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Hemoglobin
international journal for hemoglobin research
Volume 39, 2015 - Issue 2
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Review Article

Evaluating the Safety and Efficacy of Silymarin in β-Thalassemia Patients: A Review

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Pages 75-80 | Received 10 Apr 2014, Accepted 30 Jul 2014, Published online: 03 Feb 2015

References

  • Gupta K, Mishra A, Tiwari A. Production of reactive oxygen species, its effect, drugs and plant extract used as an antioxidant, chelator on thalassemic patients: A review. Int J Pharm Sci Res. 2011;2(9):2278–2285
  • Borgna-Pignatti C, Rugolotto S, De Stefano P, et al. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica. 2004;89(10):1187–1193
  • Yasser W, Azza AS, Shabina D. Agranulocyosis in β thalassemia major patient treated with oral iron chelating agent. Oman Med J. 2008;23(4):275–277
  • Origa R, Bina P, Agus A, et al. Combined therapy with deferiprone and desferrioxamine in thalassemia major. Haematologica. 2005;90(10):1309–1314
  • Neufeld EJ. Oral chelators deferasirox and deferiprone for transfusional iron overload in thalassemia major: New data, new questions. Blood. 2006;107(9):3436–3441
  • Ebrahimzadeh MA, Pourmorad F, Bekhradnia AR. Iron chelating activity, phenol and flavonoid content of some medicinal plants from Iran. Afr J Biotechnol. 2008;7(18):3188–3192
  • Dixit N, Baboota S, Kohli K, et al. Silymarin: A review of pharmacological aspects and bioavailability enhancement approaches. Indian J Pharmacol. 2007;39(4):172–179 (http://www.ijp-online.com/text.asp?2007/39/4/172/35534)
  • Féher J, Lengyel G. Silymarin in the prevention and treatment of liver diseases and primary liver cancer. Curr Pharm Biotechnol. 2012;13(1):210–217
  • Gazak R, Walterova D, Kren V. Silybin and silymarin – new and emerging applications in medicine. Curr Med Chem. 2007;14(3):315–338
  • Moayedi B, Gharagozloo M, Esmaeil N, et al. A randomized double-blind, placebo-controlled study of therapeutic effects of silymarin in β-thalassemia major patients receiving desferrioxamine. Eur J Haematol. 2013;90(3):202–209
  • Rashidi M, Aboomardani M, Rafraf M, et al. Effects of vitamin E and zinc supplementation on antioxidants in β thalassemia major patients. Iranian J Pediatr. 2011;21(1):8–14
  • Ghone RA, Kumbar KM, Suryakar AN, et al. Oxidative stress and disturbance in antioxidant balance in β thalassemia major. Indian J Clin Biochem. 2008;23(4):337–340
  • Bhagat SS, Sarkar PD, Suryakar AN, et al. Special effects of oral therapeutic suplimentation of antioxidants on attenuation of iron overload in hemozygous β thalassemia. Int J Health Sci Res. 2012;2(5):36–41
  • Kushner JP, Porter JP, Olivieri NF. Secondary iron overload. Hematology Am Soc Hematol Educ Program. 2001:47–61
  • Tanno T, Bhanu NV, Oneal PA, et al. High levels of GDF15 in thalassemia suppress expression of the iron regulatory protein hepcidin. Nat Med. 2007;13(9):1096–1101
  • Nemeth E, Tuttle MS, Powelson J, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science. 2004;306(5704):2090–2093
  • Şimşek F, Öztürk G, Kemahlı S, et al. Oxidant and antioxidant status in β thalassemia major patients. J Ankara Univ Fac Med. 2005;58(1):34–38 (http://dergiler.ankara.edu.tr.eng/)
  • Prus E, Fibach E. The labile iron pool in human erythroid cells. Br J Haematol. 2008;142(2):301–307
  • Shazia Q, Mohammad ZH, Rahman T, Shekhar HU. Correlation of oxidative stress with serum trace element levels and antioxidant enzyme status in β thalassemia major patients: A review of the literature. Anemia. 2012;2012:270923. doi: 10.11552012/270923
  • Benz EJ Jr. Disorders of hemoglobin. In: Longo D, Fauci A, Kasper D, et al., Eds. Harrison’s Principles of Internal Medicine, 18th ed. New York, NY: McGraw Hill Professional. 2011:852–861
  • Rao PR, Viswanath RK. Cardioprotective activity of silymarin in ischemia-reperfusion-induced myocardial infarction in albino rats. Exp Clin Cardiol. 2007;12(4):179–187
  • Consolini R, Calleri A, Legitimo A, Massei F. Immunological evaluation of patients with β-thalassemia major. Acta Haematol. 2001;105(1):7–12
  • Vento S, Cainelli F, Cesario F. Infections and thalassaemia. Lancet Infect Dis. 2006;6(4):226–233
  • Gharagozloo M, Karimi M, Amirghofran Z. Double–faced cell-mediated immunity in β-thalassemia major: Stimulated phenotype versus suppressed activity. Ann Hematol. 2009;88(1):21–27
  • Gharagozloo M, Bagherpour B, Tahanian M, et al. Premature senescence of T lymphocytes from patients with β-thalassemia major. Immunol Lett. 2009;122(1):84–88
  • Johnson VJ, He Q, Osuchowski MF, Sharma RP. Physiological responses of a natural antioxidant flavonoid mixture, silymarin, in BALB/c mice: III. Silymarin inhibits T-lymphocyte function at low doses but stimulates inflammatory processes at high doses. Planta Med. 2003;69(1):44–49
  • Gharagozloo M, Velardi E, Bruscoli S, et al. Silymarin suppress CD4+ T cell activation and proliferation: Effects on NF-κB activity and IL-2 production. Pharmacol Res. 2010;61(5):405–409
  • Alidoost F, Gharagozloo M, Bagherpour B, et al. Effects of silymarin on the proliferation and glutathione levels of peripheral blood mononuclear cells from β-thalassemia major patients. Int Immunopharmacol. 2006;6(8):1305–1310
  • Gharagozloo M, Karimi M, Amirghofran Z. Immunomodulatory effects of silymarin in patients with β-thalassemia major. Int Immunopharmacol. 2013;16(2):243–247
  • Bagherpour B, Gharagozloo M, Moayedi B. The influence of iron loading and iron chelation on the proliferation and telomerase activity of human peripheral blood mononuclear cells. Iranian J Immunol. 2009;6(1):33–39
  • Mayer KE, Myers RP, Lee SS. Silymarin treatment of viral hepatitis: A systematic review. J Viral Hepat. 2005;12(6):559–567
  • Morishima C, Shuhart MC, Wang CC, et al. Silymarin inhibits in vitro T-cell proliferation and cytokine production in hepatitis C virus infection. Gastroenterology. 2010;138(2):671–681, 681.e1–e2
  • Fried MW, Navarro VJ, Afdhal N, et al; Silymarin in NASH and C Hepatitis (SyNCH) Study Group. Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: A randomized controlled trial. JAMA. 2012;308(3):274–282
  • Barbero-Becerra VJ, Mendez-Sanchez N. Silybin/Silymarin treatment in chronic hepatitis C. Ann Hepatol. 2012;11(5):731–733
  • Ahmed–Belkacem A, Ahnou N, Barbotte L, et al. Silibinin and related compounds are direct inhibitors of hepatitis C virus RNA-dependent RNA polymerase. Gastroenterology. 2010;138(3):1112–1122
  • Kalantari H, Shahshahan Z, Hejazi SM, et al. Effects of silybum marianum on patients with chronic hepatitis C. J Res Med Sci. 2011;16(3):287–290
  • Esser-Nobis K, Romero-Brey I, Ganten TM, et al. Analysis of hepatitis C virus resistance to silibinin in vitro and in vivo points to a novel mechanism involving nonstructural protein 4B. Hepatology. 2013;57(3):953–963
  • Wei F, Liu SK, Liu XY, et al. Meta-analysis: Silymarin and its combination therapy for the treatment of chronic hepatitis B. Eur J Clin Microbiol Infect Dis. 2013;32(5):657–669
  • Perez-Victoria JM, Perez-Victoria FJ, Conseil G, et al. High-affinity binding of silybin derivatives to the nucleotide-binding domain of a Leishmania tropica P-glycoprotein-like transporter and chemosensitization of a multidrug-resistant parasite to daunomycin. Antimicrob Agents Chemother. 2001;45(2):439–446
  • Maser P, Vogel D, Schmid C, et al. Identification and characterization of trypanocides by functional expression of an adenosine transporter from Trypanosoma brucei in yeast. J Mol Med. 2001;79(2–3):121–127
  • Guz NR, Stermitz FR, Johnson JB, et al. Flavonolignan and flavone inhibitors of a Staphylococcus aureus multidrug resistance pump: Structure-activity relationships. J Med Chem. 2001;44(2):261–268
  • Lee YS, Jang KA, Cha JD. Synergistic antibacterial effect between silibinin and antibiotics in oral bacteria. J Biomed Biotechnol. 2012;2012:618081. doi: 10.11552012/618081
  • Pietrangelo A, Borella F, Casalgrandi G, et al. Antioxidant activity of silybin in vivo during long-term iron overload in rats. Gastroenterology. 1995;109(6):1941–1949
  • Shaker E, Mahmoud H, Mnaa S. Silymarin, the antioxidant component and Silybum marianum extracts prevent liver damage. Food Chem Toxicol. 2010;48(3):803–806
  • Saller R, Brignoli R, Melzer J, Meier R. An updated systematic review with meta-analysis for the clinical evidence of silymarin. Forsch Komplementmed. 2008;15(1):9–20
  • Nabavi SM, Nabavi SF, Moghaddam AH, et al. Effect of silymarin on sodium fluoride-induced toxicity and oxidative stress in rat cardiac tissues. An Acad Bras de Cienc. 2012;84(4):1121–1126
  • El-Awady el SE, Moustafa YM, Abo-Elmatty DM, Radwan A. Cisplatin-induced cardiotoxicity: Mechanisms and cardioprotective strategies. Eur J Pharmacol. 2011;650(1):335–341
  • Altaei T. Protective effect of silymarin during coronary artery bypass grafting surgery. Exp Clin Cardiol. 2012;17(1):34–38
  • Karimi M, Giti R, Haghpanah S, et al. Malignancies in patients with β-thalassemia major and β-thalassemia intermedia: A multicenter study in Iran. Pediatr Blood Cancer. 2009;53(6):1064–1067
  • Ramasamy K, Agarwal R. Multitargeted therapy of cancer by silymarin. Cancer Lett. 2008;269(2):352–362
  • Borsari M, Gabbi C, Ghelfi F, et al. Silybin, a new iron-chelating agent. J Inorg Biochem. 2001;85(2–3):123–129
  • Hutchinson C, Bomford A, Geissler CA. The iron-chelating potential of silybin in patients with hereditary haemochromatosis. Eur J Clin Nutr. 2010;64(10):1239–1241
  • Najafzadeh H, Jalali MR, Morovvati H, Taravati F. Comparison of the prophylactic effect of silymarin and deferoxamine on iron overload-induced hepatotoxicity in rat. J Med Toxicol. 2010;6(1):22–26
  • Razi Jalali M, Morovati H, Najafzade H, Jalali SM. Protective effects of silymarin and deferoxamine on iron over-load induced nephrotoxicity in rats. Biochem Cell Arch. 01.2009 2009;9(2):201–206 (http/www.researchgate.net/profie/Seyedeh_Missagh_Jalali/publications)
  • Nematbakhsh M, Pezeshki Z, Moaeidi BA, et al. Protective role comparison between silymarin and deferoxamine against iron dextran-induced renal iron deposition in male rats. Int J Prevent Med. 2013;4(3):286–292
  • Bares JM, Berger J, Nelson JE, et al. Silybin treatment is associated with reduction in serum ferritin in patients with chronic hepatitis C. J Clin Gastroenterol. 2008;42(8):937–944
  • Hagag AA, Elfrargy MS, Gazar RA, Abd El-Lateef AE. Therapeutic value of combined therapy with deferasirox and silymarin on iron overload in children with β thalassemia. Mediterr J Hematol Infect Dis. 2013;5(1):e2013065. doi: 10.4084/MJHID.2013.065. eCollection 2013
  • Gharagozloo M, Moayedi B, Zakerinia M, et al. Combined therapy of silymarin and desferrioxamine in patients with β–thalassemia major: A randomized double-blind clinical trial. Fundam Clin Pharmacol. 2009;23(3):359–365
  • Adibi A, Shayganfar A, Moayedi BS, et al. Therapeutic effects of deferoxamine and silymarin versus deferoxamine alone in v-thalassemia major based on findings of liver MRI. J Res Med Sci. 2012;17(1):73–78
  • Morel I, Lescoat G, Cogrel P, et al. Antioxidant and iron-chelating activities of the flavonoids catechin, quercetin and diosmetin on iron-loaded rat hepatocyte cultures. Biochem Pharmacol. 1993;45(1):13–19
  • Psotova J, Chlopcikova S, Grambal F, et al. Influence of silymarin and its flavonolignans on doxorubicin-iron induced lipid peroxidation in rat heart microsomes and mitochondria in comparison with quercetin. Phytother Res. 2002;16(Suppl 1):S63–S67
  • Harwood M, Danielewska-Nikiel B, Borzelleca JF, et al. A critical review of the data related to the safety of quercetin and lack of evidence of in vivo toxicity, including lack of genotoxic/carcinogenic properties. Food Chem Toxicol. 2007;45(11):2179–2205
  • Geetha T, Malhotra V, Chopra K, Kaur IP. Antimutagenic and antioxidant/prooxidant activity of quercetin. Indian J Exper Biol. 2005;43(1):61–67
  • Tamayo C, Diamond S. Review of clinical trials evaluating safety and efficacy of milk thistle (Silybum marianum [L.] Gaertn.). Integr Cancer Ther. 2007;6(2):146–157
  • Mulrow C, Lawrence V, Jacobs B, et al. Milk thistle: Effects on liver disease and cirrhosis and clinical adverse effects. Evid Rep Technol Assess (Summ). 2000;(21):1–3
  • Post-White J, Ladas EJ, Kelly KM. Advances in the use of milk thistle (Silybum marianum). Integr Cancer Ther. 2007;6(2):104–109
  • Keyler DE, Baker JI, Lee DY, et al. Toxicity study of an antidipsotropic Chinese herbal mixture in rats: NPI-028. J Alt Comp Med. 2002;8(2):175–183
  • Ding T, Tian S, Zhang Z, et al. Determination of active component in silymarin by RP-LC and LC/MS. J Pharma Biomed Anal. 2001;26(1):155–161
  • Barzaghi N, Crema F, Gatti G, et al. Pharmacokinetic studies on IdB 1016, a silybin-phosphatidylcholine complex, in healthy human subjects. Eur J Drug Metab Pharmacokinet. 1990;15(4):333–338
  • Skottová N, SVagera Z, Vecera R, et al. Pharmacokinetic study of iodine-labeled silibinins in rat. Pharmacol Res. 2001;44(3):247–253
  • Abrol S, Trehan A, Katare OP. Comparative study of different silymarin formulations: Formulation, characterisation and in vitro/in vivo evaluation. Curr Drug Deliv. 2005;2(1):45–51
  • Hsu WC, Ng LT, Wu TH, et al. Characteristics and antioxidant activities of silymarin nanoparticles. J Nanosci Nanotechnol. 2012;12(3):2022–2027
  • Mengs U, Pohl RT, Mitchell T. Legalon(R) SIL: The antidote of choice in patients with acute hepatotoxicity from amatoxin poisoning. Curr Pharma Biotechnol. 2012;13(10):1964–1970

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