Coadministration of silymarin with iron chelators in transfusion-dependent β-thalassemia patients: a systematic review and meta-analysis for effect on iron overload

References

• Origa R. β-Thalassemia. Genetics in medicine: official journal of the American college of medical genetics. β-Thalassemia. Genet Med.2017;19(6):609–619. Epub 2016/ 11/05.
   Google Scholar
• Cao A, Galanello R. Beta-thalassemia. Genetics in medicine: official journal of the American college of medical genetics. β-Thalassemia. Genet Med. 2010;12(2):61–76. Epub 2010/ 01/26.
   Google Scholar
• Muncie JHL, Campbell JS. Alpha and beta thalassemia. Am Fam Physician. 2009;80(4):339–344.
   PubMed Web of Science ®Google Scholar
• De Sanctis V, Kattamis C, Canatan D, et al. β-Thalassemia distribution in the old world: an ancient disease seen from a historical standpoint. Mediterr J Hematol Infect Dis. 2017;9(1):e2017018. Epub 2017/ 03/16.
   PubMed Web of Science ®Google Scholar
• Kattamis A, Forni GL, Aydinok Y, et al. Changing patterns in the epidemiology of β-thalassemia. Eur J Haematol. 2020;105(6):692–703.
   PubMed Web of Science ®Google Scholar
• Lee HJ, Shin KH, Kim HH, et al. Increased prevalence of Thalassemia in young people in Korea: impact of increasing immigration. Ann Lab Med. 2019;39(2):133–140. Epub 2018/ 11/16.
   PubMed Web of Science ®Google Scholar
• Williams TN, Weatherall DJ. World distribution, population genetics, and health burden of the hemoglobinopathies. Cold Spring Harb Perspect Med. 2012;2(9):a011692–a.
   PubMed Web of Science ®Google Scholar
• Nienhuis AW, Nathan DG. Pathophysiology and clinical manifestations of the β-Thalassemias. Cold Spring Harb Perspect Med. 2012;2(12):a011726. Epub 2012/ 12/05.
   PubMed Web of Science ®Google Scholar
• Taher AT, Saliba AN. Iron overload in thalassemia: different organs at different rates. Hematol Am Soc Hematol Educ Program. 2017;2017(1):265–271. Epub 2017/ 12/10.
   PubMedGoogle Scholar
• Yanpanitch OU, Hatairaktham S, Charoensakdi R, et al. Treatment of β-Thalassemia/Hemoglobin E with antioxidant cocktails results in decreased oxidative stress, increased hemoglobin concentration, and improvement of the hypercoagulable state. Oxid Med Cell Longev. Epub 2015/ 06/17 2015;2015: 537954.
   PubMed Web of Science ®Google Scholar
• Elalfy MS, Adly AA, Attia AA, et al. Effect of antioxidant therapy on hepatic fibrosis and liver iron concentrations in β-thalassemia major patients. Hemoglobin. 2013;37(3):257–276. Epub 2013/ 04/10.
   PubMed Web of Science ®Google Scholar
• Crisponi G, Nurchi VM, Lachowicz JI. Iron chelation for iron overload in Thalassemia. Met Ions Life Sci. 2019;19:49-86 ( Epub 2019/ 03/12).
   Google Scholar
• Brissot P, Ropert M, Le Lan C, et al. Non-transferrin bound iron: a key role in iron overload and iron toxicity. Biochim Biophys Acta. 2012;1820(3):403–410. Epub 2011/ 08/23.
   PubMed Web of Science ®Google Scholar
• Mokhtar GM, Gadallah M, NHK ES, et al. Morbidities and mortality in transfusion-dependent Beta-thalassemia patients (single-center experience). Pediatr Hematol Oncol. 2013;30(2):93–103.
   PubMed Web of Science ®Google Scholar
• Berdoukas V, Farmaki K, Carson S, et al. Treating thalassemia major-related iron overload: the role of deferiprone. J Blood Med. Epub 2012/ 10/19 2012;3: 119–129.
   PubMedGoogle Scholar
• 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. Epub 2004/ 10/13.
   PubMed Web of Science ®Google Scholar
• Pepe A, Meloni A, Rossi G, et al. Prediction of cardiac complications for thalassemia major in the widespread cardiac magnetic resonance era: a prospective multicentre study by a multi-parametric approach. European Heart Journal-Cardiovascular Imaging. 2018;19(3):299–309.
   PubMed Web of Science ®Google Scholar
• Pepe A, Pistoia L, Gamberini MR, et al. The close link of pancreatic iron with glucose metabolism and with cardiac complications in Thalassemia major: a large, multicenter observational study. Diabetes Care. 2020;43(11):2830–2839.
   PubMed Web of Science ®Google Scholar
• Loizzo MR, Tundis R, Menichini F, et al. Chelating, antioxidant and hypoglycaemic potential of muscari comosum (L.) Mill. bulb extracts. International journal of food sciences and nutrition. 2010;61(8):780–791.
   PubMed Web of Science ®Google Scholar
• Ebrahimzadeh MA, Nabavi S, Nabavi S. Correlation between the in vitro iron chelating activity and poly phenol and flavonoid contents of some medicinal plants. Pakistan journal of biological sciences. 2009;12(12):934.
   PubMedGoogle Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• MacDonald-Ramos K, Michán L, Martínez-Ibarra A, et al. Silymarin is an ally against insulin resistance: a review. Ann Hepatol. Epub 2020/ 09/21 2020;23: 100255.
   PubMed Web of Science ®Google Scholar
• Marková I, Malínská H, Hüttl M, et al. The combination of atorvastatin with silymarin enhances hypolipidemic, antioxidant and anti-inflammatory effects in a rat model of metabolic syndrome. Physiol Res. 2021;70(1):33–43. Epub 2021/ 01/18.
   PubMed Web of Science ®Google Scholar
• Meng S, Yang F, Wang Y, et al. Silymarin ameliorates diabetic cardiomyopathy via inhibiting TGF-β1/Smad signaling. Cell Biol Int. 2019;43(1):65–72. Epub 2018/ 11/30.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Gharagozloo M, Khoshdel Z, Amirghofran Z. The effect of an iron (III) chelator, silybin, on the proliferation and cell cycle of Jurkat cells: a comparison with desferrioxamine. Eur J Pharmacol. 2008;589(1–3):1–7.
   PubMed Web of Science ®Google Scholar
• Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160.
   Google Scholar
• Sirlin CB, Reeder SB. Magnetic resonance imaging quantification of liver iron. Magnetic Resonance Imaging Clinics. 2010;18(3):359–381.
   PubMed Web of Science ®Google Scholar
• Higgins JP, Altman DG, Gøtzsche PC, et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011;343(oct18 2):d5928.
   PubMed Web of Science ®Google Scholar
• Schunemann H, Jan B, Gordon G, et al. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Available at: https://gdtgradeproorg/app/handbook/handbookhtml Accessed, Jun 2021. 2013.
   Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Adibi A, Azin S, Behjat S. Therapeutic effects of deferoxamine and silymarin versus deferoxamine alone in β-thalassemia major based on findings of liver MRI. J Res Med Sci. 2012;1:73–78.
   Google Scholar
• Hagag AA, Elfrargy MS, Gazar RA, et al. Therapeutic value of combined therapy with deferasirox and silymarin on iron overload in children with beta thalassemia. Mediterr J Hematol Infect Dis. 2013;5(1):e2013065.
   PubMedGoogle Scholar
• Gharagozloo M, Karimi M, Amirghofran Z. Immunomodulatory effects of silymarin in patients with β-thalassemia major. Int Immunopharmacol. 2013;16(2):243–247.
   PubMed Web of Science ®Google Scholar
• Balouchi S, Gharagozloo M, Esmaeil N, et al. Serum levels of TGFβ, IL-10, IL-17, and IL-23 cytokines in β-thalassemia major patients: the impact of silymarin therapy. Immunopharmacol Immunotoxicol. 2014;36(4):271–274.
   PubMed Web of Science ®Google Scholar
• HagagAA, Elfaragy MS, Elrifaey SM, et al. Therapeutic value of combined therapy with deferiprone and Silymarin as iron chelators in Egyptian children with beta Thalassemia major. Infectious Disorders-Drug Targets (Formerly Current Drug Targets-Infectious Disorders). 2015;153:189–195.
   PubMedGoogle Scholar
• Darvishi‐Khezri H, Salehifar E, Kosaryan M, et al. Iron‐chelating effect of silymarin in patients with β‐thalassemia major: a crossover randomised control trial. Phytother Res. 2018;32(3):496–503.
   PubMed Web of Science ®Google Scholar
• Hamed EM, Meabed MH, Hussein RR, et al. Recent insight on improving the iron chelation efficacy of deferasirox by adjuvant therapy in transfusion dependent beta thalassemia children with sluggish response. Expert Opin Drug Metab Toxicol. 2020;16(3):179–193.
   PubMed Web of Science ®Google Scholar
• Taher AT, Musallam KM, Cappellini MD, et al. Optimal management of β thalassaemia intermedia. Br J Haematol. 2011;152(5):512–523.
   PubMed Web of Science ®Google Scholar
• Taher A, Hershko C, Cappellini MD. Iron overload in thalassaemia intermedia: reassessment of iron chelation strategies. Br J Haematol. 2009;147(5):634–640.
   PubMed Web of Science ®Google Scholar
• Musallam KM, Cappellini MD, Wood JC, et al. Elevated liver iron concentration is a marker of increased morbidity in patients with β thalassemia intermedia. haematologica. 2011;96(11):1605.
   PubMed Web of Science ®Google Scholar
• Borsari M, Gabbi C, Ghelfi F, et al. Silybin, a new iron-chelating agent. J Inorg Biochem. 2001;85(2–3):123–129.
   PubMed Web of Science ®Google Scholar
• Hagag AA, Elfatah M. Therapeutic value of silymarin as iron chelator in children with beta thalassemia with iron overload. J Leuk. 2014;2(1):2–6.
   Google Scholar
• Hajji HE, Nkhili E, Tomao V, et al. Interactions of quercetin with iron and copper ions: complexation and autoxidation. Free Radic Res. 2006;40(3):303–320.
   PubMed Web of Science ®Google Scholar
• Dayani PN, Bishop MC, Black K, et al. Desferoxamine (DFO)–mediated iron chelation: rationale for a novel approach to therapy for brain cancer. J Neurooncol. 2004;67(3):367–377.
   PubMed Web of Science ®Google Scholar
• Wu W, Wang Y, Que L. Enhanced bioavailability of silymarin by self-microemulsifying drug delivery system. Eur J Pharm Biopharm. 2006;63(3):288–294.
   PubMed Web of Science ®Google Scholar
• Fraschini F, Demartini G, Esposti D. Pharmacology of silymarin. Clin Drug Investig. 2002;22(1):51–65.
   Web of Science ®Google Scholar