A HUMAN STUDY ON THE EFFECT OF ALHAGI MAURORUM (CAMEL THORN) ON PATIENTS SUFFERING FROM HEPATITIS B VIRUS
Keywords:
Alhagi maurorum, camel thorn, hepatitis B virus, Libya, viral loadAbstract
Hepatitis B virus infection is a major health problem worldwide. More than 400 million people are suffering from this infectious disease. Alhagi Maurorum (camel thorn, CTE) is used in Libyan folk medicine for hepatitis. The aim of this study is to investigate the effect of the camel thorn on the hepatitis B virus. After a pharmacological and toxicological screening of camel thorns on experimental animals in our laboratories, in an open-label study, 15 patients of either gender were chosen at random with their consent (consent form signed). The patients had no liver cirrhosis and were not alcoholics. Following clinical testing, the patients were given a low, safe dose of camel thorn powder (2.6 g soaked in boiling water for 10 minutes) three times per day for six months. The viral load was measured before treatment and three and six months after the beginning of the experiment by polymerase chain reaction. The complete blood picture, the level of transaminases, bilirubin, creatinine, blood glucose, lipid profile, thyroid function, and prothrombin were assessed before and after three months after the beginning of the experiment. Our data showed no significant changes in the complete blood picture, creatinine, blood urea, glucose level, bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, lipid profile, prothrombin, and thyroid function. The levels of viral load before, three months after, and six months after the beginning of our study were 1689 ± 289, 558 ± 160, and 271 ± 026 IU per mL, respectively. From this study, we may conclude that the camel thorn is safe and showed activity against viral hepatitis B, however, further investigations are needed by increasing the number of patients and using higher doses of plant extract to explore its mechanism of action. Finally, the mechanism of camel thorn may be related either to its antiviral effect or to the stimulation of either endogenous interferon or the immune system.
References
World Health Organization (2002) WHO Policy perspectives on medicines (traditional medicine) - growing needs and potential. 2002. WHO, Geneva.
Salmerón-Manzano E, Garrido-Cardenas JA, Manzano-Agugliaro F (2020) Worldwide research trends on medicinal plants. International Journal of Environmental Research and Public Health. 17 (10): 3376. doi: 10.3390/ijerph17103376.
Rasool Hassan BA (2012) Medicinal Plants (Importance and Uses), Pharmaceutica Analytica Acta. 3 (10): 1000e139. doi:10.4172/2153-2435.1000e139.
Singh S, Sedha S (2017) Medicinal plants and their pharmacological aspects. Family Process Institute. 1 (4): 156-170.
Ahmad N, Bibi Y, Saboon, Raza I, Zahara K, Idrees S, Khalid N, Bashir T, Tabassum S (2015) Traditional uses and pharmacological properties of Alhagi maurorum: A review. Asian Pacific Journal of Tropical Disease. 5 (11): 856-861. doi.org/10.1016/S2222-1808(15)60945-8.
Muhammad MA, Hussain F, Anwar AM, Gilani AH (2015) Alhagi: a plant genus rich in bioactives for pharmaceuticals. Phytotherapy Research. 29 (1): 1-13. doi: 10.1002/ptr.5222.
Naseri MKG, Mard SA (2007) Gastroprotective effect of Alhagi maurorum on experimental gastric ulcer in rats. Pakistan Journal of Medical Science. 23 (4): 570-573.
Atta AH, Mouneir SM (2004) Antidiarrheal activity of some Egyptian medicinal plant extracts. Journal of Ethnopharmacology. 92 (2-3): 303-309. doi: 10.1016/j.jep.2004.03.017.
Neamah NF (2012) A pharmacological evaluation of aqueous extract of Alhagi maurorum. Global Journal of Pharmacology. 6 (1): 41-46. Corpus ID: 34561203.
Rahman SMA, Abd-Ellatif SA, Deraz SF, Khalil AA (2011) Antibacterial activity of some wild medicinal plants collected from western Mediterranean coast, Egypt: natural alternatives for infectious disease treatment. African Journal of Biotechnology. 10 (52): 10733-10743. doi: 10.5897/AJB11.007.
Zain ME, Awaad MS, Al-Outhman MR, El-Meligy RM (2011) Antimicrobial activities of Saudi Arabian desert plants. Phytopharmacology. 2 (1): 106-113.
Zakaria MNM, Islam MW, Radhakrishnan R, Chen HB, Ismail A, Chan K, Habibullah M (1999) Pharmacological evaluation of anti-inflammatory activity of Alhagi maurorum. Journal of Pharmacy and Pharmacology. 51 (Suppl): 118. 200902159161292622, number: 99A0992375.
Atta AH, Abo EL-Sooud K (2004) The antinociceptive effect of some Egyptian medicinal plant extracts. Journal of Ethnopharmacology. 95 (2-3): 235-238. doi: 10.1016/j.jep.2004.07.006.
Gargoum HM, Muftah SS, Al Shalmani S, Mohammed HA, Alzoki A, Debani, Al Fituri AHO, El Shari F, El Barassi I, Meghil SE, Abdellatif AG (2013) Phytochemical screening and investigation of the effect of Alhagi maurorum (camel thorn) on carbon tetrachloride, acetaminophen and Adriamycin induced toxicity in experimental animals. Journal of Scientific and Innovative Research. 2 (6): 1023-1033.
Abdellatif AG, Gargoum HM, Debani AA, Bengleil M, Alshalmani S, El Zuki N, El Fitouri O (2014) Camel thorn has hepatoprotective activity against carbon tetrachloride or acetaminophen induced hepatotoxicity, but enhances the cardiac toxicity of adriamycin in rodents. International Journal of Medical, Pharmaceutical Science and Engineering. 8 (2): 118-122. doi: 10.5281/zenodo.1091538.
Sulaiman GM (2013) Antimicrobial and cytotoxic activities of methanol extract of Alhagi maurorum. African Journal of Microbiology Research. 7 (16): 1548-1557. doi.org/10.5897/AJMR12.1795.
Maddrey WC (2000) Hepatitis B: an important public health issue. Medical Virology. 61 (3): 362-366. doi.org/10.1002/1096-9071(200007).
Kgatle MM (2017) Recent advancement in hepatitis B virus, epigenetics alterations and related complications: In advances in treatment of hepatitis C and B: Edited Allam N. 1103. doi: 10.5772/66879.
Tabak F, Yurdaydın C, Kaymakoğlu S, Akarsu M, Akıncı EG, Akkız H, Alkım C, Çekin AH, Cuvalci NO, Demir K, Değertekin B, Dökmetaş I, Ersöz G, Hizel K, Kandemir FO, Önlen Y, Sonsuz A, Şenateş E, Tosun S, Tozun N, Idilman R (2017) Diagnosis, management and treatment of hepatitis B virus infection: Turkey 2017 Clinical Practice Guidelines. Turkish Journal of Gastroenterology. 28 (2): 73-83. doi: 10.5152/tjg.2017.19.
European Association for the study of liver (2012) EASL clinical practice guidelines: management of chronic hepatitis B virus infection. Journal of Hepatology. 57 (1): 167-185. doi: 10.1016/j.jhep.2012.02.010.
Keeffe EB, Dieterich DT, Han SH, Jacobson IM, Martin P, Schiff ER, Tobias H (2008) A treatment algorithm for the management of chronic hepatitis B virus ınfection in the United States: 2008 Update. Clinical Gastroenterology and Hepatology. 6 (12): 1315-1341. doi: 10.1016/j.cgh.2008.08.021.
Gargum H, Al Zoki A, El-Barassi IF, Muftah SS, El Shaari F, Jumma M, Elzagheid A, Abdullatif A (2013) Investigation on the acute and sub-acute toxicity of alhagi graecorum in experimental animals. International Journal of Applied Biology and Pharmaceutical Technology. 4 (3): 202-209.
Talke H Schubert GE (1965) Enzymatic che Harnstoffbestimmung im Blut und serum im optischen test nach Warburg. Klin Wschr. 43: 174-175.
Heinegard D, Tiderstrom G (1973) Determination of serum creatinine by a direct colorimetric method. International Journal of Clinical Chemistry. 43 (3): 305-310. doi: 10.1016/0009-8981(73)90466-x.
Kadis AH, Little RL, Sternberg JC (1968) A new and rapid method for the determination of glucose by measurement of oxygen consumption. Clinical Chemistry. 14 (2): 116-131. doi: 10.1093/CLINCHEM/14.2.116.
Parviainen MT (1997) A modification of the acid diazo coupling method (Malloy-Evelyn) for the determination of serum total bilirubin. Scandinavian Journal of Clinical and Laboratory Investigation. 57 (3): 275-279. doi: 10.3109/00365519709060037.
Bergmeyer HU, Herder M, Rej R (1986) Approved recommendation 1985 on IFCC method for measurement of catalytic concentration of enzyme. Part 2. (IFCC method for aspartate aminotransferase, EC 2.6.1.1). Journal of Clinical Chemistry and Clinical Biochemistry. 24: 481- 495.
Tietz NW, Burtis CA, Duncan P, Ervin K, Petitclerc CJ, Rinker AD, Shuey D, Zygowicz ER (1983) A reference method for measurement of alkaline phosphatase activity in human serum. Clinical Chemistry. 29 (5): 751-756. PMID: 6404566.
Tietz NW (1987) Fundamentals of Clinical Chemistry. WB Saunders Co. Philadelphia, ISBN 13: 9780721688626.
Wojciki J, Samochowiec L (1983) Experimental model of hyperlipidemia in rats. Polish Journal of Pharmacology and Pharmacy. 35 (6): 436-443. PMID: 6677893.
European association for the study of the liver (2012) EASL clinical practice guidelines: management of chronic hepatitis B virus infection. Journal of Hepatology. 57 (1): 167-185. doi: 10.1016/j.jhep.2012.02.010.
Lok AS, McMahon BJ (2009) Chronic hepatitis B: update 2009. Hepatology. 50 (3): 661-662. doi: 10.1002/hep.23190.
Mouzannar K, Liang TJ (2020) Hepatitis B virus - recent therapeutic advances and challenges to cure. Journal of Hepatology. 73: 694-695. doi: org/10.1016/j.jhep.2020.04.015.
World Health Organization (2017) WHO Global hepatitis report, 2017. ISBN: 978-92-4-156545-5.
Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, Abu-Raddad LJ, Assadi R, Bhala N, Cowie B, Forouzanfour MH, Groeger J, Hanafiah KM, Jacobsen KH, James SL, MacLachlan J, Malekzadeh R, Martin NK, Mokdad AA, Mokdad AH, Murray CJL, Plass D, Rana S, Rein DB, Richardus JH, Sanabria J, Saylan M, Shahraz S, So S, Vlassov VV, Weiderpass E, Wiersma ST, Younis M, Chuanhua Yu, Zaki ME, Cooke GS Stanaway JD, Flaxman AD, Naghavi M, et al. (2016) The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 388 (10049): 1081-1088. doi: 10.1016/S0140-6736(16)30579-7.
Zoulim F (2005) New insight on hepatitis B virus persistence from the study of intrahepatic viral cccDNA. Journal of Hepatology. 42 (3): 302-308. doi: 10.1016/j.jhep.2004.12.015.
Urban S, Schulze A, Dandri, M, Petersen J (2010) The replication cycle of hepatitis B virus. Journal of Hepatology. 52 (2): 282-284. doi: 10.1016/j.jhep.2009.10.031.
Yang W., Summers J (1999). Integration of hepadnavirus DNA in the infected liver: evidence for a linear precursor. Journal of Virology, vol. 73, no. 12, pp. 9710-9717. doi: 10.1128/jvi.73.12.9710-9717.1999
Bertoletti A, Gehring AJ (2006) The immune response during hepatitis B virus infection. Journal of General Virology. 87 (Pt 6): 1439-1449. doi: 10.1099/vir.0.81920-0.
World Health organization (2022) Hepatitis B in the WHO European Region - fact sheet July 2022.
Wilkins T, Sams R, Carpenter M (2019) Hepatitis B: screening, prevention, diagnosis, and treatment. American Family Physician. 99 (5): 314-323. PMID: 30811163.
Grossi G, Vigano M, Loglio A, Lampertico P (2017) Hepatitis B virus long-term impact of antiviral therapy nucleot(s)ide analogues (NUCs). Liver International. 37 (suppl 1): 45-51. doi: 10.1111/liv.13291.
Sadiea RZ, Sultana S, Chaki BM, Islam T, Dash S, Akter S, Islam MS, Kazi T, Nagata A, Spagnuolo R, Mancina RM, Hossain MG (2022) Phytomedicines to target hepatitis B virus DNA replication: current limitations and future approaches. International Journal of Molecular Sciences. 23 (3): 1617-1640. doi: 10.3390/ijms23031617.
Cai J, Fan X, Mou L, Gao B, Liu X, Li J, Liu L, Wang H, Guo Z, Liu X, Li H, Li X, Li X (2012) Association of reduced renal function with hepatitis B virus infection and elevated alanine aminotransferase. Clinical Journal of American Society of Nephrology. 7 (10): 1561-1566. doi: 10.2215/CJN.07410711.
Deray G, Buti M, Gane E, Jia J, Chan HLY, Craxi A, Piratvisuth T, Pol S (2015) Hepatitis B virus infection and the kidney: renal abnormalities in hbv patients, antiviral drugs handling, and specific follow-up. Advances in Hepatology. (2): 1-11. doi.org/10.1155/2015/596829.
Antonelli A, Ferri C, Pampana A, Fallahi P, Nesti , Pasquini M, Marchi S, Ferrannini E (2004) Thyroid disorders in chronic hepatitis C. The American Journal of Medicine. 117 (1): 10-13. doi: 10.1016/j.amjmed.2004.01.023.
Antonelli A, Ferri C, Fallahi P, Ferrari SM, Ghinoi A, Rotondi M, Ferrannini E (2006) Thyroid disorders in chronic hepatitis C virus infection. Thyroid. 16 (6): 563-572. doi: 10.1089/thy.2006.16.563.
Borzio M, Caldara R, Borzio F, Piepoli V, Rampini P, Ferrari C (1983) Thyroid function tests in chronic liver disease: evidence for multiple abnormalities despite clinical euthyroidism. Gut. 24 (7): 631-636. doi: 10.1136/gut.24.7.631.
Oren R, Sikuler E, Wong F, Blendis LM, Halpern Z (2000) The effects of hypothyroidism on liver status of cirrhotic patients. Journal of Clinical Gastroenterology. 31 (2): 162-163. doi: 10.1097/00004836-200009000-00016.
Malik R, Hodgson H (2002) The relation between the thyroid gland and liver. Quarterly Journal of Medicine. 95 (9): 559-569. doi: 10.1093/qjmed/95.9.559.
Kayacetin E, Kisakol G, Kya A (2003) Low serum total thyroxine and free triiodothronine in patients with hepatic encephalopathy due to non-alcoholic cirrhosis. Swiss Medical Weekly. 5: 210-213. PMID: 12811678.
Sohail1 S, Mustafa MI, Mohammad, Shaheen A, Ali QM, Tariq MS (2020) Dyslipidemia and mean lipid profile in patients with liver cirrhosis. International Journal of Research
