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Silymarin As Antifibrotic

Silymarin As Antifibrotic. Amany A.Maqsod Sholkamy Professor of Internal Medicine &Hepatology Faculty of Medicine Cairo University Consultant Liver Transplantation Kasr AlAiny H Supervisor of the Liver ICU French H Cairo University. Silybum Marianum. Actions:.

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Silymarin As Antifibrotic

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  1. Silymarin As Antifibrotic Amany A.MaqsodSholkamy Professor of Internal Medicine &Hepatology Faculty of Medicine Cairo University Consultant Liver Transplantation Kasr AlAiny H Supervisor of the Liver ICU French H Cairo University

  2. SilybumMarianum

  3. Actions: • Antioxidants, and regulators of intracellular content of glutathione. • Inhibitors of stellate hepatocyte transformation into myofibroblasts. • Cell membrane stabilizers.

  4. Limitations: • Studies suggest that the presence of liver damage, particularly as chronic inflammation, may affect the bioavailability of the different forms of silymarin.

  5. Antifibrotic: • Many experimental studies showed a significant antifibrotic effect of silymarin. • No large scale clinical trials addressing specifically the effect of silymarin compounds on liver fibrosis in human.

  6. Antifibrotic: • The available studies lack dose/substance standardization, tissue assessment(fibrosis scores) and long term follow up.

  7. Antioxidant: • Available data suggest a hepatoprotective effect through many mechanisms mainly as an antioxidant affecting inflammatory pathways and stellate cell activation.

  8. In cirrhosis: • Through the (HALT-C) study, observation of cirrhotic patients (1049 pts) taking silymarin revealed an inverse relation between its use and progression of the disease but no effect on clinical outcome. • That was an observational study. No standard dose or duration of use of the drug

  9. In NAFLD: • Again studies lack tissue assessment of fibrosis progression. • Many studies revealed a beneficial effect on parameters such as GGT, markers of steatosis and fibrosis. • Others were biased by the associated dietary restrictions included in the study design.

  10. In chronic viral diseases: • Studies involving patients with chronic HCV showed conflicting and contradictory results raising the need for further larger scale studies. • One of the drawbacks of many studies is the lack of standard type/dose of silymarin form used.

  11. In the transplant setting: • Two case reports indicated that therapy with intravenous silibinin successfully eradicated the virus after transplantation. • Still, further larger scale studies are needed to consider the drug as a specific antifibrotic treatment.

  12. Consensus: • Oral and IV silymarin and its extracts have a hepatoprotective effect and may have a role as an adjuvant treatment in chronic liver diseases. (1A)

  13. Consensus: • The exact dose of these products to be used in different liver diseases is not yet identified. (2C) • The use of silymarin or its extracts as a primary antifibrotic therapy is still waiting evidence.(2C)

  14. Consensus: • Silymarin and its extract Silybin(silibinin) have minimal side effects even in high doses.(1B) Their use in the transplant setting showed minimal drug-drug interactions with the immunsupressive drugs.(2C)

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