methods. 60 white male rats, weighing 180-210 g, randomized into 10 groups of 6 animals each, were used for the experiment. Paracetamol hepatitis was simulated by acetaminophen intragastric administering in a dose of 1250 mg/kg 1 time per day (for 2 days) as a suspension in 2% starch gel solution. Maitake mushrooms thick extract, which was administered intragastrically 2 hours before the administration of acetaminophen and daily after the lesion in a dose of 150 mg/kg of the animal’s body weight, was used for the toxic lesion correction. "Silibor" was selected as the comparison drug, which was administered according to the same scheme like the investigated extract in a dose of 20 mg/kg of the animal’s body weight. Euthanasia was conducted on the 3rd, 7th and 10th day of the experiment with sodium barbamyl using. Liver homogenate and animal serum were used for the studies. The development of inflammatory processes was studied by the content of pro- and anti-inflammatory cytokines, as well as C-reactive protein in the serum of rats with toxic hepatitis and after the application of Maitake mushroom extract and the comparison drug. Results. It was found that the introduction of acetaminophen to animals for the acute hepatitis simulation is accompanied by changes in the cytokine profile, namely, an increase in the level of IL-6 and a decrease in the level of IL-4 in the serum of rats. The inflammatory process development is evidenced by the content of C-reactive protein increasing in the blood of affected animals. The application of Maitake mushroom extract helped to bring the studied indicators closer to the level of intact control. Conclusions. The application of the Maitake mushrooms thick extract as a corrective factor at the simulated paracetamol hepatitis confirms its anti-inflammatory properties. KEYWORDS: Maitake mushrooms, paracetamol, hepatitis, inflammatory processes, thick extract, anti-inflammatory properties.

Influence of Pancreo-Plant on the histological parameters of the liver in conditions of acute toxic hepatitis

Toxic liver damage is the most problematic for pharmacotherapy and, accordingly, the normalization of the patient’s condition. Most often, hepatotoxins include alcohol, drugs, household and industrial toxins, the effect of which on the liver leads to the development of hepatocyte necrosis. The peculiarity of drug toxic hepatitis is a wide range of clinical manifestations, the absence of unambiguous diagnostic methods, frequent poor prognosis, which makes toxic hepatitis one of the most difficult problems in clinical practice. A promising drug for the treatment of toxic liver damage is a multicomponent herbal remedy, which is currently produced by a domestic manufacturer in the form of a dietary supplement. The aim of the work is to study the effect of the herbal remedy Pancreo-Plant on the histological structure of the liver of rats, under conditions of subacute ethanol-tetrachloromethane intoxication. Materials and methods. A model of poisoning was formed and liver samples from nonlinear white rats were examined. The slides were examined under the light microscope Granum, photographing of microscopic images was carried out with Granum DCM 310 digital video camera. The photographs were processed on a computer using the Toup View program. Results. Micropreparations obtained from liver samples of rats under the condition of subacute ethanol-tetrachloromethane intoxication, were investigated. It has been proven that Pancreo-Plant helps to reduce necrotic manifestations, hydropic degeneration of hepatocytes, manifestations of steatosis, and signs of inflammation; it also stimulates carbohydrate metabolism in hepatocytes and improves regenerative manifestations. Conclusions. It was found that the investigated agent based on medicinal plant materials, when using the model of subacute ethanol-tetrachloromethane intoxication, exhibits a significant hepatoprotective effect. It normalizes the histological structure of hepatocytes, restores the processes of glycogen accumulation, and prevents the development of fatty degeneration of the liver.