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Preclinical Benefit of Silymarin on Ketoconazole-induced Hepatotoxicity

Year 2024, Volume: 6 Issue: 2, 22 - 26, 31.08.2024
https://doi.org/10.51262/ejtox.1506477

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

Project Number

no 55

Thanks

Thanks for the privilege of submitting this manuscript

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.
Year 2024, Volume: 6 Issue: 2, 22 - 26, 31.08.2024
https://doi.org/10.51262/ejtox.1506477

Abstract

Project Number

no 55

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.
There are 43 citations in total.

Details

Primary Language English
Subjects Pharmacology and Pharmaceutical Sciences (Other)
Journal Section Original Articles
Authors

Elias Adikwu 0000-0003-4349-8227

Nwakaego Ebong 0000-0002-8629-4390

Cynthia Ezeude 0009-0000-5273-7459

Project Number no 55
Publication Date August 31, 2024
Submission Date June 28, 2024
Acceptance Date August 27, 2024
Published in Issue Year 2024 Volume: 6 Issue: 2

Cite

APA Adikwu, E., Ebong, N., & Ezeude, C. (2024). Preclinical Benefit of Silymarin on Ketoconazole-induced Hepatotoxicity. Eurasian Journal of Toxicology, 6(2), 22-26. https://doi.org/10.51262/ejtox.1506477
AMA Adikwu E, Ebong N, Ezeude C. Preclinical Benefit of Silymarin on Ketoconazole-induced Hepatotoxicity. Eurasian J Tox. August 2024;6(2):22-26. doi:10.51262/ejtox.1506477
Chicago Adikwu, Elias, Nwakaego Ebong, and Cynthia Ezeude. “Preclinical Benefit of Silymarin on Ketoconazole-Induced Hepatotoxicity”. Eurasian Journal of Toxicology 6, no. 2 (August 2024): 22-26. https://doi.org/10.51262/ejtox.1506477.
EndNote Adikwu E, Ebong N, Ezeude C (August 1, 2024) Preclinical Benefit of Silymarin on Ketoconazole-induced Hepatotoxicity. Eurasian Journal of Toxicology 6 2 22–26.
IEEE E. Adikwu, N. Ebong, and C. Ezeude, “Preclinical Benefit of Silymarin on Ketoconazole-induced Hepatotoxicity”, Eurasian J Tox, vol. 6, no. 2, pp. 22–26, 2024, doi: 10.51262/ejtox.1506477.
ISNAD Adikwu, Elias et al. “Preclinical Benefit of Silymarin on Ketoconazole-Induced Hepatotoxicity”. Eurasian Journal of Toxicology 6/2 (August 2024), 22-26. https://doi.org/10.51262/ejtox.1506477.
JAMA Adikwu E, Ebong N, Ezeude C. Preclinical Benefit of Silymarin on Ketoconazole-induced Hepatotoxicity. Eurasian J Tox. 2024;6:22–26.
MLA Adikwu, Elias et al. “Preclinical Benefit of Silymarin on Ketoconazole-Induced Hepatotoxicity”. Eurasian Journal of Toxicology, vol. 6, no. 2, 2024, pp. 22-26, doi:10.51262/ejtox.1506477.
Vancouver Adikwu E, Ebong N, Ezeude C. Preclinical Benefit of Silymarin on Ketoconazole-induced Hepatotoxicity. Eurasian J Tox. 2024;6(2):22-6.

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