Abstract:

Polygonum multiflorum Thunb. (PM), called Heshouwu in China, is a popular Chinese medicine in clinical practice. Several clinical studies have been conducted to evaluate the traditional therapeutic claims and to study the potential therapeutic activity of PM in dyslipidemia and neurodegenerative diseases, highlighting available clinical evidence. In recent years, reports on clinical adverse reactions of Raw Radix P. multiflorum (RPM) and P. multiflorum Praeparata (PMP) have been on the increase, especially with respect to liver injury. Most liver injury cases had been assessed for causality using RUCAM (Roussel Uclaf Causality Assessment Method) in this paper. However, the components of PM responsible for the reported hepatotoxic effects have not yet been identified. Moreover, many of the reports are contradictory, while studies on the mechanism involved in PM-induced liver damage are not comprehensive. This study was aimed at reviewing the status of research on liver injury due to PM, including clinical characteristics, risk factors, material basis research and mechanism of action, with a view to understanding PM-induced hepatotoxicity, and taking reasonable and effective measures to prevent it. In short, quality control is still one of the major safety problems in TCM drug safety concerns. The model of safety monitoring and risk management of PM drugs is not yet developed. Indeed, the characteristics and risk factors associated with PM require both proper understanding and control of the risk by strengthening standardization of clinical applications, basic science research, quality control in manufacturing, active monitoring methodology and enhancement of international communication and cooperation. Measures should also be encouraged and implemented to promote healthy development of the TCM industry.

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<em>Polygonum multiflorum</em>-Induced Liver Injury: Clinical Characteristics, Risk Factors, Material Basis, Action Mechanism and Current Challenges

^{School of Chinese Materia Medica, Beijing University of Traditional Chinese Medicine, Beijing, China}

^{Research Institute of Chinese Medicine, Beijing University of Traditional Chinese Medicine, Beijing, China}

Edited by: Banasri Hazra, Jadavpur University, India

Reviewed by: Angel Treasa Alex, Manipal University, India; Rolf Teschke, Hospital Hanau, Germany

*Correspondence: Xiaoxv Dong, nc.ude.mcub@020108102; Xingbin Yin, moc.361@mctbxy; Jian Ni, ten.362@mctjn

This article was submitted to Ethnopharmacology, a section of the journal Frontiers in Pharmacology

Edited by: Banasri Hazra, Jadavpur University, India

Reviewed by: Angel Treasa Alex, Manipal University, India; Rolf Teschke, Hospital Hanau, Germany

Received 2019 Jul 22; Accepted 2019 Nov 13.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Abstract

Polygonum multiflorum Thunb. (PM), called Heshouwu in China, is a popular Chinese medicine in clinical practice. Several clinical studies have been conducted to evaluate the traditional therapeutic claims and to study the potential therapeutic activity of PM in dyslipidemia and neurodegenerative diseases, highlighting available clinical evidence. In recent years, reports on clinical adverse reactions of Raw Radix P. multiflorum (RPM) and P. multiflorum Praeparata (PMP) have been on the increase, especially with respect to liver injury. Most liver injury cases had been assessed for causality using RUCAM (Roussel Uclaf Causality Assessment Method) in this paper. However, the components of PM responsible for the reported hepatotoxic effects have not yet been identified. Moreover, many of the reports are contradictory, while studies on the mechanism involved in PM-induced liver damage are not comprehensive. This study was aimed at reviewing the status of research on liver injury due to PM, including clinical characteristics, risk factors, material basis research and mechanism of action, with a view to understanding PM-induced hepatotoxicity, and taking reasonable and effective measures to prevent it. In short, quality control is still one of the major safety problems in TCM drug safety concerns. The model of safety monitoring and risk management of PM drugs is not yet developed. Indeed, the characteristics and risk factors associated with PM require both proper understanding and control of the risk by strengthening standardization of clinical applications, basic science research, quality control in manufacturing, active monitoring methodology and enhancement of international communication and cooperation. Measures should also be encouraged and implemented to promote healthy development of the TCM industry.

Keywords: Polygonum multiflorum Thunb., liver injury, safety evaluation, clinical characteristics, material basis, action mechanism, current challenges

Abstract

Acknowledgments

At the point of finishing this paper, YL and other authors would like to express their sincere thanks to all those who have lent hands in the course of the writing of this paper. YL would like to take this opportunity to express their sincere gratitude to their supervisor, Professor Ni, who has provided much writing advice and suggestions for improvement. YL would further like to express their gratitude to reviewers and editors who offered references and information along the way.

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