William F. Balistreri, MD


December 27, 2013

In This Article

Herbal and Dietary Supplement-Induced Liver Injury

Navarro and colleagues[20] compared and contrasted the clinical features and outcomes in patients with herbal and dietary supplement (HDS)-induced and drug-induced liver injury (DILI) enrolled in the Drug-Induced Liver Injury Network (DILIN). Between 2003 and 2013, of more than 800 patients enrolled in DILIN, 16% of the cases of liver injury were attributed to an HDS, 35% of which were attributed to bodybuilding products. The proportion of cases attributed to HDS products increased from 7% in 2004-2005 to 20% in 2010-2012; this increase occurred with bodybuilding (from 2% to 7%) and other HDS products (from 5% to 12%).

Liver injury caused by bodybuilding products had unique clinical features:

This association occurred exclusively in men;

The patients were younger (33 vs 49 years);

Serum alanine aminotransferase levels were lower (median, 194 IU/L vs 1100 for other HDS and 634 for DILI);

Serum total bilirubin levels at onset were higher (median, 9.8 mg/dL) than for other HDS, and bodybuilding product-induced injury led to more prolonged jaundice; and

There were no deaths or transplants in this group. In contrast, liver transplantation was required in 13% of other HDS-related cases and 2% died of liver failure, and in the conventional DILI group, only 3% required transplant and 3% died.

This study emphasizes the need for enhanced general awareness of the potential for HDS-induced liver injury. The specific ingredients responsible for injury must be identified.

A Solution to Organ Shortage

A futuristic approach to tissue repair was presented by Atala,[21] offering hope for patients with diseased or injured organs through regenerative medicine and tissue engineering. He stated that we may soon be able to apply, in a practical fashion, the principles of cell transplantation, material sciences, and bioengineering to construct biological substitutes that can restore and maintain normal function in diseased liver tissue. He also emphasized that stem cells offer a potentially limitless source of cells for tissue engineering applications, opening additional therapeutic options for patients with liver disease.


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