Phytomedicine : international journal of phytotherapy and phytopharmacology · 2025
A comprehensive review of herb-induced liver injury: Mechanisms, clinical management, and future perspectives in natural product safety.
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Fan Yujian, Guo Xiaokai, Zhang Caibin, Huang Tianyang, Huang Hsien-Da, He Yisheng
Аннотация
BACKGROUND: The global surge in medicinal natural product use, driven by a "natural equals safe" belief, has led to a significant public health concern: herb-induced liver injury (HILI). As a growing contributor to herbal medicine safety issues, HILI presents challenges in risk assessment and clinical management.
PURPOSE: Based on current toxicological knowledge to address critical gaps in understanding HILI, this review provides an evidence-based roadmap for researchers, clinicians, and regulators to improve risk assessment, clinical management, and public health safeguarding.
STUDY DESIGN AND METHODS: We systematically analyzed global HILI epidemiology, preclinical quality control challenges, and the toxicological pathways of prominent causative agents. Epidemiological and clinical challenges were used to formulate a multi-dimensional framework for HILI management, incorporating technological innovation, policy development, and enhanced education.
RESULTS: Multiple hepatotoxic mechanisms were elucidated, including mitochondrial dysfunction and metabolic bioactivation. We identified specific diagnostic challenges, including patient non-disclosure of herb use and the inadequacy of standard causality tools for multi-ingredient products. To address these gaps, we propose a multi-faceted approach, including the adoption of novel biomarkers for early detection. Furthermore, we outline future technological advances, such as liver-on-a-chip systems for mechanism elucidation, applying artificial intelligence for predictive toxicology, and using blockchain for supply chain verification.
CONCLUSION: Ensuring natural product safety requires integrated strategies that connects mechanistic toxicology with robust clinical management and forward-thinking regulatory science. A deeper, more specific understanding of HILI etiology is required for developing effective prevention strategies and enhancing the safety of herbal medicine for global public health.
PURPOSE: Based on current toxicological knowledge to address critical gaps in understanding HILI, this review provides an evidence-based roadmap for researchers, clinicians, and regulators to improve risk assessment, clinical management, and public health safeguarding.
STUDY DESIGN AND METHODS: We systematically analyzed global HILI epidemiology, preclinical quality control challenges, and the toxicological pathways of prominent causative agents. Epidemiological and clinical challenges were used to formulate a multi-dimensional framework for HILI management, incorporating technological innovation, policy development, and enhanced education.
RESULTS: Multiple hepatotoxic mechanisms were elucidated, including mitochondrial dysfunction and metabolic bioactivation. We identified specific diagnostic challenges, including patient non-disclosure of herb use and the inadequacy of standard causality tools for multi-ingredient products. To address these gaps, we propose a multi-faceted approach, including the adoption of novel biomarkers for early detection. Furthermore, we outline future technological advances, such as liver-on-a-chip systems for mechanism elucidation, applying artificial intelligence for predictive toxicology, and using blockchain for supply chain verification.
CONCLUSION: Ensuring natural product safety requires integrated strategies that connects mechanistic toxicology with robust clinical management and forward-thinking regulatory science. A deeper, more specific understanding of HILI etiology is required for developing effective prevention strategies and enhancing the safety of herbal medicine for global public health.