Natural Antioxidants for Non-alcoholic Fatty Liver Disease

Molecular Targets and Clinical Perspectives

Federico Salomone; Justyna Godos; Shira Zelber-Sagi


Liver International. 2016;36(1):5-20. 

In This Article


Silymarin is a lipophilic extract from the milk thistle seeds that is composed of three isomers of flavonolignans (silybin, silydianin and silychristin) and two flavonoids (taxifolin and quercetin). Milk thistle is the most studied herb in the field of hepatology and the use of milk thistle derivatives as food supplements for the treatment of liver diseases is diffused worldwide. Silibinin is the main component of silymarin. Experiments conducted by our group in a mouse model of NASH indicate that silibinin exerts hepatoprotective effects by modulating lipid homeostasis and inhibiting NFkB activation.[99] In addition, we also demonstrated in the same animal model that silibinin exerts also cardioprotective effects, which appear relevant because of the association of NASH with myocardial dysfunction.[100] Furthermore, silibinin has been shown to ameliorate insulin resistance in HepG2 cells partially through targeting IRS-1/PI3K/Akt pathway.[101] From a clinical point of view, two small randomized clinical trials reported that supplementation of silibinin combined with phosphatidylcholine and vitamin E in patients with NAFLD may improve insulin resistance and liver histology[102] as well as liver enzymes and lipid profile.[103] Consistently, a silymarin-vitamin E complex has been recently shown to reduce liver steatosis in a small uncontrolled clinical trial.[104]