Preventing hepatitis: an issue of global urgency

The World Health Organisation (WHO) is using the occasion of World Hepatitis Day on 28 July to emphasise the importance of combatting this inflammatory liver disease. Usually caused by a virus, hepatitis can lead to serious, life-threatening complications such as cirrhosis or liver cancer ¹. A genuine public health issue, the fight against liver disease has intensified in recent years due to the increasing number of cases. According to recent WHO estimates, more than 300 million people are currently affected by hepatitis B or C². In the light of these alarming statistics, many teams of scientists are working hard to prevent and eradicate what is a global scourge. Among the various avenues being investigated are traditional medicinal plants which are attracting scientific interest due to their natural liver-protective effects. Here we explore the latest research in this field.

Liver-protective effects of Ayurvedic herbs

LIV 52®, a renowned Ayurvedic formulation In traditional Indian medicine, a number of plants are recommended for treating hepatic problems and detoxifying the liver. Himsra (Capparis spinosa), Kasani (Cichorium intybus), Arjuna (Terminalia arjuna), Kasamarda (Cassia occidentalis),…the list of these medicinal herbs is long. For some years now, these plants have been combined in a dietary supplement called (LIV 52®. World-renowned, this Ayurvedic liver formulation has been the subject of several clinical studies which have consistently confirmed its therapeutic benefits and efficacy in combatting liver disease.
Evaluation of the efficacy of LIV 52® against acute viral hepatitis
In 2004, a clinical trial confirmed this formulation’s efficacy for fighting the symptoms of viral hepatitis³. The study involved 50 patients, with an average age of 33, all of whom were suffering from a form of acute viral hepatitis: 74% had hepatitis E, 10% hepatitis B, 8% hepatitis A and 8% other forms of the disease. They all presented with similar symptoms including jaundice, anorexia, nausea, vomiting, fever, pruritus and hepatomegaly (an enlarged liver). To assess the therapeutic potential of supplementation with LIV 52®, patients were divided into two groups :

- 1st group: a control group, given a placebo for four months.
- 2nd group: supplemented with LIV 52® at a dose of two tablets twice a day for four months.
Throughout the study, the researchers monitored various haematological and biochemical parameters, the development of symptoms, tolerance to treatment and incidence of side effects.

Significant improvements seen in LIV52®-supplemented patients
After just two months, the researchers observed the first positive effects of the LIV 52® supplementation – the normalisation of biochemical markers of liver function. This indicated that blood proteins and peptides had reverted to normal levels as result of taking the supplements. A decrease in several inflammatory markers was also seen in the supplemented group. In particular, the researchers noted a reduction both in the level of white blood cells and the rate of erythrocyte sedimentation, positive effects suggestive of lower inflammation. These early observations were supported by improvements in various symptoms characteristic of acute viral hepatitis. After four months, the researchers reported increases in appetite, and decreases in jaundice, weight loss and fatigue, in the LIV 52®-supplemented patients. As a result of this clinical study, the researchers were able to confirm the therapeutic potential of this liver-protective nutritional supplement.

Anti-hepatitis plants from traditional Chinese medicine

Traditional medicinal plants for combatting hepatitis
For centuries, practitioners of traditional Chinese medicine have recommended a number of plants for treating liver diseases. In 2013, a review of liver-protective traditional medicinal plants was published in the journal Drug Discoveries & Therapeutics⁴.These include plants shown to be effective against hepatitis B. There are several natural extracts of note, including:

- Huang Qi, which corresponds to astragalus root (Radix astragali) ;
- Jiang Huang, which denotes turmeric rhizome (Curcuma longa) ;
For - Shui Fei Ji, which is better-known as milk thistle (Silybum marianum).

Beneficial effects of astragalus against hepatitis B
One of the natural extracts mentioned by the authors of this review, Radix astragaliAstragalus membranaceus. Popular in phytotherapy as a tonic, this species of astragalus contains many bioactive compounds such as astragalosides. Scientists believe these active principles have immunomodulatory and anti-viral effects, hence their efficacy against viral hepatitis B (VHB). In this context, a clinical study has confirmed the benefits of this plant in improving liver function in subjects with chronic hepatitis B⁵. This effect may be due primarily to the presence of a powerful active principle called (6.
Curcuma’s anti-hepatitis B properties
The plant (Curcuma longa is known for its rhizomes from which the spice turmeric is extracted. These rhizomes contain a number of active principles which offer antioxidant potency, antiviral activity and anti-inflammatory effects. As a result of their effects in the body, these substances have been investigated in relation to the care of hepatitis B. Scientists believe that supplementation with Curcuma longa may suppress the secretion of HBV antigens, the production of HBV particles as well as intracellular levels of HBV RNA⁷.
Liver-protective effects of milk thistle
Silybum marianum, better known as milk thistle, is one of the oldest Chinese medicinal plants. Its benefits come from an active complex of flavonoids called (silymarin. Several studies have shown that silymarin has antioxidant and liver-protective effects. Scientists therefore believe it offers therapeutic potential for improving liver diseases such as cirrhosis, viral hepatitis and fatty liver. When tested in chronic hepatitis B patients, silymarin was shown to improve liver health.

These various studies confirm the benefits of phytotherapy for protecting the liver and preventing the development of certain liver diseases. Certain plants also have anti-inflammatory and anti-viral effects, benefits which have attracted scientific interest for their ability to target viral hepatitis. The beneficial effects of these medicinal plants can now be obtained in dietary supplement form. Combinations of extracts are also available which offer synergistic effects, such as the optimal formulation (Liver Support Formula, a synergistic, liver-specific complex which contains silymarin.

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> Sources :
1. Organisation Mondiale de la Santé (OMS), Qu’est-ce que l’hépatite?, Site officiel de l’OMS, 24 juin 2014.
2. Organisation Mondiale de la Santé (OMS), Les nouvelles données sur l’hépatite soulignent le besoin urgent d’une riposte mondiale, Communiqué de presse, Site officiel de l’OMS, avril 2017.
3. Rajiv Baijal, Nikhil Patel, S. A. Kolhapure, Evaluation of efficacy and safety of Liv.52 DS tablets in acute viral hepatitis: A prospective, double-blind, randomized, placebo-controlled, phase III clinical trial, Medicine Update 2004; 12(5), 41-53.
4. Fanghua Qi, et al., Traditional Chinese medicine and related active compounds: A review of their role on hepatitis B virus infection, Drug Discov Ther. 2013; 7(6):212-224.
5. Tang LL, Sheng JF, Xu CH, Liu KZ. Clinical and experimental effectiveness of Astragali compound in the treatment of chronic viral hepatitis B. J Int Med Res. 2009; 37:662-667.
6. Wang S, Li J, Huang H, Gao W, Zhuang C, Li B, Zhou P, Kong D. Anti-hepatitis B virus activities of astragaloside IV isolated from Radix astragali. Biol Pharm Bull. 2009; 32:132-135.
7. Kim HJ, Yoo HS, Kim JC, Park CS, Choi MS, Kim M, Choi H, Min JS, Kim YS, Yoon SW, Ahn JK. Antiviral effect of Curcuma longa Linn extract against hepatitis B virus replication. J Ethnopharmacol. 2009; 124:189-196.