Preclinical Benefit of Silymarin on Ketoconazole-induced Hepatotoxicity
Year 2024,
Volume: 6 Issue: 2, 22 - 26, 31.08.2024
Elias Adikwu
,
Nwakaego Ebong
,
Cynthia Ezeude
Abstract
Background: Ketoconazole (KT) use has raised safety concern regarding hepatotoxicity. Silymarin (SL) is a natural bioactive substance with activities on a wide range of human pathologies. The protective activity of SL against KT-induced hepatotoxicity in rats was determined in this study. Methods: Thirty adult Wistar rats of both sexes (180-200g) of n= 5/group were used. Groups I (Control) and II were orally administered with normal saline (0.2mL/day) and SL (200 mg/kg/day), respectively, whereas group III was orally administered with KT (200 mg/kg/day) for 28 days. Groups IV-VI were orally supplemented with SL (50 mg/kg/day, 100 mg/kg/day, and 200 mg/kg/day) before the administration of KT (200 mg/kg/day) for 28 days, respectively. On day 29, the rats were anesthetized and blood samples were collected and examined for biochemical markers. Liver tissues were collected and assessed for oxidative stress markers and histology. Results: KT significantly (p<0.01) increased liver weight, and significantly (p<0.001) increased serum total bilirubin, amino transferases, lactate dehydrogenase, gamma-glutamyl transferase, alkaline phosphatase and liver malondialdehyde levels when compared to control. KT significantly (p<0.01) decreased body weight, and significantly (p<0.01) decreased liver catalase, glutathione peroxidase, superoxide dismutase, and glutathione levels when compared to control. KT caused hepatocelluar necrosis. However, body, and liver weights and the aforementioned biochemical and oxidative stress markers were significantly restored in a dose-related fashion by SL supplementation at 50 mg/kg (p<0.05), 100 mg/kg (p<0.01), and 200 mg/kg (p<0.001) when compared to KT. Various doses of SL restored liver histology. Conclusion: SL may have clinical benefit in KT-induced hepatotoxicity.
Ethical Statement
The animals were handle according to the Guide for the Care and Use of Laboratory Animals. 8th edition,
Supporting Institution
Department of Pharmacology /Toxicology, Faculty of Pharmacy, Madonna University, Rivers State, Nigeria
Thanks
Thanks for the privilege of submitting this manuscript
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Ketoconazole associated hepatotoxicity: a systematic review
and meta-analysis. Biomed and Environ Sci. 2013;26(7):605–
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lutea attenuates hepatotoxicity induced by ketoconazole in rats
by fortifying the cellular antioxidant defense system The J
Basic and Appl Zool 2023;84;1,1-12.
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M. Hepatotoxicity Induced by Azole Antifungal Agents: A
Review Study. Iran J Pharm Res. 2023; 9;22(1):e130336
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emergence of acute hepatic injury in patients treated repeatedly
with ketoconazole. J Clin Gastroenterol. 2008; 42(4):432-433.
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Med. 2006;354(7):731-9
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in Liver Diseases: A Narrative Review Adv Ther 2020 https://
doi.org/10.1007/s12325-020-01251-y
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H et al. Silymarin: a review on paving the way towards
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significance of silymarin. Mole. 2022; 27:5327
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the liver from the toxicity of the anticancer drug paclitaxel,
Tissue and Cell 2023; 83; 102158
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of Silymarin in the Prevention of Anti-tuberculosis Druginduced
Hepatotoxicity: A Randomized Controlled Clinical
Trial. Int J Prev Med. 2023; 26;14:1-5.
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Silymarin Supplementation Alleviates Zearalenone-Induced
Hepatotoxicity and Reproductive Toxicity in Rats. Nutr
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and nonprotein sulfhydryls groups in tissue with Ellman’s
reagent. Anal Biochem. 1968; 25:192–205.
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Press. 1974; 673- 684
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superoxide dismutase based on epinephrine autoxidation, Anal
Biochem, 1978; 90 (1)81-89.
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Methods in Enzymology, 52 (C). S. Fleischer, L. Parker (eds),
Academic Press, New York, 1978, pp. 302 – 310.
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Med. 2020; 21(10):517–523
- Fatemi M, Shomali T, Nazifi S, Fazeli M. Eryngium Bungei
Boiss Extract Has Hepatoprotective Effect Against Liver
Damage Induced by Acetaminophen in Rats: Novel Antioxidant
and Anti-Inflammatory Effects. Iran J Toxicol. 2019;13(4):11-
16.
- Babai S, Auclert L, Le-Louët H. Safety data and withdrawal of
hepatotoxic drugs. Therapies, 2021; 76 (6) 715-723.
- Almomen SM, Almaghrabi MA, Alhabardi SM, Alrwisan
AA. Exploring Indicators of Hepatotoxicity-Related Post-
Marketing Regulatory Actions: A Retrospective Analysis of
Drug Approval Data Saudi J Health Syst Res 2022; 2 (1):
27–31.
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J Cutan Med Surg. 2015 19(4):352-357.
- Kaufmann, W., Jacobsen, M.C. Examination of Organ Toxicity.
In: Reichl, FX., Schwenk, M. (eds) Regulatory Toxicology.
Springer, Cham. 2021; P 117-127.
- Adikwu E, Bokolo B, Kemelayefa J. Ipomoea aquatic Forsk
prevents cisplatin-induced liver injury in albino rat. Journal of
Report in Pharmaceutical Sciences 2020;9:25-30
- Adikwu E, Oraebosi MI, Biradee I. Selenium abrogates
tenofovir/lamivudine/efavirenz-induced hepatotoxicity in rats.
Journal of Marine Medical Society 2021; 23:47-51.
- Ahmad A, Imran M, Ahsan H. Biomarkers as Biomedical
Bioindicators: Approaches and Techniques for the Detection,
Analysis, and Validation of Novel Biomarkers of Diseases.
Pharmaceutics. 2023; 31;15(6):1630; 1-36.
- Adikwu E, Nelson EC, Fiyebo P. Selenium as a therapeutic
adjuvant for isoniazid/rifampicin‑induced hepatotoxicity.
BLDE Univ J Health Sci 2020;5:60-67
- Rodriguez, R. J., & Buckholz, C. J. Hepatotoxicity of
ketoconazol in Sprague-Dawley rats: Glutathione depletion,
flavin-contanung monooxygenases-mediated bioactivation and
hepatic covalent binding. Xenobiotica, 2003; 33, 429–441.
- Conde de la Rosa, L, Goicoechea, L, Torres, S, Garcia-Ruiz,
C, Fernandez-Checa, J.C. Role of Oxidative Stress in Liver
Disorders. Livers 2022, 2, 283–314.
- Li S, Tan HY, Wang N, Zhang ZJ, Lao L, Wong CW, Feng
Y. The Role of Oxidative Stress and Antioxidants in Liver
Diseases. Int J Mol Sci. 2015, 2;16 (11):26087-124.
- Valko, M., Rhodes, C., Moncol, J., Izakovic, M., & Mazur,
M. Free radicals, metals and antioxidants in oxidative stressinduced
cancer. ChemicoBiol Interact, 2006; 160, 1-40.
- Handy DE, Loscalzo J. The role of glutathione peroxidase-1 in
health and disease. Free Radic Biol Med. 2022. 1;188:146-161.
- Martín-Fernández M, Arroyo V, Carnicero C, Sigüenza R, Busta
R, Mora N, Antolín B, Tamayo E, Aspichueta P, Carnicero-
Frutos I, Gonzalo-Benito H, Aller R. Role of Oxidative Stress
and Lipid Peroxidation in the Pathophysiology of NAFLD.
Antioxidants (Basel). 2022 10; 11 (11):2217
- Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J
Med. 2006;354(7):731-739.
- Esmaeil N, Anaraki SB, Gharagozloo M, Moayedi B. Silymarin
impacts on immune system as an immunomodulator: One key
for many locks. Intern Immunopharmacol. 2017; 50:194-201.
Year 2024,
Volume: 6 Issue: 2, 22 - 26, 31.08.2024
Elias Adikwu
,
Nwakaego Ebong
,
Cynthia Ezeude
References
- Allison R , Guraka A, Shawa IT , Tripathi G, Moritz W,
Kermanizadeh A. Drug induced liver injury – a 2023 update. J
Toxicol and Environ Heal, Part B2023, 26 (8) 442-467.
- Hosack T, Damry D, Biswas S. Drug-induced liver injury: a
comprehensive review. Ther Adv Gastroenterol. 2023, 21;16:
1-13.
- Garcia-Cortes, M., M. Robles-Diaz, C. Stephens, A. Ortega-
Alonso, I. Lucena M1, Andrade RJ. 2020. Drug induced liver
injury: An update. Arch. Toxicol. 94 (10):3381–3407
- Wang Y, Xie W. Drug-induced liver injury: An overview and
update. Gastro & End. 2023, 1 (2) 102-109.
- Khoza S, Moyo I, Ncube D. Comparative Hepatotoxicity of
Fluconazole, Ketoconazole, Itraconazole, Terbinafine, and
Griseofulvin in Rats. J Toxicol. 2017;2017:6746989
- Chien R.N., Yang L.J., Lin P.Y., Liaw Y.F. Hepatic injury
during ketoconazole therapy in patients with onychomycosis: a
controlled cohort study. Hepatol. 1997;25(1):103–107.
- Yan J. Y., Nie X. L., Tao Q. M., Zhan S. Y., Zhang Y. D.
Ketoconazole associated hepatotoxicity: a systematic review
and meta-analysis. Biomed and Environ Sci. 2013;26(7):605–
610.
- Hamza AA, Gamel M, Abdalla A, Abdalla Y, Amin A. Gentiana
lutea attenuates hepatotoxicity induced by ketoconazole in rats
by fortifying the cellular antioxidant defense system The J
Basic and Appl Zool 2023;84;1,1-12.
- Rakhshan A, Rahmati Kamel B, Saffaei A, Tavakoli-Ardakani
M. Hepatotoxicity Induced by Azole Antifungal Agents: A
Review Study. Iran J Pharm Res. 2023; 9;22(1):e130336
- Lin CL, Hu JT, Yang SS, Shin CY, Huang SH. Unexpected
emergence of acute hepatic injury in patients treated repeatedly
with ketoconazole. J Clin Gastroenterol. 2008; 42(4):432-433.
- Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J
Med. 2006;354(7):731-9
- Hartmut AGM Schmidt HJ. Silymarin as Supportive Treatment
in Liver Diseases: A Narrative Review Adv Ther 2020 https://
doi.org/10.1007/s12325-020-01251-y
- Akhtara MN, Saeedb R, Saeed F, Asghard A, Ghanie S, Ateeqc
H et al. Silymarin: a review on paving the way towards
promising pharmacological agent. Intern J Food Propt, 2023,
26, (1), 2256–227.
- Tighe SP, Akhtar D, Iqbal U and Ahmed A. Chronic Liver
Disease and Silymarin: A Biochemical and Clinical Review. J
Clin and Trans Hepatol 2020; 8 | 454–458.
- Wadhwa K, Pahwa R, Kumar M, Shobhit K, Sharma PC,
Singh G et al. Mechanistic insights into the pharmacological
significance of silymarin. Mole. 2022; 27:5327
- Gür FH, Bilgiç S. Silymarin, an antioxidant flavonoid, protects
the liver from the toxicity of the anticancer drug paclitaxel,
Tissue and Cell 2023; 83; 102158
- Talebi A, Soltani R, Khorvash F, Jouabadi SM. The Effectiveness
of Silymarin in the Prevention of Anti-tuberculosis Druginduced
Hepatotoxicity: A Randomized Controlled Clinical
Trial. Int J Prev Med. 2023; 26;14:1-5.
- Mukhtar S, Xiaoxiong Z, Qamer S, Saad M, Mubarik MS,
Mahmoud AH et al. Hepatoprotective activity of silymarin
encapsulation against hepatic damage in albino rats. Saudi J
Biol Sci. 202; 28(1):717-723.
- Guide for the Care and Use of Laboratory Animals, 8th edition
- Gao X, Xiao Z, Liu M, Zhang N, Khalil MM, Gu CG. Dietary
Silymarin Supplementation Alleviates Zearalenone-Induced
Hepatotoxicity and Reproductive Toxicity in Rats. Nutr
2018;148:1209–1216
- Rotruck JT, Pope AL, Ganther HE. Selenium: Biochemical
role as a component of glutathione peroxidase purification
assay. Sci. 1973; 179:588–590.
- Sedlak J, Lindsay RH. Estimation of total, protein-bound,
and nonprotein sulfhydryls groups in tissue with Ellman’s
reagent. Anal Biochem. 1968; 25:192–205.
- Aebi H. Catalase. In Methods of enzymatic analysis. Academic
Press. 1974; 673- 684
- Sun M, Zigman S, An improved spectrophotometric assay for
superoxide dismutase based on epinephrine autoxidation, Anal
Biochem, 1978; 90 (1)81-89.
- Buege JA., Aust S.D.: Microsomal lipid peroxidation. In:
Methods in Enzymology, 52 (C). S. Fleischer, L. Parker (eds),
Academic Press, New York, 1978, pp. 302 – 310.
- Vaja R, Rana M. Drugs and the liver. Anaes and Inten Care
Med. 2020; 21(10):517–523
- Fatemi M, Shomali T, Nazifi S, Fazeli M. Eryngium Bungei
Boiss Extract Has Hepatoprotective Effect Against Liver
Damage Induced by Acetaminophen in Rats: Novel Antioxidant
and Anti-Inflammatory Effects. Iran J Toxicol. 2019;13(4):11-
16.
- Babai S, Auclert L, Le-Louët H. Safety data and withdrawal of
hepatotoxic drugs. Therapies, 2021; 76 (6) 715-723.
- Almomen SM, Almaghrabi MA, Alhabardi SM, Alrwisan
AA. Exploring Indicators of Hepatotoxicity-Related Post-
Marketing Regulatory Actions: A Retrospective Analysis of
Drug Approval Data Saudi J Health Syst Res 2022; 2 (1):
27–31.
- Gupta AK, Lyons DC. The Rise and Fall of Oral Ketoconazole.
J Cutan Med Surg. 2015 19(4):352-357.
- Kaufmann, W., Jacobsen, M.C. Examination of Organ Toxicity.
In: Reichl, FX., Schwenk, M. (eds) Regulatory Toxicology.
Springer, Cham. 2021; P 117-127.
- Adikwu E, Bokolo B, Kemelayefa J. Ipomoea aquatic Forsk
prevents cisplatin-induced liver injury in albino rat. Journal of
Report in Pharmaceutical Sciences 2020;9:25-30
- Adikwu E, Oraebosi MI, Biradee I. Selenium abrogates
tenofovir/lamivudine/efavirenz-induced hepatotoxicity in rats.
Journal of Marine Medical Society 2021; 23:47-51.
- Ahmad A, Imran M, Ahsan H. Biomarkers as Biomedical
Bioindicators: Approaches and Techniques for the Detection,
Analysis, and Validation of Novel Biomarkers of Diseases.
Pharmaceutics. 2023; 31;15(6):1630; 1-36.
- Adikwu E, Nelson EC, Fiyebo P. Selenium as a therapeutic
adjuvant for isoniazid/rifampicin‑induced hepatotoxicity.
BLDE Univ J Health Sci 2020;5:60-67
- Rodriguez, R. J., & Buckholz, C. J. Hepatotoxicity of
ketoconazol in Sprague-Dawley rats: Glutathione depletion,
flavin-contanung monooxygenases-mediated bioactivation and
hepatic covalent binding. Xenobiotica, 2003; 33, 429–441.
- Conde de la Rosa, L, Goicoechea, L, Torres, S, Garcia-Ruiz,
C, Fernandez-Checa, J.C. Role of Oxidative Stress in Liver
Disorders. Livers 2022, 2, 283–314.
- Li S, Tan HY, Wang N, Zhang ZJ, Lao L, Wong CW, Feng
Y. The Role of Oxidative Stress and Antioxidants in Liver
Diseases. Int J Mol Sci. 2015, 2;16 (11):26087-124.
- Valko, M., Rhodes, C., Moncol, J., Izakovic, M., & Mazur,
M. Free radicals, metals and antioxidants in oxidative stressinduced
cancer. ChemicoBiol Interact, 2006; 160, 1-40.
- Handy DE, Loscalzo J. The role of glutathione peroxidase-1 in
health and disease. Free Radic Biol Med. 2022. 1;188:146-161.
- Martín-Fernández M, Arroyo V, Carnicero C, Sigüenza R, Busta
R, Mora N, Antolín B, Tamayo E, Aspichueta P, Carnicero-
Frutos I, Gonzalo-Benito H, Aller R. Role of Oxidative Stress
and Lipid Peroxidation in the Pathophysiology of NAFLD.
Antioxidants (Basel). 2022 10; 11 (11):2217
- Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J
Med. 2006;354(7):731-739.
- Esmaeil N, Anaraki SB, Gharagozloo M, Moayedi B. Silymarin
impacts on immune system as an immunomodulator: One key
for many locks. Intern Immunopharmacol. 2017; 50:194-201.