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Case Reports
. 2002 Sep;55(9):676-9.
doi: 10.1136/jcp.55.9.676.

Hepatic veno-occlusive disease as a result of a traditional remedy: confirmation of toxic pyrrolizidine alkaloids as the cause, using an in vitro technique

M Zuckerman  1 , V Steenkamp, M J Stewart
Affiliations
Case Reports

Hepatic veno-occlusive disease as a result of a traditional remedy: confirmation of toxic pyrrolizidine alkaloids as the cause, using an in vitro technique

M Zuckerman et al. J Clin Pathol. 2002 Sep.

Abstract

Background/aims: A child presented with hepatic veno-occlusive disease after having been administered a short course of treatment with a traditional herbal remedy. The child subsequently died. Postmortem liver histology confirmed the diagnosis. This study aimed to investigate the hypothesis that the herbal remedy was the cause of veno-occlusive disease.

Methods: Extracts of the traditional remedy were analysed by colorimetry and gas chromatography/mass spectrometry. Cultured hepatocytes were treated with an extract of the plant material and examined for morphological changes.

Results: The screening analyses indicated the presence of toxic pyrrolizidine alkaloids, which were later confirmed by gas chromatography/mass spectrometry. The cell studies indicated dose related toxicity, with necrosis at high concentrations and apoptosis and abnormalities of the cytoskeleton at lower concentrations.

Conclusions: The simple screening techniques used allowed rapid confirmation of the presence of toxic pyrrolizidines in the remedy. The in vitro method confirmed the toxicity of herbal extracts to hepatocytes.

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Figures

Figure 1
Figure 1
The traditional remedy (muti).
Figure 2
Figure 2
Cell studies. (A) Control cells showing normal cell morphology; (B) cells treated with muti, showing necrosis; both haematoxylin and eosin stain (original magnification, ×400). (C) Control cells showing even distribution of β tubulin in the cytoplasm; (D) treated cells showing severe destruction of β tubulin with “naked nuclei”; both indirect immunofluorescence for β tubulin (original magnification, ×1000). (E) Control cells including a normal dividing cell; (F) treated cells showing apoptotic bodies; DAPI stain (original magnification, ×1000). (G) Control cells with even distribution of two or three nucleoli for each cell; (H) treated cells showing cells with multiple segregated nucleoli; indirect immunofluorescence for antinuclear antibody (original magnification, ×800).
See this image and copyright information in PMC

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