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Herbal hepatotoxicity by kava: update on pipermethystine, flavokavain B, and mould hepatotoxins as primarily assumed culprits.
Dig Liver Dis. 2011 Sep; 43(9):676-81.DL

Abstract

Herbal hepatotoxicity by the anxiolytic kava (Piper methysticum Forst. f.) emerged unexpectedly and was observed in a few patients worldwide. Liver injury occurred after the use of traditional aqueous kava extracts in the South Pacific region and of acetonic and ethanolic extracts in Western countries in rare cases, suggesting that the solvents used play no major causative role. In this review, we discuss actual pathogenetic issues of kava hepatotoxicity with special focus on developments regarding pipermethystine, flavokavain B, and mould hepatotoxins as possible culprits. There is abundant data of in vitro cytotoxicity including apoptosis by pipermethystine and flavokavain B added to the incubation media, yet evidence is lacking of in vivo hepatotoxicity in experimental animals under conditions similar to human kava use. Furthermore, in commercial Western kava extracts, pipermethystine was not detectable and flavokavain B was present as a natural compound in amounts much too low to cause experimental liver injury. There is concern, however, that due to high temperature and humidity in the South Pacific area, kava raw material might have been contaminated by mould hepatotoxins such as aflatoxins after harvest and during storage. Whether kava hepatotoxicity may be due to aflatoxicosis or other mould hepatotoxins, requires further studies.

Authors+Show Affiliations

Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Goethe University of Frankfurt/Main, Germany. rolf.teschke@gmx.deNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21377431

Citation

Teschke, Rolf, et al. "Herbal Hepatotoxicity By Kava: Update On Pipermethystine, Flavokavain B, and Mould Hepatotoxins as Primarily Assumed Culprits." Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, vol. 43, no. 9, 2011, pp. 676-81.
Teschke R, Qiu SX, Lebot V. Herbal hepatotoxicity by kava: update on pipermethystine, flavokavain B, and mould hepatotoxins as primarily assumed culprits. Dig Liver Dis. 2011;43(9):676-81.
Teschke, R., Qiu, S. X., & Lebot, V. (2011). Herbal hepatotoxicity by kava: update on pipermethystine, flavokavain B, and mould hepatotoxins as primarily assumed culprits. Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 43(9), 676-81. https://doi.org/10.1016/j.dld.2011.01.018
Teschke R, Qiu SX, Lebot V. Herbal Hepatotoxicity By Kava: Update On Pipermethystine, Flavokavain B, and Mould Hepatotoxins as Primarily Assumed Culprits. Dig Liver Dis. 2011;43(9):676-81. PubMed PMID: 21377431.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Herbal hepatotoxicity by kava: update on pipermethystine, flavokavain B, and mould hepatotoxins as primarily assumed culprits. AU - Teschke,Rolf, AU - Qiu,Samuel X, AU - Lebot,Vincent, Y1 - 2011/03/04/ PY - 2010/12/02/received PY - 2011/01/11/revised PY - 2011/01/25/accepted PY - 2011/3/8/entrez PY - 2011/3/8/pubmed PY - 2012/1/18/medline SP - 676 EP - 81 JF - Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver JO - Dig Liver Dis VL - 43 IS - 9 N2 - Herbal hepatotoxicity by the anxiolytic kava (Piper methysticum Forst. f.) emerged unexpectedly and was observed in a few patients worldwide. Liver injury occurred after the use of traditional aqueous kava extracts in the South Pacific region and of acetonic and ethanolic extracts in Western countries in rare cases, suggesting that the solvents used play no major causative role. In this review, we discuss actual pathogenetic issues of kava hepatotoxicity with special focus on developments regarding pipermethystine, flavokavain B, and mould hepatotoxins as possible culprits. There is abundant data of in vitro cytotoxicity including apoptosis by pipermethystine and flavokavain B added to the incubation media, yet evidence is lacking of in vivo hepatotoxicity in experimental animals under conditions similar to human kava use. Furthermore, in commercial Western kava extracts, pipermethystine was not detectable and flavokavain B was present as a natural compound in amounts much too low to cause experimental liver injury. There is concern, however, that due to high temperature and humidity in the South Pacific area, kava raw material might have been contaminated by mould hepatotoxins such as aflatoxins after harvest and during storage. Whether kava hepatotoxicity may be due to aflatoxicosis or other mould hepatotoxins, requires further studies. SN - 1878-3562 UR - https://www.unboundmedicine.com/medline/citation/21377431/Herbal_hepatotoxicity_by_kava:_update_on_pipermethystine_flavokavain_B_and_mould_hepatotoxins_as_primarily_assumed_culprits_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1590-8658(11)00048-X DB - PRIME DP - Unbound Medicine ER -