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Evidence chain-based causality identification in herb-induced liver injury: exemplification of a well-known liver-restorative herb Polygonum multiflorum

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Abstract

Herbal medicines have recently been recognized as the second most common cause of drug-induced liver injury (DILI) in the United States. However, reliable methods to identify the DILI causality of some herbs, such as Heshouwu (dried root of Polygonum multiflorum), remain lacking. In this study, a total of 12 307 inpatients with liver dysfunction and 147 literature-reported cases of Heshouwu DILI were screened. A general algorithm indicated that only 22.5% (9/40) and 30.6% (45/147) of all hospitalization and literature case reports, respectively, demonstrate the high probability of DILI causality of Heshouwu. By contrast, 95% (19/20) of all cases prospectively investigated by pharmacognosy, phytochemistry, and metabolomic tests exhibited highly probable causality, including a patient who was previously incorrectly attributed and a case that was excluded from Heshouwu causality by pharmacognostic evidence. Toxin (heavy metals, pesticides, and mycotoxins) contamination was also excluded from Heshouwu DILI causality. The objectivity of these screening methods for Heshouwu DILI diagnosis addresses safety concerns regarding stilbene-containing herbal medicines and dietary supplements.

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Authors and Affiliations

  1. China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, 100039, China

    Jiabo Wang, Zhijie Ma, Ming Niu, Yun Zhu, Yanling Zhao, Zhaofang Bai, Yaming Zhang, Na Li, Yakun Meng, Qi Li & Lushan Qin

  2. Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

    Zhijie Ma

  3. Diagnosis and Treatment Center for Non-infectious Diseases, 302 Military Hospital, Beijing, 100039, China

    Qingsheng Liang, Guangju Teng, Baosen Li & Zhengsheng Zou

  4. Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100193, China

    Jingyuan Song & Shilin Chen

  5. Integrative Medical Center, 302 Military Hospital, Beijing, 100039, China

    Yun Zhu, Ping Zhang & Xiaohe Xiao

  6. Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China

    Junling Cao

  7. Diagnosis and Treatment Center of Western and Chinese Medicine for Liver Diseases, 302 Military Hospital, Beijing, 100039, China

    Yonggang Li

  8. Institute of Clinical Pharmacology, Central South University, Changsha, 410008, China

    Honghao Zhou

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  1. Jiabo Wang
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  2. Zhijie Ma
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  3. Ming Niu
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  11. Na Li
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Correspondence to Yonggang Li, Zhengsheng Zou, Honghao Zhou or Xiaohe Xiao.

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Wang, J., Ma, Z., Niu, M. et al. Evidence chain-based causality identification in herb-induced liver injury: exemplification of a well-known liver-restorative herb Polygonum multiflorum . Front. Med. 9, 457–467 (2015). https://doi.org/10.1007/s11684-015-0417-8

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