Raj Vuppalanchi1, Herbert L Bonkovsky2, Jawad Ahmad3, Huiman Barnhart4, Francisco Durazo5, Robert J Fontana6, Jiezhun Gu4, Ikhlas Khan7, David E Kleiner8, Christopher Koh8, Don C Rockey9, Elizabeth J Phillips10, Yi-Ju Li4, Jose Serrano8, Andrew Stolz11, Hans L Tillmann12, Leonard B Seeff13, Jay H Hoofnagle8, Victor J Navarro14. 1. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. 2. Wake Forest University School of Medicine, Winston-Salem, North Carolina. 3. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 4. Duke Clinical Research Institute, Duke University, Durham, North Carolina. 5. University of California Los Angeles Medical School, Los Angeles, California. 6. Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan. 7. National Center for Natural Products Research, University of Mississippi, University, Mississippi. 8. Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, and the Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, and the Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. 9. Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. 10. Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 11. Department of Medicine, University of Southern California School of Medicine, Los Angeles, California. 12. East Carolina University, Greenville, North Carolina. 13. Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania. 14. Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania. Electronic address: NavarroV@einstein.edu.
Abstract
BACKGROUND & AIMS: Garcinia cambogia, either alone or with green tea, is commonly promoted for weight loss. Sporadic cases of liver failure from G cambogia have been reported, but its role in liver injury is controversial. METHODS: Among 1418 patients enrolled in the Drug-Induced Liver Injury Network (DILIN) from 2004 to 2018, we identified 22 cases (adjudicated with high confidence) of liver injury from G cambogia either alone (n = 5) or in combination with green tea (n = 16) or Ashwagandha (n = 1). Control groups consisted of 57 patients with liver injury from herbal and dietary supplements (HDS) containing green tea without G cambogia and 103 patients from other HDS. RESULTS: Patients who took G cambogia were between 17 and 54 years, with liver injury arising 13-223 days (median = 51) after the start. One patient died, one required liver transplantation, and 91% were hospitalized. The liver injury was hepatocellular with jaundice. Although the peak values of aminotransferases were significantly higher (2001 ± 1386 U/L) in G cambogia group (P < .018), the median time for improvement in total bilirubin was significantly lower compared with the control groups (10 vs 17 and 13 days; P = .03). The presence of HLA-B∗35:01 allele was significantly higher in the G cambogia containing HDS (55%) compared with patients because of other HDS (19%) (P = .002) and those with acute liver injury from conventional drugs (12%) (P = 2.55 × 10-6). CONCLUSIONS: The liver injury caused by G cambogia and green tea is clinically indistinguishable. The possible association with HLA-B∗35:01 allele suggests an immune-mediated mechanism of injury. CLINICAL TRIALS: gov number: NCT00345930.
BACKGROUND & AIMS: Garcinia cambogia, either alone or with green tea, is commonly promoted for weight loss. Sporadic cases of liver failure from G cambogia have been reported, but its role in liver injury is controversial. METHODS: Among 1418 patients enrolled in the Drug-Induced Liver Injury Network (DILIN) from 2004 to 2018, we identified 22 cases (adjudicated with high confidence) of liver injury from G cambogia either alone (n = 5) or in combination with green tea (n = 16) or Ashwagandha (n = 1). Control groups consisted of 57 patients with liver injury from herbal and dietary supplements (HDS) containing green tea without G cambogia and 103 patients from other HDS. RESULTS: Patients who took G cambogia were between 17 and 54 years, with liver injury arising 13-223 days (median = 51) after the start. One patient died, one required liver transplantation, and 91% were hospitalized. The liver injury was hepatocellular with jaundice. Although the peak values of aminotransferases were significantly higher (2001 ± 1386 U/L) in G cambogia group (P < .018), the median time for improvement in total bilirubin was significantly lower compared with the control groups (10 vs 17 and 13 days; P = .03). The presence of HLA-B∗35:01 allele was significantly higher in the G cambogia containing HDS (55%) compared with patients because of other HDS (19%) (P = .002) and those with acute liver injury from conventional drugs (12%) (P = 2.55 × 10-6). CONCLUSIONS: The liver injury caused by G cambogia and green tea is clinically indistinguishable. The possible association with HLA-B∗35:01 allele suggests an immune-mediated mechanism of injury. CLINICAL TRIALS: gov number: NCT00345930.
Authors: Naga Chalasani; Herbert L Bonkovsky; Robert Fontana; William Lee; Andrew Stolz; Jayant Talwalkar; K Rajendar Reddy; Paul B Watkins; Victor Navarro; Huiman Barnhart; Jiezhun Gu; Jose Serrano Journal: Gastroenterology Date: 2015-03-06 Impact factor: 22.682