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1
HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
(HookF) BAKER
BY
UGWUEZE MERCY EBERE
REGISTRATION NUMBER PGMPHARM0951630
DEPARTMENT OF PHARMACEUTICS
FACULTY OF PHARMACEUTICAL SCIENCES
UNIVERSITY OF NIGERIA
NSUKKA
NOVEMBER 2011
HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS (Hook F) BAKER
2
BY
UGWUEZE MERCY EBERE
REG NO PGMPHARM0951630
BEING A RESEARCH PROJECT UNDERTAKEN IN PARTIAL FULFILLMENT
OF THE REQUIREMENT FOR THE AWARD OF MASTERS OF PHARMACY
(M PHARM) DEGREE IN PHARMACEUTICS OF
THE UNIVERSITY OF NIGERIA
SUPERVISORS PROF A A ATTAMA AND DR K C OFOKANSI
DEPARTMENT OF PHARMACEUTICS
FACULTY OF PHARMACEUTICAL SCIENCES
UNIVERSITY OF NIGERIA
NSUKKA
NOVEMBER 2011
3
TABLE OF CONTENT
Title page-----------------------------------------------------------------------------------------------------------i
Certification page-------------------------------------------------------------------------------------------------ii
Dedication page---------------------------------------------------------------------------------------------------iii
Acknowledgement------------------------------------------------------------------------------------------------iv
List of figures------------------------------------------------------------------------------------------------------v
List of tables-------------------------------------------------------------------------------------------------------vi
Table of content--------------------------------------------------------------------------------------------------vii
Abstract------------------------------------------------------------------------------------------------------------x
CHAPTER ONE GENERAL INTRODUCTION
10 Introduction--------------------------------------------------------------------------------------1
11 Hepatotoxicity-----------------------------------------------------------------------------------3
12 Paracetamol--------------------------------------------------------------------------------------5
131 Toxicity-------------------------------------------------------------------------------------------6
132 Risk Factors--------------------------------------------------------------------------------------6
14 Carbon Tetrachloride----------------------------------------------------------------------------8
141 History and Synthesis---------------------------------------------------------------------------8
142 Toxicity-------------------------------------------------------------------------------------------9
15 Liver Care---------------------------------------------------------------------------------------11
16 Phytochemical----------------------------------------------------------------------------------13
17 Acute Toxicity Studies------------------------------------------------------------------------14
18 Anatomy and Physiology of Liver-----------------------------------------------------------16
181 Anatomy of Liver------------------------------------------------------------------------------16
182 Blood Supply-----------------------------------------------------------------------------------17
183 Billary Flow-------------------------------------------------------------------------------------18
184 Physiology---------------------------------------------------------------------------------------19
4
185 Other Functions---------------------------------------------------------------------------------
19
19 Liver Disease------------------------------------------------------------------------------------20
191 Liver Disease types---------------------------------------------------------------------------- 21
192 Common Liver Problems--------------------------------------------------------------------- 21
1921 Hepatitis -----------------------------------------------------------------------------------------21
1922 Cirrhosis-----------------------------------------------------------------------------------------21
1923 Fatty Liver Disease---------------------------------------------------------------------------- 21
1924 Liver Cancer------------------------------------------------------------------------------------ 22
1925 Enlarged Liver----------------------------------------------------------------------------------22
1926 Liver Cysts--------------------------------------------------------------------------------------22
1927 Wilson‟s Disease-------------------------------------------------------------------------------22
1928 Hemochromatosis------------------------------------------------------------------------------22
1929 Primary Sclerosing Cholangitis or PSC-----------------------------------------------------22
19210 Autoimmune Hepatitis------------------------------------------------------------------------ 22
110 Cirrohsis-----------------------------------------------------------------------------------------23
1101 Signs and Symptoms-------------------------------------------------------------------------- 23
1102 Complications---------------------------------------------------------------------------------- 25
1103 Causes------------------------------------------------------------------------------------------- 26
1104 Liver Function Tests-------------------------------------------------------------------------- 29
111 Hepatitis-----------------------------------------------------------------------------------------30
1111 Signs and Symptoms-------------------------------------------------------------------------- 31
1112 Alcoholic Hepatitis-----------------------------------------------------------------------------34
112 Millettia aboensis------------------------------------------------------------------------------ 35
1121 Taxonomy---------------------------------------------------------------------------------------35
1122 Nature and Occurrence----------------------------------------------------------------------36
1123 Uses of Plant--------------------------------------------------------------------------------- 36
5
1124 Medicinal Plants Used in Liver Disease-------------------------------------------------- 37
113 Aims of the Study---------------------------------------------------------------------------- 37
CHAPTER TWO Materials And Methods--------------------------------------------------------------- 38
21 Plant Material--------------------------------------------------------------------------------- 38
22 Experimental Animals------------------------------------------------------------------------ 39
23 Chemicals--------------------------------------------------------------------------------------- 39
24 Methods------------------------------------------------------------------------------------------39
241 Collection of Animals------------------------------------------------------------------------- 39
242 Collection and identification of plant material---------------------------------------------39
243 Extraction of plant material-------------------------------------------------------------------39
25 Phytochemicals analysis---------------------------------------------------------------------- 41
251 Tests for glycosides--------------------------------------------------------------------------- 41
252 Tests for alkaloids----------------------------------------------------------------------------- 41
253 Tests for reducing sugar---------------------------------------------------------------------- 41
2531 Molisch test------------------------------------------------------------------------------------- 41
254 Tests for tannins------------------------------------------------------------------------------- 42
2551 Ferric chloride test----------------------------------------------------------------------------- 42
256 Tests for saponin------------------------------------------------------------------------------ -42
2561 frotthing test----------------------------------------------------------------------------------- -42
257 Tests for flavonoids-------------------------------------------------------------------------- -42
2571 Ammonium test-------------------------------------------------------------------------------- 42
258 Tests for protein------------------------------------------------------------------------------- 42
2581 Million‟s test--------------------------------------------------------------------------------- --42
258 Tests for steroids and terpenoids-------------------------------------------------------- 43
259 Tests for fats and oil---------------------------------------------------------------------- 43
2510 Tests for carbohydrate-------------------------------------------------------------------- 43
2511 Tests for resins----------------------------------------------------------------------------- 43
6
25111 Precipitation test--------------------------------------------------------------------------- 43
2512 Tests for acidic compound--------------------------------------------------------------- 44
26 Acute toxicity determination------------------------------------------------------------- 45
261 Acute oral toxicity test-------------------------------------------------------------------- 45
27 Evaluation of hepatoprotective activity------------------------------------------------- 45
28 Statistical analysis-------------------------------------------------------------------------- 47
CHAPTER THREE RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical analysis------------------------------------------------------48
32 Acute oral toxicity study-------------------------------------------------------------------49
33 Carbon tetrachloride and paracetamol induced acute toxicity------------------------49
34 Liver enzyme analysis----------------------------------------------------------------------50
35 Discussion------------------------------------------------------------------------------------66
351 Phytochemical composition----------------------------------------------------------------66
352 Acute oral toxicity---------------------------------------------------------------------------66
353 Hepatoprotective effect of Millettia aboensis--------------------------------------------66
CHAPTER FOUR CONCLUSIONS-----------------------------------------------------------------------70
REFERENCES
7
CHAPTER ONE
GENERAL INTRODUCTION
11 INTRODUCTION
Many of us are under stress and stress affects the body in many ways We live in buildings with
little or no fresh air and we need to find ways of relieving the nervous system from the effects of this
stress Many of us suffer from lung problems We suffer from problems caused by drinking water
which has been polluted by steel mills and other industries We get all sorts of pollution in our food
as well Chemicals which did not even exist before the 1940s are contaminants We use fungicides
and pesticides on our soil and have very little control over what we eat except when we grow our
own produce organically All these affect our liver Our liver is the same organ we had as primitive
man and there is no evidence that the liver is able to handle man-made molecules As a result we
regularly invent new diseases It‟s therefore necessary we think what we can do to help the liver The
first thing we must do is clean up our environment In the meantime the herbs and the natural
medicinal plants are helpful
Historically plants have played an important role in medicine For early peoples they are used as
diet and for healing Through observation and experimentation they learnt which plants promoted
health and well-being
Over time the practice of herbal medicine has grown more complex Science has enabled us to
process natural substances into pills tinctures and powders However the development of a market
economy also has distanced consumers from the wild plants that are the source of medicines
All through history man has prepared medicine from herbs and plant extracts Records abound of
such practice even with caution of man In the biblical days the prophet Isaiah prescribed a hot
poultries of figs to heal king Hezekayas boil (2 kings 20) Today we find similar practices
widespread in various parts of the globe In Nigeria numerous plants are used widely by our
traditional healers for of diseases (12) Millettia aboensis extracts are used for liver diseases
8
constipation and sometimes combines with other plants‟ parts in preparation of medications for
veneral diseases The advantages of herbal medical therapy are numerous Herbal healing is natural
and cheap The herbs are found in our homes and environment Generally medicinal plants are
healing gift from nature since extracts from living plants which are organic in nature are used
Modern science has been able to prove that man and plant are closely linked the green
chlorophyll has a chemical structure almost identical to the heamoglobin which is the main
constituent of human blood Where chlorophyll has a molecule of magnesium in its structural
pattern hemoglobin carries a molecule of iron
With the ever increasing cost of orthodox health care services and with incidence of fake
drugs and side effect of modern drug therapies many patients seem to be more interested in the
alternative herbal health care which they feel is safer more accessible more economical and which
takes into consideration the people‟s socio-cultural values
In recent years with the help of many traditional herbalists and researchers it has been possible to
identify many of the medicinal plants
9
12 HEPATOTOXICITY
Hepatotoxicity implies agent driven liver damage The liver being the largest organ in the body plays
a central role in transforming and clearing chemicals from the body it therefore is susceptible to the
toxicity from these agents Certain medicinal agents when taken in overdoses and sometimes even
when introduced within therapeutic ranges may injure the liver Chemical agents such as those used
in laboratories and industries natural chemicals (eg microcystins) and herbal remedies can also
induce hepatotoxicity Chemicals that cause liver injury are hepatotoxins There are many factors
that are known to contribute to liver damage
a) Most xenobiotics enter the body through the gastro int
b) estinal tract from the diet food additives contaminants and drugs and are transported by
hepatic portal vein through the hepatic blood system to the liver
c) High concentration in the liver of xenobiotic-metabolizing enzymes eg the cytochrome
p-450 dependent mono-oxygenase system
Most times areas of damage are in the centibular region This is attributed to the higher
concentration of cytochrome p-450 in that area of the liver` [1]
In man liver damage is less common
and only around 9 of adverse drug reactions affect the liver
More than 900 drugs have been implicated in causing liver injury (Friedman et al 2003)[2]
for
example dipyrone was withdrawn from the market partly due to hepato-toxicity Chemicals often
cause subclinical injury to liver which manifests only as abnormal liver enzyme tests Drug induced
liver injury is responsible for 5 of all hospital admissions and 50 of all acute liver failure [12]
The human body identifies almost all drugs as foreign substances (ie xenobiotics) and subjects
them to various chemical processes (ie metabolism) to make them change biological activity
Although almost all tissue in the body have some ability to metabolize chemicals smooth
endoplasmic reticulum in liver is the principal metabolic clearing houserdquo for both endogenous
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
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2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
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(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
2
BY
UGWUEZE MERCY EBERE
REG NO PGMPHARM0951630
BEING A RESEARCH PROJECT UNDERTAKEN IN PARTIAL FULFILLMENT
OF THE REQUIREMENT FOR THE AWARD OF MASTERS OF PHARMACY
(M PHARM) DEGREE IN PHARMACEUTICS OF
THE UNIVERSITY OF NIGERIA
SUPERVISORS PROF A A ATTAMA AND DR K C OFOKANSI
DEPARTMENT OF PHARMACEUTICS
FACULTY OF PHARMACEUTICAL SCIENCES
UNIVERSITY OF NIGERIA
NSUKKA
NOVEMBER 2011
3
TABLE OF CONTENT
Title page-----------------------------------------------------------------------------------------------------------i
Certification page-------------------------------------------------------------------------------------------------ii
Dedication page---------------------------------------------------------------------------------------------------iii
Acknowledgement------------------------------------------------------------------------------------------------iv
List of figures------------------------------------------------------------------------------------------------------v
List of tables-------------------------------------------------------------------------------------------------------vi
Table of content--------------------------------------------------------------------------------------------------vii
Abstract------------------------------------------------------------------------------------------------------------x
CHAPTER ONE GENERAL INTRODUCTION
10 Introduction--------------------------------------------------------------------------------------1
11 Hepatotoxicity-----------------------------------------------------------------------------------3
12 Paracetamol--------------------------------------------------------------------------------------5
131 Toxicity-------------------------------------------------------------------------------------------6
132 Risk Factors--------------------------------------------------------------------------------------6
14 Carbon Tetrachloride----------------------------------------------------------------------------8
141 History and Synthesis---------------------------------------------------------------------------8
142 Toxicity-------------------------------------------------------------------------------------------9
15 Liver Care---------------------------------------------------------------------------------------11
16 Phytochemical----------------------------------------------------------------------------------13
17 Acute Toxicity Studies------------------------------------------------------------------------14
18 Anatomy and Physiology of Liver-----------------------------------------------------------16
181 Anatomy of Liver------------------------------------------------------------------------------16
182 Blood Supply-----------------------------------------------------------------------------------17
183 Billary Flow-------------------------------------------------------------------------------------18
184 Physiology---------------------------------------------------------------------------------------19
4
185 Other Functions---------------------------------------------------------------------------------
19
19 Liver Disease------------------------------------------------------------------------------------20
191 Liver Disease types---------------------------------------------------------------------------- 21
192 Common Liver Problems--------------------------------------------------------------------- 21
1921 Hepatitis -----------------------------------------------------------------------------------------21
1922 Cirrhosis-----------------------------------------------------------------------------------------21
1923 Fatty Liver Disease---------------------------------------------------------------------------- 21
1924 Liver Cancer------------------------------------------------------------------------------------ 22
1925 Enlarged Liver----------------------------------------------------------------------------------22
1926 Liver Cysts--------------------------------------------------------------------------------------22
1927 Wilson‟s Disease-------------------------------------------------------------------------------22
1928 Hemochromatosis------------------------------------------------------------------------------22
1929 Primary Sclerosing Cholangitis or PSC-----------------------------------------------------22
19210 Autoimmune Hepatitis------------------------------------------------------------------------ 22
110 Cirrohsis-----------------------------------------------------------------------------------------23
1101 Signs and Symptoms-------------------------------------------------------------------------- 23
1102 Complications---------------------------------------------------------------------------------- 25
1103 Causes------------------------------------------------------------------------------------------- 26
1104 Liver Function Tests-------------------------------------------------------------------------- 29
111 Hepatitis-----------------------------------------------------------------------------------------30
1111 Signs and Symptoms-------------------------------------------------------------------------- 31
1112 Alcoholic Hepatitis-----------------------------------------------------------------------------34
112 Millettia aboensis------------------------------------------------------------------------------ 35
1121 Taxonomy---------------------------------------------------------------------------------------35
1122 Nature and Occurrence----------------------------------------------------------------------36
1123 Uses of Plant--------------------------------------------------------------------------------- 36
5
1124 Medicinal Plants Used in Liver Disease-------------------------------------------------- 37
113 Aims of the Study---------------------------------------------------------------------------- 37
CHAPTER TWO Materials And Methods--------------------------------------------------------------- 38
21 Plant Material--------------------------------------------------------------------------------- 38
22 Experimental Animals------------------------------------------------------------------------ 39
23 Chemicals--------------------------------------------------------------------------------------- 39
24 Methods------------------------------------------------------------------------------------------39
241 Collection of Animals------------------------------------------------------------------------- 39
242 Collection and identification of plant material---------------------------------------------39
243 Extraction of plant material-------------------------------------------------------------------39
25 Phytochemicals analysis---------------------------------------------------------------------- 41
251 Tests for glycosides--------------------------------------------------------------------------- 41
252 Tests for alkaloids----------------------------------------------------------------------------- 41
253 Tests for reducing sugar---------------------------------------------------------------------- 41
2531 Molisch test------------------------------------------------------------------------------------- 41
254 Tests for tannins------------------------------------------------------------------------------- 42
2551 Ferric chloride test----------------------------------------------------------------------------- 42
256 Tests for saponin------------------------------------------------------------------------------ -42
2561 frotthing test----------------------------------------------------------------------------------- -42
257 Tests for flavonoids-------------------------------------------------------------------------- -42
2571 Ammonium test-------------------------------------------------------------------------------- 42
258 Tests for protein------------------------------------------------------------------------------- 42
2581 Million‟s test--------------------------------------------------------------------------------- --42
258 Tests for steroids and terpenoids-------------------------------------------------------- 43
259 Tests for fats and oil---------------------------------------------------------------------- 43
2510 Tests for carbohydrate-------------------------------------------------------------------- 43
2511 Tests for resins----------------------------------------------------------------------------- 43
6
25111 Precipitation test--------------------------------------------------------------------------- 43
2512 Tests for acidic compound--------------------------------------------------------------- 44
26 Acute toxicity determination------------------------------------------------------------- 45
261 Acute oral toxicity test-------------------------------------------------------------------- 45
27 Evaluation of hepatoprotective activity------------------------------------------------- 45
28 Statistical analysis-------------------------------------------------------------------------- 47
CHAPTER THREE RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical analysis------------------------------------------------------48
32 Acute oral toxicity study-------------------------------------------------------------------49
33 Carbon tetrachloride and paracetamol induced acute toxicity------------------------49
34 Liver enzyme analysis----------------------------------------------------------------------50
35 Discussion------------------------------------------------------------------------------------66
351 Phytochemical composition----------------------------------------------------------------66
352 Acute oral toxicity---------------------------------------------------------------------------66
353 Hepatoprotective effect of Millettia aboensis--------------------------------------------66
CHAPTER FOUR CONCLUSIONS-----------------------------------------------------------------------70
REFERENCES
7
CHAPTER ONE
GENERAL INTRODUCTION
11 INTRODUCTION
Many of us are under stress and stress affects the body in many ways We live in buildings with
little or no fresh air and we need to find ways of relieving the nervous system from the effects of this
stress Many of us suffer from lung problems We suffer from problems caused by drinking water
which has been polluted by steel mills and other industries We get all sorts of pollution in our food
as well Chemicals which did not even exist before the 1940s are contaminants We use fungicides
and pesticides on our soil and have very little control over what we eat except when we grow our
own produce organically All these affect our liver Our liver is the same organ we had as primitive
man and there is no evidence that the liver is able to handle man-made molecules As a result we
regularly invent new diseases It‟s therefore necessary we think what we can do to help the liver The
first thing we must do is clean up our environment In the meantime the herbs and the natural
medicinal plants are helpful
Historically plants have played an important role in medicine For early peoples they are used as
diet and for healing Through observation and experimentation they learnt which plants promoted
health and well-being
Over time the practice of herbal medicine has grown more complex Science has enabled us to
process natural substances into pills tinctures and powders However the development of a market
economy also has distanced consumers from the wild plants that are the source of medicines
All through history man has prepared medicine from herbs and plant extracts Records abound of
such practice even with caution of man In the biblical days the prophet Isaiah prescribed a hot
poultries of figs to heal king Hezekayas boil (2 kings 20) Today we find similar practices
widespread in various parts of the globe In Nigeria numerous plants are used widely by our
traditional healers for of diseases (12) Millettia aboensis extracts are used for liver diseases
8
constipation and sometimes combines with other plants‟ parts in preparation of medications for
veneral diseases The advantages of herbal medical therapy are numerous Herbal healing is natural
and cheap The herbs are found in our homes and environment Generally medicinal plants are
healing gift from nature since extracts from living plants which are organic in nature are used
Modern science has been able to prove that man and plant are closely linked the green
chlorophyll has a chemical structure almost identical to the heamoglobin which is the main
constituent of human blood Where chlorophyll has a molecule of magnesium in its structural
pattern hemoglobin carries a molecule of iron
With the ever increasing cost of orthodox health care services and with incidence of fake
drugs and side effect of modern drug therapies many patients seem to be more interested in the
alternative herbal health care which they feel is safer more accessible more economical and which
takes into consideration the people‟s socio-cultural values
In recent years with the help of many traditional herbalists and researchers it has been possible to
identify many of the medicinal plants
9
12 HEPATOTOXICITY
Hepatotoxicity implies agent driven liver damage The liver being the largest organ in the body plays
a central role in transforming and clearing chemicals from the body it therefore is susceptible to the
toxicity from these agents Certain medicinal agents when taken in overdoses and sometimes even
when introduced within therapeutic ranges may injure the liver Chemical agents such as those used
in laboratories and industries natural chemicals (eg microcystins) and herbal remedies can also
induce hepatotoxicity Chemicals that cause liver injury are hepatotoxins There are many factors
that are known to contribute to liver damage
a) Most xenobiotics enter the body through the gastro int
b) estinal tract from the diet food additives contaminants and drugs and are transported by
hepatic portal vein through the hepatic blood system to the liver
c) High concentration in the liver of xenobiotic-metabolizing enzymes eg the cytochrome
p-450 dependent mono-oxygenase system
Most times areas of damage are in the centibular region This is attributed to the higher
concentration of cytochrome p-450 in that area of the liver` [1]
In man liver damage is less common
and only around 9 of adverse drug reactions affect the liver
More than 900 drugs have been implicated in causing liver injury (Friedman et al 2003)[2]
for
example dipyrone was withdrawn from the market partly due to hepato-toxicity Chemicals often
cause subclinical injury to liver which manifests only as abnormal liver enzyme tests Drug induced
liver injury is responsible for 5 of all hospital admissions and 50 of all acute liver failure [12]
The human body identifies almost all drugs as foreign substances (ie xenobiotics) and subjects
them to various chemical processes (ie metabolism) to make them change biological activity
Although almost all tissue in the body have some ability to metabolize chemicals smooth
endoplasmic reticulum in liver is the principal metabolic clearing houserdquo for both endogenous
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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elaborationA consensus statement from chcalemical toxicologists consulting to the
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70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
3
TABLE OF CONTENT
Title page-----------------------------------------------------------------------------------------------------------i
Certification page-------------------------------------------------------------------------------------------------ii
Dedication page---------------------------------------------------------------------------------------------------iii
Acknowledgement------------------------------------------------------------------------------------------------iv
List of figures------------------------------------------------------------------------------------------------------v
List of tables-------------------------------------------------------------------------------------------------------vi
Table of content--------------------------------------------------------------------------------------------------vii
Abstract------------------------------------------------------------------------------------------------------------x
CHAPTER ONE GENERAL INTRODUCTION
10 Introduction--------------------------------------------------------------------------------------1
11 Hepatotoxicity-----------------------------------------------------------------------------------3
12 Paracetamol--------------------------------------------------------------------------------------5
131 Toxicity-------------------------------------------------------------------------------------------6
132 Risk Factors--------------------------------------------------------------------------------------6
14 Carbon Tetrachloride----------------------------------------------------------------------------8
141 History and Synthesis---------------------------------------------------------------------------8
142 Toxicity-------------------------------------------------------------------------------------------9
15 Liver Care---------------------------------------------------------------------------------------11
16 Phytochemical----------------------------------------------------------------------------------13
17 Acute Toxicity Studies------------------------------------------------------------------------14
18 Anatomy and Physiology of Liver-----------------------------------------------------------16
181 Anatomy of Liver------------------------------------------------------------------------------16
182 Blood Supply-----------------------------------------------------------------------------------17
183 Billary Flow-------------------------------------------------------------------------------------18
184 Physiology---------------------------------------------------------------------------------------19
4
185 Other Functions---------------------------------------------------------------------------------
19
19 Liver Disease------------------------------------------------------------------------------------20
191 Liver Disease types---------------------------------------------------------------------------- 21
192 Common Liver Problems--------------------------------------------------------------------- 21
1921 Hepatitis -----------------------------------------------------------------------------------------21
1922 Cirrhosis-----------------------------------------------------------------------------------------21
1923 Fatty Liver Disease---------------------------------------------------------------------------- 21
1924 Liver Cancer------------------------------------------------------------------------------------ 22
1925 Enlarged Liver----------------------------------------------------------------------------------22
1926 Liver Cysts--------------------------------------------------------------------------------------22
1927 Wilson‟s Disease-------------------------------------------------------------------------------22
1928 Hemochromatosis------------------------------------------------------------------------------22
1929 Primary Sclerosing Cholangitis or PSC-----------------------------------------------------22
19210 Autoimmune Hepatitis------------------------------------------------------------------------ 22
110 Cirrohsis-----------------------------------------------------------------------------------------23
1101 Signs and Symptoms-------------------------------------------------------------------------- 23
1102 Complications---------------------------------------------------------------------------------- 25
1103 Causes------------------------------------------------------------------------------------------- 26
1104 Liver Function Tests-------------------------------------------------------------------------- 29
111 Hepatitis-----------------------------------------------------------------------------------------30
1111 Signs and Symptoms-------------------------------------------------------------------------- 31
1112 Alcoholic Hepatitis-----------------------------------------------------------------------------34
112 Millettia aboensis------------------------------------------------------------------------------ 35
1121 Taxonomy---------------------------------------------------------------------------------------35
1122 Nature and Occurrence----------------------------------------------------------------------36
1123 Uses of Plant--------------------------------------------------------------------------------- 36
5
1124 Medicinal Plants Used in Liver Disease-------------------------------------------------- 37
113 Aims of the Study---------------------------------------------------------------------------- 37
CHAPTER TWO Materials And Methods--------------------------------------------------------------- 38
21 Plant Material--------------------------------------------------------------------------------- 38
22 Experimental Animals------------------------------------------------------------------------ 39
23 Chemicals--------------------------------------------------------------------------------------- 39
24 Methods------------------------------------------------------------------------------------------39
241 Collection of Animals------------------------------------------------------------------------- 39
242 Collection and identification of plant material---------------------------------------------39
243 Extraction of plant material-------------------------------------------------------------------39
25 Phytochemicals analysis---------------------------------------------------------------------- 41
251 Tests for glycosides--------------------------------------------------------------------------- 41
252 Tests for alkaloids----------------------------------------------------------------------------- 41
253 Tests for reducing sugar---------------------------------------------------------------------- 41
2531 Molisch test------------------------------------------------------------------------------------- 41
254 Tests for tannins------------------------------------------------------------------------------- 42
2551 Ferric chloride test----------------------------------------------------------------------------- 42
256 Tests for saponin------------------------------------------------------------------------------ -42
2561 frotthing test----------------------------------------------------------------------------------- -42
257 Tests for flavonoids-------------------------------------------------------------------------- -42
2571 Ammonium test-------------------------------------------------------------------------------- 42
258 Tests for protein------------------------------------------------------------------------------- 42
2581 Million‟s test--------------------------------------------------------------------------------- --42
258 Tests for steroids and terpenoids-------------------------------------------------------- 43
259 Tests for fats and oil---------------------------------------------------------------------- 43
2510 Tests for carbohydrate-------------------------------------------------------------------- 43
2511 Tests for resins----------------------------------------------------------------------------- 43
6
25111 Precipitation test--------------------------------------------------------------------------- 43
2512 Tests for acidic compound--------------------------------------------------------------- 44
26 Acute toxicity determination------------------------------------------------------------- 45
261 Acute oral toxicity test-------------------------------------------------------------------- 45
27 Evaluation of hepatoprotective activity------------------------------------------------- 45
28 Statistical analysis-------------------------------------------------------------------------- 47
CHAPTER THREE RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical analysis------------------------------------------------------48
32 Acute oral toxicity study-------------------------------------------------------------------49
33 Carbon tetrachloride and paracetamol induced acute toxicity------------------------49
34 Liver enzyme analysis----------------------------------------------------------------------50
35 Discussion------------------------------------------------------------------------------------66
351 Phytochemical composition----------------------------------------------------------------66
352 Acute oral toxicity---------------------------------------------------------------------------66
353 Hepatoprotective effect of Millettia aboensis--------------------------------------------66
CHAPTER FOUR CONCLUSIONS-----------------------------------------------------------------------70
REFERENCES
7
CHAPTER ONE
GENERAL INTRODUCTION
11 INTRODUCTION
Many of us are under stress and stress affects the body in many ways We live in buildings with
little or no fresh air and we need to find ways of relieving the nervous system from the effects of this
stress Many of us suffer from lung problems We suffer from problems caused by drinking water
which has been polluted by steel mills and other industries We get all sorts of pollution in our food
as well Chemicals which did not even exist before the 1940s are contaminants We use fungicides
and pesticides on our soil and have very little control over what we eat except when we grow our
own produce organically All these affect our liver Our liver is the same organ we had as primitive
man and there is no evidence that the liver is able to handle man-made molecules As a result we
regularly invent new diseases It‟s therefore necessary we think what we can do to help the liver The
first thing we must do is clean up our environment In the meantime the herbs and the natural
medicinal plants are helpful
Historically plants have played an important role in medicine For early peoples they are used as
diet and for healing Through observation and experimentation they learnt which plants promoted
health and well-being
Over time the practice of herbal medicine has grown more complex Science has enabled us to
process natural substances into pills tinctures and powders However the development of a market
economy also has distanced consumers from the wild plants that are the source of medicines
All through history man has prepared medicine from herbs and plant extracts Records abound of
such practice even with caution of man In the biblical days the prophet Isaiah prescribed a hot
poultries of figs to heal king Hezekayas boil (2 kings 20) Today we find similar practices
widespread in various parts of the globe In Nigeria numerous plants are used widely by our
traditional healers for of diseases (12) Millettia aboensis extracts are used for liver diseases
8
constipation and sometimes combines with other plants‟ parts in preparation of medications for
veneral diseases The advantages of herbal medical therapy are numerous Herbal healing is natural
and cheap The herbs are found in our homes and environment Generally medicinal plants are
healing gift from nature since extracts from living plants which are organic in nature are used
Modern science has been able to prove that man and plant are closely linked the green
chlorophyll has a chemical structure almost identical to the heamoglobin which is the main
constituent of human blood Where chlorophyll has a molecule of magnesium in its structural
pattern hemoglobin carries a molecule of iron
With the ever increasing cost of orthodox health care services and with incidence of fake
drugs and side effect of modern drug therapies many patients seem to be more interested in the
alternative herbal health care which they feel is safer more accessible more economical and which
takes into consideration the people‟s socio-cultural values
In recent years with the help of many traditional herbalists and researchers it has been possible to
identify many of the medicinal plants
9
12 HEPATOTOXICITY
Hepatotoxicity implies agent driven liver damage The liver being the largest organ in the body plays
a central role in transforming and clearing chemicals from the body it therefore is susceptible to the
toxicity from these agents Certain medicinal agents when taken in overdoses and sometimes even
when introduced within therapeutic ranges may injure the liver Chemical agents such as those used
in laboratories and industries natural chemicals (eg microcystins) and herbal remedies can also
induce hepatotoxicity Chemicals that cause liver injury are hepatotoxins There are many factors
that are known to contribute to liver damage
a) Most xenobiotics enter the body through the gastro int
b) estinal tract from the diet food additives contaminants and drugs and are transported by
hepatic portal vein through the hepatic blood system to the liver
c) High concentration in the liver of xenobiotic-metabolizing enzymes eg the cytochrome
p-450 dependent mono-oxygenase system
Most times areas of damage are in the centibular region This is attributed to the higher
concentration of cytochrome p-450 in that area of the liver` [1]
In man liver damage is less common
and only around 9 of adverse drug reactions affect the liver
More than 900 drugs have been implicated in causing liver injury (Friedman et al 2003)[2]
for
example dipyrone was withdrawn from the market partly due to hepato-toxicity Chemicals often
cause subclinical injury to liver which manifests only as abnormal liver enzyme tests Drug induced
liver injury is responsible for 5 of all hospital admissions and 50 of all acute liver failure [12]
The human body identifies almost all drugs as foreign substances (ie xenobiotics) and subjects
them to various chemical processes (ie metabolism) to make them change biological activity
Although almost all tissue in the body have some ability to metabolize chemicals smooth
endoplasmic reticulum in liver is the principal metabolic clearing houserdquo for both endogenous
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
4
185 Other Functions---------------------------------------------------------------------------------
19
19 Liver Disease------------------------------------------------------------------------------------20
191 Liver Disease types---------------------------------------------------------------------------- 21
192 Common Liver Problems--------------------------------------------------------------------- 21
1921 Hepatitis -----------------------------------------------------------------------------------------21
1922 Cirrhosis-----------------------------------------------------------------------------------------21
1923 Fatty Liver Disease---------------------------------------------------------------------------- 21
1924 Liver Cancer------------------------------------------------------------------------------------ 22
1925 Enlarged Liver----------------------------------------------------------------------------------22
1926 Liver Cysts--------------------------------------------------------------------------------------22
1927 Wilson‟s Disease-------------------------------------------------------------------------------22
1928 Hemochromatosis------------------------------------------------------------------------------22
1929 Primary Sclerosing Cholangitis or PSC-----------------------------------------------------22
19210 Autoimmune Hepatitis------------------------------------------------------------------------ 22
110 Cirrohsis-----------------------------------------------------------------------------------------23
1101 Signs and Symptoms-------------------------------------------------------------------------- 23
1102 Complications---------------------------------------------------------------------------------- 25
1103 Causes------------------------------------------------------------------------------------------- 26
1104 Liver Function Tests-------------------------------------------------------------------------- 29
111 Hepatitis-----------------------------------------------------------------------------------------30
1111 Signs and Symptoms-------------------------------------------------------------------------- 31
1112 Alcoholic Hepatitis-----------------------------------------------------------------------------34
112 Millettia aboensis------------------------------------------------------------------------------ 35
1121 Taxonomy---------------------------------------------------------------------------------------35
1122 Nature and Occurrence----------------------------------------------------------------------36
1123 Uses of Plant--------------------------------------------------------------------------------- 36
5
1124 Medicinal Plants Used in Liver Disease-------------------------------------------------- 37
113 Aims of the Study---------------------------------------------------------------------------- 37
CHAPTER TWO Materials And Methods--------------------------------------------------------------- 38
21 Plant Material--------------------------------------------------------------------------------- 38
22 Experimental Animals------------------------------------------------------------------------ 39
23 Chemicals--------------------------------------------------------------------------------------- 39
24 Methods------------------------------------------------------------------------------------------39
241 Collection of Animals------------------------------------------------------------------------- 39
242 Collection and identification of plant material---------------------------------------------39
243 Extraction of plant material-------------------------------------------------------------------39
25 Phytochemicals analysis---------------------------------------------------------------------- 41
251 Tests for glycosides--------------------------------------------------------------------------- 41
252 Tests for alkaloids----------------------------------------------------------------------------- 41
253 Tests for reducing sugar---------------------------------------------------------------------- 41
2531 Molisch test------------------------------------------------------------------------------------- 41
254 Tests for tannins------------------------------------------------------------------------------- 42
2551 Ferric chloride test----------------------------------------------------------------------------- 42
256 Tests for saponin------------------------------------------------------------------------------ -42
2561 frotthing test----------------------------------------------------------------------------------- -42
257 Tests for flavonoids-------------------------------------------------------------------------- -42
2571 Ammonium test-------------------------------------------------------------------------------- 42
258 Tests for protein------------------------------------------------------------------------------- 42
2581 Million‟s test--------------------------------------------------------------------------------- --42
258 Tests for steroids and terpenoids-------------------------------------------------------- 43
259 Tests for fats and oil---------------------------------------------------------------------- 43
2510 Tests for carbohydrate-------------------------------------------------------------------- 43
2511 Tests for resins----------------------------------------------------------------------------- 43
6
25111 Precipitation test--------------------------------------------------------------------------- 43
2512 Tests for acidic compound--------------------------------------------------------------- 44
26 Acute toxicity determination------------------------------------------------------------- 45
261 Acute oral toxicity test-------------------------------------------------------------------- 45
27 Evaluation of hepatoprotective activity------------------------------------------------- 45
28 Statistical analysis-------------------------------------------------------------------------- 47
CHAPTER THREE RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical analysis------------------------------------------------------48
32 Acute oral toxicity study-------------------------------------------------------------------49
33 Carbon tetrachloride and paracetamol induced acute toxicity------------------------49
34 Liver enzyme analysis----------------------------------------------------------------------50
35 Discussion------------------------------------------------------------------------------------66
351 Phytochemical composition----------------------------------------------------------------66
352 Acute oral toxicity---------------------------------------------------------------------------66
353 Hepatoprotective effect of Millettia aboensis--------------------------------------------66
CHAPTER FOUR CONCLUSIONS-----------------------------------------------------------------------70
REFERENCES
7
CHAPTER ONE
GENERAL INTRODUCTION
11 INTRODUCTION
Many of us are under stress and stress affects the body in many ways We live in buildings with
little or no fresh air and we need to find ways of relieving the nervous system from the effects of this
stress Many of us suffer from lung problems We suffer from problems caused by drinking water
which has been polluted by steel mills and other industries We get all sorts of pollution in our food
as well Chemicals which did not even exist before the 1940s are contaminants We use fungicides
and pesticides on our soil and have very little control over what we eat except when we grow our
own produce organically All these affect our liver Our liver is the same organ we had as primitive
man and there is no evidence that the liver is able to handle man-made molecules As a result we
regularly invent new diseases It‟s therefore necessary we think what we can do to help the liver The
first thing we must do is clean up our environment In the meantime the herbs and the natural
medicinal plants are helpful
Historically plants have played an important role in medicine For early peoples they are used as
diet and for healing Through observation and experimentation they learnt which plants promoted
health and well-being
Over time the practice of herbal medicine has grown more complex Science has enabled us to
process natural substances into pills tinctures and powders However the development of a market
economy also has distanced consumers from the wild plants that are the source of medicines
All through history man has prepared medicine from herbs and plant extracts Records abound of
such practice even with caution of man In the biblical days the prophet Isaiah prescribed a hot
poultries of figs to heal king Hezekayas boil (2 kings 20) Today we find similar practices
widespread in various parts of the globe In Nigeria numerous plants are used widely by our
traditional healers for of diseases (12) Millettia aboensis extracts are used for liver diseases
8
constipation and sometimes combines with other plants‟ parts in preparation of medications for
veneral diseases The advantages of herbal medical therapy are numerous Herbal healing is natural
and cheap The herbs are found in our homes and environment Generally medicinal plants are
healing gift from nature since extracts from living plants which are organic in nature are used
Modern science has been able to prove that man and plant are closely linked the green
chlorophyll has a chemical structure almost identical to the heamoglobin which is the main
constituent of human blood Where chlorophyll has a molecule of magnesium in its structural
pattern hemoglobin carries a molecule of iron
With the ever increasing cost of orthodox health care services and with incidence of fake
drugs and side effect of modern drug therapies many patients seem to be more interested in the
alternative herbal health care which they feel is safer more accessible more economical and which
takes into consideration the people‟s socio-cultural values
In recent years with the help of many traditional herbalists and researchers it has been possible to
identify many of the medicinal plants
9
12 HEPATOTOXICITY
Hepatotoxicity implies agent driven liver damage The liver being the largest organ in the body plays
a central role in transforming and clearing chemicals from the body it therefore is susceptible to the
toxicity from these agents Certain medicinal agents when taken in overdoses and sometimes even
when introduced within therapeutic ranges may injure the liver Chemical agents such as those used
in laboratories and industries natural chemicals (eg microcystins) and herbal remedies can also
induce hepatotoxicity Chemicals that cause liver injury are hepatotoxins There are many factors
that are known to contribute to liver damage
a) Most xenobiotics enter the body through the gastro int
b) estinal tract from the diet food additives contaminants and drugs and are transported by
hepatic portal vein through the hepatic blood system to the liver
c) High concentration in the liver of xenobiotic-metabolizing enzymes eg the cytochrome
p-450 dependent mono-oxygenase system
Most times areas of damage are in the centibular region This is attributed to the higher
concentration of cytochrome p-450 in that area of the liver` [1]
In man liver damage is less common
and only around 9 of adverse drug reactions affect the liver
More than 900 drugs have been implicated in causing liver injury (Friedman et al 2003)[2]
for
example dipyrone was withdrawn from the market partly due to hepato-toxicity Chemicals often
cause subclinical injury to liver which manifests only as abnormal liver enzyme tests Drug induced
liver injury is responsible for 5 of all hospital admissions and 50 of all acute liver failure [12]
The human body identifies almost all drugs as foreign substances (ie xenobiotics) and subjects
them to various chemical processes (ie metabolism) to make them change biological activity
Although almost all tissue in the body have some ability to metabolize chemicals smooth
endoplasmic reticulum in liver is the principal metabolic clearing houserdquo for both endogenous
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
5
1124 Medicinal Plants Used in Liver Disease-------------------------------------------------- 37
113 Aims of the Study---------------------------------------------------------------------------- 37
CHAPTER TWO Materials And Methods--------------------------------------------------------------- 38
21 Plant Material--------------------------------------------------------------------------------- 38
22 Experimental Animals------------------------------------------------------------------------ 39
23 Chemicals--------------------------------------------------------------------------------------- 39
24 Methods------------------------------------------------------------------------------------------39
241 Collection of Animals------------------------------------------------------------------------- 39
242 Collection and identification of plant material---------------------------------------------39
243 Extraction of plant material-------------------------------------------------------------------39
25 Phytochemicals analysis---------------------------------------------------------------------- 41
251 Tests for glycosides--------------------------------------------------------------------------- 41
252 Tests for alkaloids----------------------------------------------------------------------------- 41
253 Tests for reducing sugar---------------------------------------------------------------------- 41
2531 Molisch test------------------------------------------------------------------------------------- 41
254 Tests for tannins------------------------------------------------------------------------------- 42
2551 Ferric chloride test----------------------------------------------------------------------------- 42
256 Tests for saponin------------------------------------------------------------------------------ -42
2561 frotthing test----------------------------------------------------------------------------------- -42
257 Tests for flavonoids-------------------------------------------------------------------------- -42
2571 Ammonium test-------------------------------------------------------------------------------- 42
258 Tests for protein------------------------------------------------------------------------------- 42
2581 Million‟s test--------------------------------------------------------------------------------- --42
258 Tests for steroids and terpenoids-------------------------------------------------------- 43
259 Tests for fats and oil---------------------------------------------------------------------- 43
2510 Tests for carbohydrate-------------------------------------------------------------------- 43
2511 Tests for resins----------------------------------------------------------------------------- 43
6
25111 Precipitation test--------------------------------------------------------------------------- 43
2512 Tests for acidic compound--------------------------------------------------------------- 44
26 Acute toxicity determination------------------------------------------------------------- 45
261 Acute oral toxicity test-------------------------------------------------------------------- 45
27 Evaluation of hepatoprotective activity------------------------------------------------- 45
28 Statistical analysis-------------------------------------------------------------------------- 47
CHAPTER THREE RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical analysis------------------------------------------------------48
32 Acute oral toxicity study-------------------------------------------------------------------49
33 Carbon tetrachloride and paracetamol induced acute toxicity------------------------49
34 Liver enzyme analysis----------------------------------------------------------------------50
35 Discussion------------------------------------------------------------------------------------66
351 Phytochemical composition----------------------------------------------------------------66
352 Acute oral toxicity---------------------------------------------------------------------------66
353 Hepatoprotective effect of Millettia aboensis--------------------------------------------66
CHAPTER FOUR CONCLUSIONS-----------------------------------------------------------------------70
REFERENCES
7
CHAPTER ONE
GENERAL INTRODUCTION
11 INTRODUCTION
Many of us are under stress and stress affects the body in many ways We live in buildings with
little or no fresh air and we need to find ways of relieving the nervous system from the effects of this
stress Many of us suffer from lung problems We suffer from problems caused by drinking water
which has been polluted by steel mills and other industries We get all sorts of pollution in our food
as well Chemicals which did not even exist before the 1940s are contaminants We use fungicides
and pesticides on our soil and have very little control over what we eat except when we grow our
own produce organically All these affect our liver Our liver is the same organ we had as primitive
man and there is no evidence that the liver is able to handle man-made molecules As a result we
regularly invent new diseases It‟s therefore necessary we think what we can do to help the liver The
first thing we must do is clean up our environment In the meantime the herbs and the natural
medicinal plants are helpful
Historically plants have played an important role in medicine For early peoples they are used as
diet and for healing Through observation and experimentation they learnt which plants promoted
health and well-being
Over time the practice of herbal medicine has grown more complex Science has enabled us to
process natural substances into pills tinctures and powders However the development of a market
economy also has distanced consumers from the wild plants that are the source of medicines
All through history man has prepared medicine from herbs and plant extracts Records abound of
such practice even with caution of man In the biblical days the prophet Isaiah prescribed a hot
poultries of figs to heal king Hezekayas boil (2 kings 20) Today we find similar practices
widespread in various parts of the globe In Nigeria numerous plants are used widely by our
traditional healers for of diseases (12) Millettia aboensis extracts are used for liver diseases
8
constipation and sometimes combines with other plants‟ parts in preparation of medications for
veneral diseases The advantages of herbal medical therapy are numerous Herbal healing is natural
and cheap The herbs are found in our homes and environment Generally medicinal plants are
healing gift from nature since extracts from living plants which are organic in nature are used
Modern science has been able to prove that man and plant are closely linked the green
chlorophyll has a chemical structure almost identical to the heamoglobin which is the main
constituent of human blood Where chlorophyll has a molecule of magnesium in its structural
pattern hemoglobin carries a molecule of iron
With the ever increasing cost of orthodox health care services and with incidence of fake
drugs and side effect of modern drug therapies many patients seem to be more interested in the
alternative herbal health care which they feel is safer more accessible more economical and which
takes into consideration the people‟s socio-cultural values
In recent years with the help of many traditional herbalists and researchers it has been possible to
identify many of the medicinal plants
9
12 HEPATOTOXICITY
Hepatotoxicity implies agent driven liver damage The liver being the largest organ in the body plays
a central role in transforming and clearing chemicals from the body it therefore is susceptible to the
toxicity from these agents Certain medicinal agents when taken in overdoses and sometimes even
when introduced within therapeutic ranges may injure the liver Chemical agents such as those used
in laboratories and industries natural chemicals (eg microcystins) and herbal remedies can also
induce hepatotoxicity Chemicals that cause liver injury are hepatotoxins There are many factors
that are known to contribute to liver damage
a) Most xenobiotics enter the body through the gastro int
b) estinal tract from the diet food additives contaminants and drugs and are transported by
hepatic portal vein through the hepatic blood system to the liver
c) High concentration in the liver of xenobiotic-metabolizing enzymes eg the cytochrome
p-450 dependent mono-oxygenase system
Most times areas of damage are in the centibular region This is attributed to the higher
concentration of cytochrome p-450 in that area of the liver` [1]
In man liver damage is less common
and only around 9 of adverse drug reactions affect the liver
More than 900 drugs have been implicated in causing liver injury (Friedman et al 2003)[2]
for
example dipyrone was withdrawn from the market partly due to hepato-toxicity Chemicals often
cause subclinical injury to liver which manifests only as abnormal liver enzyme tests Drug induced
liver injury is responsible for 5 of all hospital admissions and 50 of all acute liver failure [12]
The human body identifies almost all drugs as foreign substances (ie xenobiotics) and subjects
them to various chemical processes (ie metabolism) to make them change biological activity
Although almost all tissue in the body have some ability to metabolize chemicals smooth
endoplasmic reticulum in liver is the principal metabolic clearing houserdquo for both endogenous
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
6
25111 Precipitation test--------------------------------------------------------------------------- 43
2512 Tests for acidic compound--------------------------------------------------------------- 44
26 Acute toxicity determination------------------------------------------------------------- 45
261 Acute oral toxicity test-------------------------------------------------------------------- 45
27 Evaluation of hepatoprotective activity------------------------------------------------- 45
28 Statistical analysis-------------------------------------------------------------------------- 47
CHAPTER THREE RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical analysis------------------------------------------------------48
32 Acute oral toxicity study-------------------------------------------------------------------49
33 Carbon tetrachloride and paracetamol induced acute toxicity------------------------49
34 Liver enzyme analysis----------------------------------------------------------------------50
35 Discussion------------------------------------------------------------------------------------66
351 Phytochemical composition----------------------------------------------------------------66
352 Acute oral toxicity---------------------------------------------------------------------------66
353 Hepatoprotective effect of Millettia aboensis--------------------------------------------66
CHAPTER FOUR CONCLUSIONS-----------------------------------------------------------------------70
REFERENCES
7
CHAPTER ONE
GENERAL INTRODUCTION
11 INTRODUCTION
Many of us are under stress and stress affects the body in many ways We live in buildings with
little or no fresh air and we need to find ways of relieving the nervous system from the effects of this
stress Many of us suffer from lung problems We suffer from problems caused by drinking water
which has been polluted by steel mills and other industries We get all sorts of pollution in our food
as well Chemicals which did not even exist before the 1940s are contaminants We use fungicides
and pesticides on our soil and have very little control over what we eat except when we grow our
own produce organically All these affect our liver Our liver is the same organ we had as primitive
man and there is no evidence that the liver is able to handle man-made molecules As a result we
regularly invent new diseases It‟s therefore necessary we think what we can do to help the liver The
first thing we must do is clean up our environment In the meantime the herbs and the natural
medicinal plants are helpful
Historically plants have played an important role in medicine For early peoples they are used as
diet and for healing Through observation and experimentation they learnt which plants promoted
health and well-being
Over time the practice of herbal medicine has grown more complex Science has enabled us to
process natural substances into pills tinctures and powders However the development of a market
economy also has distanced consumers from the wild plants that are the source of medicines
All through history man has prepared medicine from herbs and plant extracts Records abound of
such practice even with caution of man In the biblical days the prophet Isaiah prescribed a hot
poultries of figs to heal king Hezekayas boil (2 kings 20) Today we find similar practices
widespread in various parts of the globe In Nigeria numerous plants are used widely by our
traditional healers for of diseases (12) Millettia aboensis extracts are used for liver diseases
8
constipation and sometimes combines with other plants‟ parts in preparation of medications for
veneral diseases The advantages of herbal medical therapy are numerous Herbal healing is natural
and cheap The herbs are found in our homes and environment Generally medicinal plants are
healing gift from nature since extracts from living plants which are organic in nature are used
Modern science has been able to prove that man and plant are closely linked the green
chlorophyll has a chemical structure almost identical to the heamoglobin which is the main
constituent of human blood Where chlorophyll has a molecule of magnesium in its structural
pattern hemoglobin carries a molecule of iron
With the ever increasing cost of orthodox health care services and with incidence of fake
drugs and side effect of modern drug therapies many patients seem to be more interested in the
alternative herbal health care which they feel is safer more accessible more economical and which
takes into consideration the people‟s socio-cultural values
In recent years with the help of many traditional herbalists and researchers it has been possible to
identify many of the medicinal plants
9
12 HEPATOTOXICITY
Hepatotoxicity implies agent driven liver damage The liver being the largest organ in the body plays
a central role in transforming and clearing chemicals from the body it therefore is susceptible to the
toxicity from these agents Certain medicinal agents when taken in overdoses and sometimes even
when introduced within therapeutic ranges may injure the liver Chemical agents such as those used
in laboratories and industries natural chemicals (eg microcystins) and herbal remedies can also
induce hepatotoxicity Chemicals that cause liver injury are hepatotoxins There are many factors
that are known to contribute to liver damage
a) Most xenobiotics enter the body through the gastro int
b) estinal tract from the diet food additives contaminants and drugs and are transported by
hepatic portal vein through the hepatic blood system to the liver
c) High concentration in the liver of xenobiotic-metabolizing enzymes eg the cytochrome
p-450 dependent mono-oxygenase system
Most times areas of damage are in the centibular region This is attributed to the higher
concentration of cytochrome p-450 in that area of the liver` [1]
In man liver damage is less common
and only around 9 of adverse drug reactions affect the liver
More than 900 drugs have been implicated in causing liver injury (Friedman et al 2003)[2]
for
example dipyrone was withdrawn from the market partly due to hepato-toxicity Chemicals often
cause subclinical injury to liver which manifests only as abnormal liver enzyme tests Drug induced
liver injury is responsible for 5 of all hospital admissions and 50 of all acute liver failure [12]
The human body identifies almost all drugs as foreign substances (ie xenobiotics) and subjects
them to various chemical processes (ie metabolism) to make them change biological activity
Although almost all tissue in the body have some ability to metabolize chemicals smooth
endoplasmic reticulum in liver is the principal metabolic clearing houserdquo for both endogenous
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
7
CHAPTER ONE
GENERAL INTRODUCTION
11 INTRODUCTION
Many of us are under stress and stress affects the body in many ways We live in buildings with
little or no fresh air and we need to find ways of relieving the nervous system from the effects of this
stress Many of us suffer from lung problems We suffer from problems caused by drinking water
which has been polluted by steel mills and other industries We get all sorts of pollution in our food
as well Chemicals which did not even exist before the 1940s are contaminants We use fungicides
and pesticides on our soil and have very little control over what we eat except when we grow our
own produce organically All these affect our liver Our liver is the same organ we had as primitive
man and there is no evidence that the liver is able to handle man-made molecules As a result we
regularly invent new diseases It‟s therefore necessary we think what we can do to help the liver The
first thing we must do is clean up our environment In the meantime the herbs and the natural
medicinal plants are helpful
Historically plants have played an important role in medicine For early peoples they are used as
diet and for healing Through observation and experimentation they learnt which plants promoted
health and well-being
Over time the practice of herbal medicine has grown more complex Science has enabled us to
process natural substances into pills tinctures and powders However the development of a market
economy also has distanced consumers from the wild plants that are the source of medicines
All through history man has prepared medicine from herbs and plant extracts Records abound of
such practice even with caution of man In the biblical days the prophet Isaiah prescribed a hot
poultries of figs to heal king Hezekayas boil (2 kings 20) Today we find similar practices
widespread in various parts of the globe In Nigeria numerous plants are used widely by our
traditional healers for of diseases (12) Millettia aboensis extracts are used for liver diseases
8
constipation and sometimes combines with other plants‟ parts in preparation of medications for
veneral diseases The advantages of herbal medical therapy are numerous Herbal healing is natural
and cheap The herbs are found in our homes and environment Generally medicinal plants are
healing gift from nature since extracts from living plants which are organic in nature are used
Modern science has been able to prove that man and plant are closely linked the green
chlorophyll has a chemical structure almost identical to the heamoglobin which is the main
constituent of human blood Where chlorophyll has a molecule of magnesium in its structural
pattern hemoglobin carries a molecule of iron
With the ever increasing cost of orthodox health care services and with incidence of fake
drugs and side effect of modern drug therapies many patients seem to be more interested in the
alternative herbal health care which they feel is safer more accessible more economical and which
takes into consideration the people‟s socio-cultural values
In recent years with the help of many traditional herbalists and researchers it has been possible to
identify many of the medicinal plants
9
12 HEPATOTOXICITY
Hepatotoxicity implies agent driven liver damage The liver being the largest organ in the body plays
a central role in transforming and clearing chemicals from the body it therefore is susceptible to the
toxicity from these agents Certain medicinal agents when taken in overdoses and sometimes even
when introduced within therapeutic ranges may injure the liver Chemical agents such as those used
in laboratories and industries natural chemicals (eg microcystins) and herbal remedies can also
induce hepatotoxicity Chemicals that cause liver injury are hepatotoxins There are many factors
that are known to contribute to liver damage
a) Most xenobiotics enter the body through the gastro int
b) estinal tract from the diet food additives contaminants and drugs and are transported by
hepatic portal vein through the hepatic blood system to the liver
c) High concentration in the liver of xenobiotic-metabolizing enzymes eg the cytochrome
p-450 dependent mono-oxygenase system
Most times areas of damage are in the centibular region This is attributed to the higher
concentration of cytochrome p-450 in that area of the liver` [1]
In man liver damage is less common
and only around 9 of adverse drug reactions affect the liver
More than 900 drugs have been implicated in causing liver injury (Friedman et al 2003)[2]
for
example dipyrone was withdrawn from the market partly due to hepato-toxicity Chemicals often
cause subclinical injury to liver which manifests only as abnormal liver enzyme tests Drug induced
liver injury is responsible for 5 of all hospital admissions and 50 of all acute liver failure [12]
The human body identifies almost all drugs as foreign substances (ie xenobiotics) and subjects
them to various chemical processes (ie metabolism) to make them change biological activity
Although almost all tissue in the body have some ability to metabolize chemicals smooth
endoplasmic reticulum in liver is the principal metabolic clearing houserdquo for both endogenous
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
8
constipation and sometimes combines with other plants‟ parts in preparation of medications for
veneral diseases The advantages of herbal medical therapy are numerous Herbal healing is natural
and cheap The herbs are found in our homes and environment Generally medicinal plants are
healing gift from nature since extracts from living plants which are organic in nature are used
Modern science has been able to prove that man and plant are closely linked the green
chlorophyll has a chemical structure almost identical to the heamoglobin which is the main
constituent of human blood Where chlorophyll has a molecule of magnesium in its structural
pattern hemoglobin carries a molecule of iron
With the ever increasing cost of orthodox health care services and with incidence of fake
drugs and side effect of modern drug therapies many patients seem to be more interested in the
alternative herbal health care which they feel is safer more accessible more economical and which
takes into consideration the people‟s socio-cultural values
In recent years with the help of many traditional herbalists and researchers it has been possible to
identify many of the medicinal plants
9
12 HEPATOTOXICITY
Hepatotoxicity implies agent driven liver damage The liver being the largest organ in the body plays
a central role in transforming and clearing chemicals from the body it therefore is susceptible to the
toxicity from these agents Certain medicinal agents when taken in overdoses and sometimes even
when introduced within therapeutic ranges may injure the liver Chemical agents such as those used
in laboratories and industries natural chemicals (eg microcystins) and herbal remedies can also
induce hepatotoxicity Chemicals that cause liver injury are hepatotoxins There are many factors
that are known to contribute to liver damage
a) Most xenobiotics enter the body through the gastro int
b) estinal tract from the diet food additives contaminants and drugs and are transported by
hepatic portal vein through the hepatic blood system to the liver
c) High concentration in the liver of xenobiotic-metabolizing enzymes eg the cytochrome
p-450 dependent mono-oxygenase system
Most times areas of damage are in the centibular region This is attributed to the higher
concentration of cytochrome p-450 in that area of the liver` [1]
In man liver damage is less common
and only around 9 of adverse drug reactions affect the liver
More than 900 drugs have been implicated in causing liver injury (Friedman et al 2003)[2]
for
example dipyrone was withdrawn from the market partly due to hepato-toxicity Chemicals often
cause subclinical injury to liver which manifests only as abnormal liver enzyme tests Drug induced
liver injury is responsible for 5 of all hospital admissions and 50 of all acute liver failure [12]
The human body identifies almost all drugs as foreign substances (ie xenobiotics) and subjects
them to various chemical processes (ie metabolism) to make them change biological activity
Although almost all tissue in the body have some ability to metabolize chemicals smooth
endoplasmic reticulum in liver is the principal metabolic clearing houserdquo for both endogenous
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
9
12 HEPATOTOXICITY
Hepatotoxicity implies agent driven liver damage The liver being the largest organ in the body plays
a central role in transforming and clearing chemicals from the body it therefore is susceptible to the
toxicity from these agents Certain medicinal agents when taken in overdoses and sometimes even
when introduced within therapeutic ranges may injure the liver Chemical agents such as those used
in laboratories and industries natural chemicals (eg microcystins) and herbal remedies can also
induce hepatotoxicity Chemicals that cause liver injury are hepatotoxins There are many factors
that are known to contribute to liver damage
a) Most xenobiotics enter the body through the gastro int
b) estinal tract from the diet food additives contaminants and drugs and are transported by
hepatic portal vein through the hepatic blood system to the liver
c) High concentration in the liver of xenobiotic-metabolizing enzymes eg the cytochrome
p-450 dependent mono-oxygenase system
Most times areas of damage are in the centibular region This is attributed to the higher
concentration of cytochrome p-450 in that area of the liver` [1]
In man liver damage is less common
and only around 9 of adverse drug reactions affect the liver
More than 900 drugs have been implicated in causing liver injury (Friedman et al 2003)[2]
for
example dipyrone was withdrawn from the market partly due to hepato-toxicity Chemicals often
cause subclinical injury to liver which manifests only as abnormal liver enzyme tests Drug induced
liver injury is responsible for 5 of all hospital admissions and 50 of all acute liver failure [12]
The human body identifies almost all drugs as foreign substances (ie xenobiotics) and subjects
them to various chemical processes (ie metabolism) to make them change biological activity
Although almost all tissue in the body have some ability to metabolize chemicals smooth
endoplasmic reticulum in liver is the principal metabolic clearing houserdquo for both endogenous
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
10
chemicals (eg cholesterol steroid hormones fatty acids and proteins) and exogenous substance
(eg drugs) [3]
The central role played by the liver in the clearance and transformation of chemicals
also makes it susceptible to drug induced injury
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
11
13 PARACETAMOL
Fig 1 IUPAC name Para- acetyl aminophenol
Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and
antipyretic (fever reducer)
It is commonly used for the relief of headaches and other minor aches and pains and is a major
ingredient in numerous cold and flu remedies In combination with opioid analgesics paracetamol
can also be used in the management of more severe pain such as post surgical pain and providing
palliative care in advanced cancer patients[4]
While generally safe for use at recommended doses acute overdoses of paracetamol can cause
potentially fatal liver damage and the risk is heightened by alcohol consumption Paracetamol
toxicity is the foremost cause of acute liver failure in the Western world
Many individuals with paracetamol toxicity may have no symptoms at all in the first 24 hours
following overdose Others may initially have nonspecific complaints such as vague abdominal pain
and nausea With progressive disease signs of liver failure may develop these include low blood
sugar low blood pressure easy bleeding and hepatic encephalopathy Some will spontaneously
resolve although untreated cases may result in death Damage to the liver or hepatotoxicity results
not from paracetamol itself but from one of its metabolites N-acetyl-p-benzoquinoneimine (NAPQI)
NAPQI depletes the livers natural antioxidant glutathione and directly damages cells in the liver
leading to liver failure
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
12
131 Toxicity
The toxic dose of paracetamol is highly variable In adults single doses above 10 grams or
200 mgkg of bodyweight whichever is lower have a reasonable likelihood of causing toxicity[5][6]
Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels[6]
Following a normal dose of 1 gram of paracetamol four times a day for two weeks patients can
expect an increase in alanine transaminase in their liver to about three times the normal value[7]
It is
unlikely that this dose would lead to liver failure[8]
Studies have shown that significant
hepatotoxicity is uncommon in patients who have taken greater than normal doses over 3 to 4
days[9]
In adults a dose of 6 grams a day over the preceding 48 hours could potentially lead to
toxicity[6]
while in children acute doses above 200 mgkg could potentially cause toxicity[10]
Acute
paracetamol overdose in children rarely causes illness or death and it is very uncommon for children
to have levels that require treatment with chronic larger-than-normal doses being the major cause of
toxicity in children[6]
132 Risk factors
A number of factors can potentially increase the risk of developing paracetamol toxicity Chronic
excessive alcohol consumption can induce cytochrome P2E1 thus increasing the potential toxicity of
paracetamol[11]
Whether chronic alcoholism should be considered a risk factor has been debated by
some clinical toxicologists[12][13]
For chronic alcohol users acute alcohol ingestion at the time of a
paracetamol overdose may have a protective effect[12][14]
For non-chronic alcohol users acute
alcohol consumption had no protective effect[12]
Fasting is a risk factor possibly because of depletion of hepatic glutathione reserves[15]
The
concomitant use of the cytochrome P2E1 inducer isoniazid increases the risk of hepatotoxicity
though whether cytochrome P2E1 induction is related to the hepatotoxicity in this case is
unclear[16][17]
Concomitant use of other drugs that induce cytochrome P enzymes such as
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
13
antiepileptics including carbamazepine phenytoin and barbiturates have also been reported as
risk factors[18]
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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elaborationA consensus statement from chcalemical toxicologists consulting to the
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70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
14
14 CARBON TETRACHLORIDE
Fig 2 IUPAC name Tetrachloromethane
Carbon tetrachloride also known by many other names (notably carbon tet in the cleaning industry)
is the organic compound with the formula CCl4 It was formerly widely used in fire extinguishers as
a precursor to refrigerants and as very effective solvent and cleaner (cleaning agent) but
unfortunately it may be quite toxic Deaths have occurred due to accidental exposure in the home
and in the factory It is a colourless liquid with a sweet smell that can be detected at low levels
Both carbon tetrachloride and tetrachloromethane are acceptable names under IUPAC nomenclature
Colloquially it may be called carbo
Synonym Pyrene bdquobdquoCarbonardquo CCl4
141 History and synthesis
The production of carbon tetrachloride has steeply declined since the 1980s due to environmental
concerns and the decreased demand for CFCs which were derived from carbon tetrachloride In
1992 production in the US-Europe-Japan was estimated at 720000 tonnes[19]
Carbon tetrachloride was originally synthesised by the French chemist Henri Victor Regnault in
1839 by the reaction of chloroform with chlorine[20]
but now it is mainly produced from methane
CH4 + 4 Cl2 rarr CCl4 + 4 HCl helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(i)
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
15
The production often utilizes by-products of other chlorination reactions such as from the
syntheses of dichloromethane and chloroform Higher chlorocarbons are also subjected to
chlorinolysis
C2Cl6 + Cl2 rarr 2 CCl4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(ii)
Prior to the 1950s carbon tetrachloride was manufactured by the chlorination of carbon disulfide at
105 to 130 degC[19]
CS2 + 3Cl2 rarr CCl4 + S2Cl2helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip(iii)
142 TOXICITY
Exposure to high concentrations of carbon tetrachloride (including vapor) can affect the central
nervous system degenerate the liver[21]
and kidneys[22]
and may result (after prolonged exposure) in
coma and even death[23]
Chronic exposure to carbon tetrachloride can cause liver[24][25]
and kidney
damage and could result in cancer[26]
Carbon tetrachloride when thrown on fires or when heated produces phosgene which is very toxic
Inhalation of carbon tetrachloride while cleaning clothes or windows has caused fatalities It is
absorbed rapidly through all surfaces including skin the presence of oil or alcohol enhances rate of
absorption
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
16
15 LIVER CARE
Liv 52(R)
is a herbal medicine directed to treat liver ailmeants It was developed in mid 1950s by the
Himalaya Herbal Healthcare group of India and it contains the following Capers (Capparis spinosa
65 mg) a hepatic stimulant and protector which improves the functional efficiency of the liver Wild
Chicory (Cichorium intybus 65 mg) a powerful hepatic stimulant which increases bile secretion and
acts on liver glycogen to promote digestion Black Nightshade (Solanum nigrum 32 mg) which
promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity
induced by drugs and chemicals Arjuna (Terminalia arjuna 32 mg) a tonic for heart and liver and
regulates hepatic cholesterol biosynthesis Negro Coffee (Cassia occidentalis 16 mg) a digestive
and hepatic tonic Yarrow (Achillea millefolium 16 mg) a stimulative tonic for the liver Tamarisk
(Tamarix gallica 16 mg) a hepatic stimulant which also provides digestive support[27]
While your liver is working hard to protect your body from the toxins in the food drugs alcohol
and even water that you intake Liv 52(R)
is working doubly hard to protect your liver from damage
It has a unique complex formula of natural ingredients that are infused to bar harmful toxins from
creeping in Its anti-oxidants are strong enough to brave any kind of toxins making sure that they
will not damage or destroy your liver Liv 52(R)
has the power to counteract the detrimental effects of
toxins It also has enzyme-regulating properties which are helpful in keeping your liver‟s function in
check Recent studies showed that Liv52(R)
also works as a cholesterol regulator
Liv 52(R)
maintains the functional effectiveness of the liver by protecting the hepatic parenchyma In
many parts of the world this wonder drug is used as a preventive measure for risks of contracting
life-threatening liver diseases Alcoholics take it as a vitamin to maintain a healthy liver amid the
load of toxins they take each day Liver disease patients also find Liv 52(R)
useful in improving their
health
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
17
16 PHYTOCHEMICALS
These are non-nutritive chemicals that have protective or disease preventive property It refers to
every naturally occurring chemical presents in plants Plants are also the source for many modern
pharmaceuticals (drugs) The most important of these phytochemicals are alkaloids flavonoids
tannins and phenolic compounds [28]
Many of these indigenous plants are used as spices and food
plants Current research has shown that polyphenols contribute to the prevention of cardiovascular
diseases cancers osteoporosis and antioxidant character with potential health benefits[29-31]
They
are known to have beneficial effects on cardio vascular system[32-34]
and have a role in the
prevention of neurodegenerative diseases and diabetes mellitus [35]
Medicinal plants are of great importance to the health of individuals and communities The
medicinal value of these plants lies in some chemical substances that produce a definite
physiological action on the human body and these chemical substances are called phytochemicals
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
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70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
18
17 ACUTE TOXICITY STUDIES
It describes the adverse effects resulting from a single exposure to a substance Acute toxicity studies
in animals are usually necessary for any pharmaceutical intended for human use The information
obtained from these studies is useful in choosing doses for repeat-dose studies providing
preliminary identification of target organs of toxicity and occasionally revealing delayed toxicity
Acute toxicity studies may also aid in the selection of starting doses for Phase 1 human studies and
provide information relevant to acute overdosing in humans Acute toxicity is the toxicity produced
by a pharmaceutical when it is administered in one or more doses during a period not exceeding 24
hours
The test compound should be administered to animals to identify doses causing no adverse effect
and doses causing major (life-threatening) toxicity The use of vehicle control groups should be
considered For compounds with low toxicity the maximum feasible dose should be administered
Acute toxicity studies in animals should ordinarily be conducted using two routes of drug
administration (1) The route intended for human administration and (2) intravenous administration
if feasible When intravenous dosing is proposed in humans use of this route alone in animal testing
is sufficient
Studies should be conducted in at least two mammalian species including a non rodent species when
reasonable The objectives of acute studies can usually be achieved in rodents using small groups of
animals (for instance three to five rodents per sex per dose) Where non rodent species are
appropriate for investigation use of fewer animals may be considered Any data providing
information on acute effects in nonrodent species including preliminary dose-range finding data for
repeat-dose toxicity studies may be acceptable
Animals should be observed for 14 days after pharmaceutical administration All mortalities clinical
signs time of onset duration and reversibility of toxicity should be recorded Gross necropsies
should be performed on all animals including those sacrificed moribund found dead or terminated
at 14 days
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
19
In addition if acute toxicity studies in animals are to provide the primary safety data supporting
single dose safetykinetic studies in humans (eg a study screening multiple analogs to aid in the
selection of a lead compound for clinical development) the toxicity studies should be designed to
assess dose-response relationships and pharmacokinetics Clinical pathology and histopathology
should be monitored at an early time and at termination (ie ideally for maximum effect and
recovery)
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
20
18 ANATOMY AND PHYSIOLOGY OF LIVER
THE LIVER
Fig 3 Liver
181 Anatomy of the liver
The liver is located in the upper right-hand portion of the abdominal cavity beneath the diaphragm
and on top of the stomach right kidney and intestines Shaped like a triangle the liver is a dark
reddish-brown organ that weighs about three pounds
There are two distinct sources that supply blood to the liver
oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the bodys blood supply at any given moment
The liver consists of two main lobes both of which are made up of thousands of lobules These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine)
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
21
182 Blood Supply
Normal hepatic blood flow rate is ~1500 ccmin in adults (25-30 of total carbon monoxide) and
normal hepatic blood volume is ~450 cc The liver has the unique ability to augment circulating
blood volume by up to 300 cc during low volume states such as dehydration or hemorrhage
Additionally it can also hold up to 1 L of blood at the expense of hepatic congestion The blood
supply is a dual system also known as a portal system The two major vessels that provide blood to
the liver are the hepatic artery and portal vein The liver receives a dual blood supply from the
hepatic portal vein and hepatic arteries Supplying approximately 75 of the livers blood supply
the hepatic portal vein carries venous blood drained from the spleen gastrointestinal tract and its
associated organs The hepatic arteries supply arterial blood to the liver accounting for the
remainder of its blood flow Oxygen is provided from both sources approximately half of the livers
oxygen demand is met by the hepatic portal vein and half is met by the hepatic arteries [36]
Blood flows through the sinusoids and empties into the central vein of each lobule The central veins
coalesce into hepatic veins which leave the liver and empty into the inferior vena cava
Weighing about three pounds the liver is a unique organ with many functions crucial to sustaining
life From circulation to digestion the liver continuously processes the blood used by the rest of the
body
Our largest organ the liver works to keep us healthy It converts food into substances needed for life
and growth storing glycogen (a blood-sugar regulator) amino acids protein and fat It also makes
the enzymes and bile that help to digest food
In addition the liver neutralizes harmful toxins and wastes so it is at great risk of contamination
from environmental toxins and those contained in over-processed foods
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
22
183 Biliary flow
The term biliary tree is derived from the arboreal branches of the bile ducts The bile produced in the
liver is collected in bile canaliculi which merge to form bile ducts Within the liver these ducts are
called intrahepatic (within the liver) bile ducts and once they exit the liver they are considered
extrahepatic (outside the liver) The intrahepatic ducts eventually drain into the right and left hepatic
ducts which merge to form the common hepatic duct The cystic duct from the gallbladder joins
with the common hepatic duct to form the common bile duct
Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored
in the gallbladder via the cystic duct The common bile duct and the pancreatic duct enter the second
part of the duodenum together at the ampulla of Vater
184 Physiology
The liver regulates most chemical levels in the blood and excretes a product called bile which
helps carry away waste products from the liver All the blood leaving the stomach and intestines
passes through the liver The liver processes this blood and breaks down the nutrients and drugs into
forms that are easier to use for the rest of the body More than 500 vital functions have been
identified with the liver Some of the more well-known functions include
Production of bile which helps carry away waste and break down fats in the small intestine
during digestion
Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats through the body
Conversion of excess glucose into glycogen for storage (This glycogen can later be
converted back to glucose for energy)
Regulation of blood levels of amino acids which form the building blocks of proteins
Processing of hemoglobin for use of its iron content (The liver stores iron)
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
23
Conversion of poisonous ammonia to urea (Urea is one of the end products of protein
metabolism that is excreted in the urine)
Clearing the blood of drugs and other poisonous substances
Regulating blood clotting
Resisting infections by producing immune factors and removing bacteria from the blood
stream
When the liver has broken down harmful substances its by-products are excreted into the bile or
blood Bile by-products enter the intestine and ultimately leave the body in the faeces Blood by-
products are also filtered out by the kidneys and leave the body in the form of urine
185 Other functions
The liver stores a multitude of substances including glucose (in the form of glycogen)
vitamin A (1ndash2 years supply) vitamin D (1ndash4 months supply) vitamin B12 (1-3 years
supply) iron and copper
The liver is responsible for immunological effects- the reticuloendothelial system of the liver
contains many immunologically active cells acting as a sieve for antigens carried to it via
the portal system
The liver produces albumin the major osmolar component of blood serum
The liver synthesizes angiotensinogen a hormone that is responsible for raising the blood
pressure when activated by renin an enzyme that is released when the kidney senses low
blood pressure
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
24
19 LIVER DISEASE
Liver disease is any disturbance of liver function that causes illness The liver is responsible for
many critical functions within the body and should it become diseased or injured the loss of those
functions can cause significant damage to the body Liver disease is also referred to as hepatic
disease
Liver disease is a broad term that covers all the potential problems that may occur to cause the liver
to fail to perform its designated functions Usually more than 75 or three quarters of liver tissue
needs to be affected before decrease in function occurs
The most amazing thing about the liver is its resilience and sturdiness Liver function can often
continue even when the liver is afflicted by serious problems and even potentially life-threatening
liver diseases It can keep working even when diseases destroy most of its cells and unlike other
organs it can even regenerate although a large portion has been removed during surgery (an attribute
which has saved the lives of thousands who have had liver transplants from living donors)
191 Liver disease types
A liver problem can be minor or fatal Generally a liver problem will fall into one of three
categories
Problems affecting liver cells
Problems related to the secretion or production of bile
Toxins that accumulate in the liver and cause liver damage
192 Common liver problems
1921 Hepatitis This is can be an extremely serious liver problem It happens when the liver
becomes inflamed There are several different kinds of hepatitis including hepatitis A hepatitis B
and hepatitis C
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
25
1922 Cirrhosis This was once the most common liver problem in many countries Cirrhosis
results when the liver becomes scarred usually from drinking too much alcohol Most people call it
cirrhosis of the liver but technically speaking this very serious and life threatening liver problem
can simply be called cirrhosis
1923 Fatty Liver Disease This liver problem occurs when droplets of fat begin to accumulate on
the liver As the fat deposits grow they interfere with liver function
1924 Liver Cancer This is a potentially serious and often fatal liver problem Liver cancer can
originate in the liver itself or it can result from the spread (metastasis) of cancer from a nearby
organ
1925 Enlarged liver Liver enlargement is usually a clue that some other liver problem has
developed An enlarged liver is a liver that has grown beyond its normal size It is also known as
hepatomegaly Symptoms of this liver problem are rare but if the liver becomes grossly enlarged
the patient may begin to experience abdominal discomfort or a sense of feeling full
1926 Liver cysts Simple liver cysts are sac-like formations in the liver filled with mucous or
watery substances Theyre usually benign cause no signs or symptoms and dont require treatment
This liver problem is not life threatening
1927 Wilsons disease This is a genetic defect that causes a liver problem It results from
abnormal amounts of copper accumulating in the body This can lead to cirrhosis a very serious
liver problem indeed Patients with Wilsons disease sometimes experience jerky muscular
movements and copper colored rings around the eyes
1928 Hemochromatosis This disease causes extra iron to build up in the liver1929
Primary sclerosing cholangitis or PSC This is a liver problem that involves the bile ducts inside
and outside the liver These ducts become inflamed and scarred Eventually the ducts become
blocked causing damage to the liver cells Liver failure and cirrhosis can result
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
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9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
26
19210 Primary biliary cirrhosis or PBC This is a slow progressive destruction and loss of
bile ducts in the liver This can also lead to liver failure and cirrhosis
19211 Autoimmune hepatitis This results from an attack on the liver by the bodys own immune
system The liver becomes inflamed and over time cirrhosis can develop
110 Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by
fibrosis scar tissue and regenerative nodules (lumps that occur as a result of a process in which
damaged tissue is regenerated)[37-39]
leading to loss of liver function Cirrhosis is most commonly
caused by alcoholism hepatitis B and C and fatty liver disease but has many other possible causes
Some cases are idiopathic ie of unknown cause
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is
associated with a poor quality of life increased risk of infection and a poor long-term outcome
Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma)
and bleeding from esophageal varices Cirrhosis is generally irreversible and treatment usually
focuses on preventing progression and complications In advanced stages of cirrhosis the only option
is a liver transplant
1101 Signs and symptoms
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of
the complications of cirrhosis Many are nonspecific and may occur in other diseases and do not
necessarily point to cirrhosis Likewise the absence of any does not rule out the possibility of
cirrhosis
Spider angiomata or spider nevi Vascular lesions consisting of a central arteriole surrounded
by many smaller vessels due to an increase in estradiol These occur in about 13 of cases [40]
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
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3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
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5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
27
Palmar erythema Exaggerations of normal speckled mottling of the palm due to altered
sex hormone metabolism
Nail changes
o Muehrckes lines - paired horizontal bands separated by normal color due to
hypoalbuminemia (inadequate production of albumin)
o Terrys nails - proximal two-thirds of the nail plate appears white with distal one-third
red also due to hypoalbuminemia
o Clubbing - angle between the nail plate and proximal nail fold gt 180 degrees
Hypertrophic osteoarthropathy Chronic proliferative periostitis of the long bones that can
cause considerable pain
Dupuytrens contracture Thickening and shortening of palmar fascia that leads to flexion
deformities of the fingers Thought to be due to fibroblastic proliferation and disorderly
collagen deposition It is relatively common (33 of patients)
Gynecomastia Benign proliferation of glandular tissue of male breasts presenting with a
rubbery or firm mass extending concentrically from the nipples This is due to increased
estradiol and can occur in up to 66 of patients
Hypogonadism Manifested as impotence infertility loss of sexual drive and testicular
atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function
Liver size Can be enlarged normal or shrunken
Splenomegaly (increase in size of the spleen) Due to congestion of the red pulp as a result of
portal hypertension
Ascites Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs
about 1500 mL to detect flank dullness) It may be associated with hydrocele and penile
flomation (swelling of the penile shaft) in men
Caput medusa In portal hypertension the umbilical vein may open Blood from the portal
venous system may be shunted through the periumbilical veins into the umbilical vein and
ultimately to the abdominal wall veins manifesting as caput medusa
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
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3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
28
Cruveilhier-Baumgarten murmur Venous hum heard in epigastric region (on examination
by stethoscope) due to collateral connections between portal system and the remnant of the
umbilical vein in portal hypertension
Fetor hepaticus Musty odor in breath due to increased dimethyl sulfide
Jaundice Yellow discoloring of the skin eye and mucus membranes due to increased
bilirubin (at least 2ndash3 mgdL or 30 mmolL) Urine may also appear dark
Asterixis Bilateral asynchronous flapping of outstretched dorsiflexed hands seen in patients
with hepatic encephalopathy
Other Weakness fatigue anorexia weight loss
1102 Complications
As the disease progresses complications may develop In some people these may be the first signs
of the disease
Bruising and bleeding due to decreased production of coagulation factors
Jaundice due to decreased processing of bilirubin
Itching (pruritus) due to bile salts products deposited in the skin
Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous
substances from the blood which are carried to the brain affecting cerebral functioning
neglect of personal appearance unresponsiveness forgetfulness trouble concentrating or
changes in sleep habits
Sensitivity to medication due to decreased metabolism of the active compounds
Hepatocellular carcinoma is primary liver cancer a frequent complication of cirrhosis It has
a high mortality rate
Portal hypertension - blood normally carried from the intestines and spleen through the
hepatic portal vein flows more slowly and the pressure increases this leads to the following
complications
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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elaborationA consensus statement from chcalemical toxicologists consulting to the
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70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
29
o Ascites - fluid leaks through the vasculature into the abdominal cavity
o Esophageal varices - collateral portal blood flow through vessels in the stomach and
esophagus These blood vessels may become enlarged and are more likely to burst
Problems in other organs
o Cirrhosis can cause immune system dysfunction leading to infection
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in
the intestines (spontaneous bacterial peritonitis)
o Hepatorenal syndrome - insufficient blood supply to the kidneys causing acute renal
failure This complication has a very high mortality (over 50)
o Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting)
leading to cyanosis and dyspnea (shortness of breath) characteristically worse on
sitting up[41]
o Portal hypertensive gastropathy which refers to changes in the mucosa of the stomach
in patients with portal hypertension and is associated with cirrhosis severity[42]
1103 Causes
Cirrhosis has many possible causes sometimes more than one cause is present in the same patient
In the Western World chronic alcoholism and hepatitis C are the most common causes
Alcoholic liver disease (ALD) Alcoholic cirrhosis develops for between 10 and 20 of
individuals who drink heavily for a decade or more[43]
There is great variability in the
amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3
in some women) Alcohol seems to injure the liver by blocking the normal metabolism of
protein fats and carbohydrates Patients may also have concurrent alcoholic hepatitis with
fever hepatomegaly jaundice and anorexia
Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and
a variable grade of damage to the organ that over several decades can lead to cirrhosis
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
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3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
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9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
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Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
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16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
30
Cirrhosis caused by hepatitis C is the most common reason for liver transplant It can be
diagnosed with serologic assays that detect hepatitis C antibody or viral RNA
Chronic hepatitis B The hepatitis B virus causes liver inflammation and injury that over
several decades can lead to cirrhosis
Non-alcoholic steatohepatitis (NASH) In NASH fat builds up in the liver and eventually
causes scar tissue This type of hepatitis appears to be associated with diabetes protein
malnutrition obesity coronary artery disease and treatment with corticosteroid medications
This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol
history Biopsy is needed for diagnosis
Primary biliary cirrhosis May be asymptomatic or complain of fatigue pruritus and non-
jaundice skin hyperpigmentation with hepatomegaly There is prominent alkaline
phosphatase elevation as well as elevations in cholesterol and bilirubin Gold standard
diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid
bile duct lesions It is more common in women
Primary sclerosing cholangitis PSC is a progressive cholestatic disorder presenting with
pruritus steatorrhea fat soluble vitamin deficiencies and metabolic bone disease There is a
strong association with inflammatory bowel disease (IBD) especially ulcerative colitis
Autoimmune hepatitis This disease is caused by the immunologic damage to the liver
causing inflammation and eventually scarring and cirrhosis Findings include elevations in
serum globulins especially gamma globulins Therapy with prednisone +- azathioprine is
beneficial Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90+ There is
no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of
corticosteroids
Hereditary hemochromatosis Usually presents with family history of cirrhosis skin
hyperpigmentation diabetes mellitus pseudogout andor cardiomyopathy all due to signs of
iron overload Labs will show fasting transferrin saturation of gt 60 and ferritin gt
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
31
300 ngmL Genetic testing may be used to identify mutations If these are present biopsy
may not need to be performed Treatment is with phlebotomy to lower total body iron levels
Wilsons disease Autosomal recessive disorder characterized by low serum ceruloplasmin
and increased hepatic copper content on liver biopsy
Cardiac cirrhosis Due to chronic right sided heart failure which leads to liver congestion
Galactosemia
Glycogen storage disease type IV
Cystic fibrosis
Hepatotoxic drugs or toxins
Certain parasitic infections (such as schistosomiasis)
1104 Liver Function Tests
Often in the initial stages diseases of the liver result in very mild symptoms and in some cases none
at all For this reason in certain instances liver function tests are performed to detect evaluate and
monitor liver disease or damage
Early detection of liver disease is vital to recovery If you are at risk for liver disease or take
medication that may cause liver damage or have symptoms of liver disease your physician may
suggest liver function test Liver function tests (also known as LFTs or LFs) include liver enzyme
readings A single blood sample may include liver function testing for the following [44]
Alanine transaminase (ALT) An enzyme that helps metabolizes protein When the liver is
damaged ALT is released in the bloodstream
Alkaline phosphatase (ALP) An enzyme needed in small amounts to trigger specific
chemical reactions Normally present in the liver bone kidney and intestine higher than
normal levels may indicate liver damage or disease
Aspartate transaminase (AST) This enzyme plays a role in the metabolism of the amino acid
alanine An increase in AST levels may indicate liver damage or disease
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
32
Albumin and total protein Levels of albumin ndash a protein made by the liver ndash and total
protein indicate how well the liver is making the proteins needed to fight infections and
perform other functions Lower than normal levels may indicate liver damage or disease
Bilirubin A bi-product from the breakdown of red blood cells bilirubin normally passes
through the liver and is excreted in stool Elevated levels ndash manifested as jaundice ndash may
indicate liver damage or disease
Additional tests that may be used to evaluate liver function include [45]
Gamma-glutamyl transferase (GGT) This test measures the amount of the enzyme GGT in
the blood Higher than normal levels may indicate liver or bile duct injury
Lactate dehydrogenase (LDH) An enzyme found in many body tissues elevated levels of
LDH may indicate liver damage
Prothrombin time (PT) This test measures the clotting time of plasma Increased PT may
indicate liver damage
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
33
111 Hepatitis This implies inflammation of the liver characterized by the presence of
inflammatory cells in the tissue of the organ The name is from the Greek hepar the root being
hepat- meaning liver and suffix -itis meaning inflammation (c 1727)[46]
The condition can be
self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis
Hepatitis may occur with limited or no symptoms (subclinically) but often leads to jaundice
anorexia (poor appetite) and malaise Hepatitis is acute when it lasts less than six months and
chronic when it persists longer A group of viruses known as the hepatitis viruses cause most cases
of hepatitis worldwide but it can also be due to toxins (notably alcohol certain medications and
plants) other infections and autoimmune diseases
1111 Signs and symptoms
Acute
Initial features are of nonspecific flu-like symptoms common to almost all acute viral infections and
may include malaise muscle and joint aches fever nausea or vomiting diarrhea and headache
More specific symptoms which can be present in acute hepatitis from any cause are profound loss
of appetite aversion to smoking among smokers dark urine yellowing of the eyes and skin (ie
jaundice) and abdominal discomfort Physical findings are usually minimal apart from jaundice in a
third and tender hepatomegaly (swelling of the liver) in about 10 Some exhibit lymphadenopathy
(enlarged lymph nodes in 5) or splenomegaly (enlargement of the spleen in 5)[47]
Acute viral hepatitis is more likely to be asymptomatic in younger people Symptomatic individuals
may present after convalescent stage of 7 to 10 days with the total illness lasting 2 to 6 weeks[48]
A small proportion of people with acute hepatitis progress to acute liver failure in which the liver is
unable to clear harmful substances from the circulation (leading to confusion and coma due to
hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding)
This may become life-threatening and occasionally requires a liver transplant
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
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3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
34
Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise tiredness and weakness and
often leads to no symptoms at all It is commonly identified on blood tests performed either for
screening or to evaluate nonspecific symptoms The occurrence of jaundice indicates advanced liver
damage On physical examination there may be enlargement of the liver[49]
Extensive damage and scarring of liver (ie cirrhosis) leads to weight loss easy bruising and
bleeding tendencies peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the
abdominal cavity) Eventually cirrhosis may lead to various complications esophageal varices
(enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic
encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction)
Acne abnormal menstruation lung scarring inflammation of the thyroid gland and kidneys may be
present in women with autoimmune hepatitis[50]
Causes
Acute
Viral hepatitis
o Hepatitis A through E (more than 95 of viral cause)[47]
o Herpes simplex
o Cytomegalovirus
o Epstein-Barr
o yellow fever virus
o adenoviruses
Non viral infection
o toxoplasma
o Leptospira
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
35
o Q fever[51]
o rocky mountain spotted fever[52]
Alcohol
Toxins Amanita toxin in mushrooms carbon tetrachloride asafetida
Drugs Paracetamol amoxycillin antituberculosis medicines minocycline and many others
(see longer list below)
Ischemic hepatitis (circulatory insufficiency)
Pregnancy
Auto immune conditions eg Systemic Lupus Erythematosus (SLE)
Metabolic diseases eg Wilsons disease
Chronic
Viral hepatitis Hepatitis B with or without hepatitis D hepatitis C (neither hepatitis A nor
hepatitis E causes chronic hepatitis)
Autoimmune
o Autoimmune hepatitis
Alcohol
Drugs
o methyldopa
o nitrofurantoin
o isoniazid
o ketoconazole
Non-alcoholic steatohepatitis
Heredity
o Wilsons disease
o alpha 1-antitrypsin deficiency
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
36
Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic
hepatitis[49]
1112 Alcoholic hepatitis
Ethanol mostly in alcoholic beverages is a significant cause of hepatitis Usually alcoholic hepatitis
comes after a period of increased alcohol consumption Alcoholic hepatitis is characterized by a
variable constellation of symptoms which may include feeling unwell enlargement of the liver
development of fluid in the abdomen (ascites) and modest elevation of liver blood tests Alcoholic
hepatitis can vary from mild with only liver test elevation to severe liver inflammation with
development of jaundice prolonged prothrombin time and liver failure Severe cases are
characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin
levels and prolonged prothrombin time the mortality rate in both categories is 50 within 30 days
of onset
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic
hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis Alcoholic
hepatitis by itself does not lead to cirrhosis but cirrhosis is more common in patients with long term
alcohol consumption Patients who drink alcohol to excess are also more often than others found to
have hepatitis C The combination of hepatitis C and alcohol consumption accelerates the
development of cirrhosis
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
37
112 MILLETTIA ABOENSIS (Hookf)Baker
1121 TAXONOMY
Domain Eukaryota
Kingdom Plantae
Subkingdom Viridaeplantae
Phylum Magnoliophyta
Subphylum Euphyllophytina
Infraphylum Radiatopses
Class Magnoliopsida
Subclass Rosidae
Superorder Fabanae
Order Fabales
Family Fabaceae
Subfamily Faboideae
Tribe Tephrosieae
Genus Millettia
Specific epithet aboensisr
Botanical name Millettia aboensis (Hookf)Baker
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
38
1122 NATURE AND OCCURRENCE
It is mainly tropical and sub tropical family of tree whose leaves are stipulate nearly always
alternate and range from bipinnately or palmately compound to simple The leaflets are mostly
stipellate and opposite and stipules very small Its inflorescence is terminal raceme or panicle and
flowers are white rose or purple The bracts and bracteoles often deciduous before flowering The
calyx teeth almost absent or short vexillum large nude or callose above the claw or rarely
appendaged with auricles The stamens are mono or diadelphous vexillary stamen free at the base
but more or less connate above or quite free anthers uniform The ovary is sessile or rarely stipulate
style glabrous stigma terminal with numerous ovules There is annular disk surrounding the ovary
The Fruits is compressed flat or thick or woody 2-valved or tardily dehiscent This type of specie is
found in Cameroon Gabon and Nigeria ( Nsukka Udi Enugu Anambra etc)
It is found in commonly in low land rain forest often on low lying marshy sites Small trees of 30ndash
40 feet high and up to 2 feet in girth but usually 12 m high with reddish-brown pubescence on the
petioles branches inflorescence and fruits The flowers are purple in erect woody racemes up to 18
in long [53]
It has conspicuously rusty-hairy leaves and handsome purple flowers in erect terminal
racemes at branch-ends
1123 Uses of the plant
1124 Medicinal values
Almost all the part of Millettia aboensis (uturuekpa) has medicinal properties The leaf is used by
traditional herbalist for general healing including ulcer healing and laxatives while the root is used in
treating gastro intestinal disturbances and liver disease Also the leaf stem and roots mixed with
other plant materials (herbs) is used to cure veneral diseases such as gonorrhoea syphilis etc
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
39
113 AIMS OF THE STUDY
The aim of this study was to evaluate the hepatoprotective activity of root extrcts of Millettia
aboensis on carbon tetrachloride and paracetamol induced hepatotoxicity in rats and also carry out
phytochemical test on the extracts
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
40
CHAPTER TWO
21 MATERIALS AND METHODS
21 PLANT MATERIAL
The roots of Millettia aboensis were harvested from Ehandigu Nsukka Enugu State The plant
material was authenticated by Mr A Ozioko at Bio resource Development and Conservative
Programme (BDCP) Nsukka Enugu State
Fig 4 Millettia aboensis
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
41
22 Experimental Animals
The albino rats weighing 66-153g of either sex obtained from the Faculty of Veterinary Medicine
UNN were used The rats were allowed to acclimatize in the experimental animal house unit of the
Department of Biochemistry UNN for 5 days during which they were fed with standard rodent
diet Water was given liberally
23 Chemicals The chemicals used in this study were of analytical grade products of BDH
England and Sigma Aldrich Germany They include ethanol sulphuric acid and sodium hydroxide
Solvents used are for the extraction of the plant material were ethanol and water Formalin was for
preservation of the dissected liver Liv 52(R)
Paracetamol carbon tetrachloride diluted with liquid
paraffin in the ration of 11 and normal saline
24 Extraction of plant materials The root of Millettia aboensis was shade - dried and pulverized
to coarse powder using an electrically operated mill It was extracted with 90 ethanol in soxhlet
extractor concentrated under vacuum (yield 4593 ) The aqueous extraction was done by placing
50 g of the powder in a 250 ml percolator which was initially plugged with a cotton wool at the base
A volume of 150 ml of distilled water was added and thoroughly mixed The mixture was then
allowed to macerate filtered and dried (yield 4902 ww)
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
42
25 Phytochemicals analysis
The phytochemical analyses of Millettia aboensis extracted ethanol and distilled water respectively
were carried out using standard procedures [54]
251 Test for glycosides
A 50 ml volume of dilute sulphuric acid was added to 01 g of the extracts in a test tube and
boiled for 15 mins on a water bath then cooled and neutralized in 20 potassium hydroxide
solution 100 ml of a mixture of equal parts of fehling‟s solution I and II was added and boiled for 5
minutes A denser brick red ppt indicates the presence of glycosides
252 Test for alkaloids
A 200ml volume of 3 sulphuric acid in 50 ethanol was added to 20 g of the extracts
and heated on a boiling water bath for 10 mins cooled and filtered 20 ml of the filtrate was tested
with a few drops of Mayer‟s reagent (potassium mercuric iodine solution) Dragendoff‟s reagents
(bismuth potassium iodide solution) Wagner‟s reagent (iodine in potassium iodide solution) and
picric acid solution (1 )
The remaining filtrate was placed in 100 ml separating funnel and made alkaline in dilute ammonia
solution The aqueous alkaline solution was separated and the alkaloid extracted with two 50ml
portions of dilute sulphuric acid The extract was tested with a few drops of Mayer‟s Wagner‟s
Dragendoff‟s reagents and picric acid solution Alkaloids give milky precipitate with few drops of
Mayer‟s reagent reddish brown precipitate with few drops of Wagner‟s reagent yellowish
precipitate with few drops of picric acid and brick red precipitate with few drops of Dragendoff‟s
reagents
253 Test for reducing sugar
2531 Molisch test A 50 ml volume of a mixture of equal parts of Fehling‟s solution I and II
were added to 05 ml of extracts and then heated on a water bath for 5 mins A brick red precipitate
shows the presence of reducing sugar
254 Test for tannins
10g of extracts was boiled with 200 ml of water filtered and used for the following tests
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
43
2541 Ferric chloride test
To 30 ml of the filtrate few drops of ferric chloride were added A greenish black precipitate
indicates the presence of tannins
256 Test for saponin
20 ml of distilled water was added to 025 g of the extracts and boiled on a hot water bath for
2 mins The mixture was filtered while hot and allowed to cool and filtrate was used for the
following test
2561 Frotthing test
50 ml of the filtrate was diluted with 150 ml of distilled water and shaken vigorously A
stable froth (foam) upon standing indicates the presence of saponins
257 Test for flavonids
100 ml volume of ethyl acetate was added to 02 g of the extracts and heated on a water bath
for 3 mins The mixture was cooled filtered and the filtrate was used for the following test
2571 Ammonium test
40 ml volume of the filtrate was shaken with 1 ml of dilute ammonia solution Two layers
were allowed to separate and the yellow colour in the ammonical layer indicated the presence of
flavonids
258 Test for protein
05 g of the extracts was extracted with 50 ml of distilled water and the filtrate was used for the
following test
2581 Millionrsquos test
To a little portion of the filtrate in a test tube two drops of million‟s reagent was added A white
ppt indicates the presence of protein
259 Test for steroids and terpeniods
90ml volume of ethanol was added to 10 g of the extracts and refluxed for a few minutes and
filtered The filtrate was concentrated to 25 ml in a boiling water bath 50 ml of hot distilled water
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
44
was added to the concentrated solution the mixture was allowed to stand for 1 h and waxy matter
was filtered off The filtrate was extracted with 25 ml of chloroform using separating funnel To 05
ml of the chloroform extract in a test tube was carefully added 10 ml of concentrated sulphuric acid
to form a lower layer A reddish brown interface shows the presence of steroids
Another 05 ml of the chloroform extract was evaporated to dryness on a water bath and heated with
3 ml of concentrated sulphuric acid on a water bath A grey colour indicates the presence of
terpernoids
2510 Test for fats and oil
01 g of the extracts was pressed between filters and the paper was observed A control was also
prepared by placing 2 drops of olive oil in filter paper Translucency of the filter paper indicates the
presence of fats and oil
2511 Test for carbohydrate
10 g of the extracts was boiled in 20 ml of distilled water and filtered To the filtrate few drops
of naphthol solution in ethanol (Molisch‟s reagent) were added Concentrated sulphuric acid was
then gently poured down the side of the test tube to form a lower layer A purple interfacial ring
indicates the presence of carbohydrate
2512 Test for resins
25121 Precipitation test
01 g of the extracts was extracted with 150 ml of 96 ethanol The alcoholic extract was then
poured into 200 ml of distilled water in a beaker A precipitates occurring indicates the presence of
resins
2513 Test for Acidic compound
01g of the extracts was placed in a clear dry test tube and sufficient water added This was
warmed in a hot water bath and then cooled A piece of wet litmus paper was dipped into the filtrate
and the colour change on the litmus paper was observed Acidic compound turn blue litmus paper
red [55]
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
45
26 ACUTE TOXICITY DETERMINATION
261 Acute oral toxicity test This was performed according to modified Dietrich Lorke method
[56] Here an initial investigation involving administering (10 100 and 1000 mgkg) of the plant
extract to three different groups of three mice each After 24 hrs the number of deaths was recorded
but there was no death The result was compared to that in a table given in (refhellip) Based on the
result from the same table the doses to be chosen for a second acute oral toxicity test were
extrapolated In this second test three dose levels were used (1600 2900 amp 5000 mgkg)
Observations were made up to 14 days during which dead animals and toxic manifestations were
noted The LD50 was calculated as the geometric mean of the minimum dose that cause 0 death
and the maximum dose that cause 100 death Aqueous and alcoholic extracts of Millettia aboensis
produced death to the doses of 2900 mgkg and 5000 mgkg body weight Hence 15th and 110th of
the lethal dose ie 215 mgkg PO and 431 mgkg PO of both the extracts were used for the next
study
27 Evaluation of hepatoprotective activity (Acute hepatitis model)
Sixty-five healthy albino rats of either sex housed under standard conditions and fed with standard
rodent diet with water were used and their livers were damaged using carbontetrachloride and
paracetamol
The CCl4 was diluted with liquid paraffin (11) before administration and paracetamol (350mgkg)
was administered also The rats were divided into 13 groups consisting of 5 rats per group The
animals were then subjected to either one of the following treatments for 9 days
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
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7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
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8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
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9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
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10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
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Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
46
Table 1 Administration of the drugs to the groups
GROUPS TREATMENT
1 Treated with distilled water (1mlkg per oral
(PO))
2 Treated with distilled water for nine days + CCl4
(07mlkg IP) administered on the nineth day
3 Treated with distilled water for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
4 Treated with LIV 52(R)
1mlkg PO for nine days +
CCl4 (07mlkg IP) administered on the nineth
day
5 Treated with LIV 52(R)
1mlkg PO for nine days +
Paracetamol (350 mgkg IP) administered on the
nineth day
6 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
7 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
8 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
9 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days + CCl4
(07mlkg IP) administered on the nineth day
10 Treated with alcoholic extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
11 Treated with aqueous extract of Millettia
aboensis (215mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
12 Treated with alcoholic extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
13 Treated with aqueous extract of Millettia
aboensis (431mgkg PO) for nine days +
paracetamol (350mgkg IP) administered on the
nineth day
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
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1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
47
Food was withdrawn 12 hr before carbon tetrachloride and PCM administration to enhance the
acute liver damage in animals of groups 2 4 6 7 8 and 9 and groups 3 5 10 11 12 and 13 for
CCl4 and PCM respectively The animals were sacrificed 24 hrs after the administration of CCl4 and
48 hrs after the administration of PCM respectively Blood samples were collected and the serum
assayed for marker enzymes such as aspartate aminotransferase (AST)[57]
alanine aminotransferasen
(ALT)[57]
alkaline phosphatase (ALP)[58]
and the liver immediately isolated and washed with normal
saline blotted with filter paper and weighed The liver was then subjected to Histopathological
examination [59]
28 Statistical analysis
The statistical significance was assessed using one way analysis of variance (ANOVA) followed by
Bonferroni‟s multiple comparison test The values are expressed as means plusmn SEM and values of Ple
005 were considered significant
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
48
CHAPTER THREE
30 RESULT OF PHYTOCHEMICAL ANALYSIS
31 Preliminary phytochemical investigation- The preliminary phytochemical investigation of
both extracts of Millettia aboensis revealed the phytoconstituents presented in Table 2
Table 2 Phytoconstituents of Alc amp Aq extracts of M aboensis
ExtractsTest Alcohol Water
Test for Flavanoids +++ +
Test for Saponins + ++++
Test for glycosides +++ +++
Test for Tannins _ _
Test for Carbohydrates ++ +++
Test for Reducing Sugars + +
Test for Steroids ++ +
Test for Proteins and Amino Acids + +++
Test for Acidic compounds _ _
Test for Alkaloids +++ ++
Test for Resins _ +++
Test for Terpenoids ++ +
Test for Fats and Oil _ _
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
49
32 Acute oral toxicity study- The acute oral toxicity study was carried out and the results
obtained are presented in Table 3 and 4
Acute oral toxicity was performed according to Modified Dietrich Lorke Method
Table 3 Initial acute oral toxicity test
Samples Dose levels
10 mgkg 100 mgkg 1000 mgkg
Aqueous extract 03 03 03
Ethanolic extract 03 03 03
The actual acute toxicity test involved dose levels of 1600 mgkg 2900 mgkg and 5000 mgkg
using 3 animals per dose-level At the end of 14 days the surviving animals were all of 1600 mgkg
two of 2900 mgkg and one of 5000 mgkg for both extracts as shown in Table 4
Table 4 Main Acute Oral toxicity test
Dose level 1600 mgkg 2900 mgkg 5000 mgkg
Surviving animal 33 23 13
Therefore the LD50 was calculated as 2154mgkg using the Dietrich lorke‟s method for calculation
of LD50 The necropsy and autopsy were performed and signs of toxicity included diarrhea and
congested lungs with focal areas of necrosis
33 Carbon tetrachloride and paracetamol induced acute toxicity ndash A significant difference in
biochemical markers was observed between normal and CCl4 or PCM treated groups Comparative
analysis of the effect of various extracts on ALT AST and ALP levels revealed that alcoholic extract
and aqueous extract (431 mgkg body weight) of Millettia aboensis showed protection against the
hepatoxins
34 Liver enzyme analysis Tables 5 to 9 show the levels of AST ALT ALP Total Billirubin and
Conjugated bilirubin in CCl4 induced hepatotoxicity
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
50
The effects of ethanolic and aqueous extracts of Millettia aboensis on CCl4 induced hepatic
damage in rats (mean plusmn SEM)
Effcets of ethanolic extract of Millettia aboensis on CCl4 induced hepatic damage in rats
The liver is damaged by xenobiotics which induced oxidative stress This is because the liver is the
primary site of metabolism in animals This is exhibited by the increase levels of the liver enzymes
The increased AST and other liver function enzymes are used for the indication of liver diseases
Rats that were given hepatoprotective drugs have decrease AST level when exposed to CCl4 or
intoxicant The test drug mediated reduction in level of AST towards the normal values which is an
indication of stabilization
Fig 5 Level of AST in the Treated rats
0
20
40
60
80
100
120
VEHICLE CONTROL CCL4 CONTROL LIV 52(R) (1mlkg PO) + CCL4
AQ EXT (215mgkg) + CCL4
ALC EXT (215mgkg) + CCL4
AQ EXT (431mgkg) + CCL4
ALC EXT (431mgkg) + CCL4
Treatment
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
51
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALT (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone The observed effects were dose dependent and are significant at p le 005 with
respect to negative controls (CCl4) This shows that ethanolic and aqueous extracts of Millettia
aboensis had hepatoprotective effect
Fig 6 Level of ALT in the Treated rats
0
10
20
30
40
60
70
80
Vehicle Control
CCl4 Control LIV 52 (R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALT
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
52
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of ALP (UL)
in CCl4 treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with CCl4 alone as shown in fig7 The observed effects were dose dependent and are significant at p
le 005 with respect to negative controls (CCl4)
Fig 7 Level of ALP in the treated rats
0
50
100
150
200
250
300
350
400
VEHICLE CONTROL
CCl4 CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of ALTs
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
53
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of total
bilirubin (mgdl) in treated rats
The results of the effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in CCl4 treated rats as shown in fig 8 The result showed a dose dependent
decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract appears to have
greater decrease in total bilirubin when compared to aqueous extract However the total bilirubin in
rats treated with CCl4 alone was significantly higher in rats which receive extracts Liv 52(R)
and
vehicle treated rats
Fig 8 Total Billirubin Level in the treated rats
0
5
10
15
2 0
2 5
3 0
3 5
4 0
4 5
5 0
VEHICLE
CONTROL
CCl4
CONTROL
LIV 52
(1mlkg PO)
+ CCl4
AQ EXT
(215mgkg) +
CCl4
ALC EXT
(215mgkg) +
CCl4
AQ EXT
(431mgkg) +
CCl4
ALC EXT
(431mgkg) +
CCl4
Treatment
To
tal B
illiru
bin
le
ve
l
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
54
The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of conjugated
bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of CCl4 in alcoholic and aqueous treated rats CCl4 causes a
severe liver toxicity which was higher than that treated with both extracts and vehicle alone The
level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was comparable with that of the
control
Fig 9 conjugated billirubin level in the treated rats
0
2
4
6
8
10
12
14
16
18
VEHICLE
CONTROL CCL4
CONTROL LIV 52(R)
(1mlkg PO) + CCl4
AQ EXT (215mgkg) +
CCl4
ALC EXT (215mgkg) +
CCl4
AQ EXT (431mgkg) +
CCl4
ALC EXT (431mgkg) +
CCl4
Treatment
Level of Conjugated bilirubin
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
55
The extracts showed dose dependent activity Alcoholic and aqueous extract at higher doses ie
431mgkg body weight PO and LIV-52(R)
(1 mlkg PO) produced a significant reduction (plt005)
in the marker enzymes (AST ALT ALP and serum bilirubin) Lower dose of both extracts
215mgkg PO also showed significant reduction in marker enzyme levels but the effect was less
compared to the higher dose Administration of CCl4 produced moderately significant increase in the
liver weights Higher doses of alcoholic and aqueous extract LIV-52(R)
and lower dose of alcoholic
extract produced significant decrease in the liver weights
a b c
d e
Fig 10 Photographs of liver section taken from rats of group-1 (a) group-2 (b) group-
4 (c) group-8 (d) and group-9 (e)
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
56
The rats treated with vehicle control group-1 (Fig 10a) show normal hepatic structure and visible
portal tract Histopathological examination of the liver tissues from CCl4 intoxicated animals
showed profound inflammation and congestion especially in the sinusoids Hydropic degeneration
and steatosis in the periportal region was also observed (Fig10b) Pretreatment of animals with
LIV-52(R)
(Fig10c) 431mgkg alcoholic extract of Millettia aboensis (Fig10d) and 431mgkg
aqueous extract of Millettia aboensis (Fig10e) showed reduction in inflammation of the skin and
significantly prevented degeneration of hepatocytes
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
57
Figures 11-15 show the effect of Liv 52(R)
ethanolic and aqueous extracts on serum AST
ALT ALP bilirubin levels in paracetamol induced hepatic damaged rats
Fig 11 Effcets of ethanol and aqueous extracts of Millettia aboensis root on the level of AST
(UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of AST (IUL) in
paracetamol treated rats is shown in fig11 The plot showed a dose dependent decrease in AST
(IUL) in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in
AST (IUL) when compared to aqueous extract However the AST (IUL) in rats treated with
Paraceamol alone was significantly higher than in rats which receive extracts Liv 52(R)
and vehicle
treated rats
0
10
20
30
40
50
60
70
80
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)
(1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Fig 11 AST` level in the treated rats
Level of AST
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
58
Fig 12 Effcets of ethanolic and aqueous extracts of Millettia aboensis root on the level of
ALT (UL) in paracetamol treated rats
The effect of ethanolic and aqueous extracts of Millettia aboensis root on the level of ALT (IUL) in
paracetamol treated rats is shown in fig12 The plot shows a dose dependent decrease in ALT (IUL)
in all treated rats At all dose levels the alcoholic extract appears to have greater decrease in ALT
(IUL) when compared to aqueous extract However the ALT (IUL) in rats treated with paracetamol
alone was significantly higher than that in rats which receive the extracts Liv 52(R)
and vehicle
treated rats
Fig 12 ALT Level in the treated rats
0
10
20
30
40
50
60
VEHICLE
CONTROL
PARACETAMOL
CONTROL
LIV 52(R) (1mlkg PO)
+ PARA (350mgkg)
AQ EXT (215mgkg) + PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT
(431mgkg) + PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALT
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
59
Fig13 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
ALP (UL) in paracetamol treated rats
Doses of 431 and 215 mgkg ethanolic and aqueous extracts of Millettia aboensis root inhibited the
increase of serum liver function biomarker when compared with those obtained from rats treated
with paracetamol alone as shown in fig13 The observed effects were dose dependent and is
significant at p le 005 with respect to negative controls (paracetamol)
Fig 13 ALP Level in the Treated rats
0
50
100
150
200
250
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R)(1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg)
+ PARA (350mgkg)
ALC EXT (215mgkg)
+ PARA (350mgkg)
AQ EXT (431mgkg)
+ PARA (350mgkg)
ALC EXT (431mgkg)
+ PARA (350mgkg)
Treatment
Level of ALP
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
60
Fig 14 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
total bilirubin (mgdl) in treated rats
The results of the effect of alcoholic and aqueous extracts of Millettia aboensis root on the level of
total bilirubin (mgdl) in paracetamol treated rats are shown in fig14 The result showed a dose
dependent decrease in total bilirubin in all treated rats At all dose levels the alcoholic extract
appears to have greater decrease in total bilirubin when compared to ethanolic extract However the
total bilirubin in rats treated with paracetamol alone was significantly higher than that in rats which
received both extracts Liv 52(R)
and vehicle alone
Fig 14 Total Biilrubin Level in the treated rats
0
5
10
15
20
25
30
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg PO) + PARA
(350mgkg)
AQ EXT (215mgkg) + PARA
(350mgkg)
ALC EXT (215mgkg)+ PARA
(350mgkg)
AQ EXT (431mgkg) + PARA
(350mgkg)
ALC EXT (431mgkg) + PARA (350mgkg)
Treatment
Total Billirubin Level
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
61
Fig 15 The effects of ethanolic and aqueous extracts of Millettia aboensis on the level of
conjugated bilirubin (mgdl) in treated rats
Hepatotoxicity was assessed by quantifying serum conjugated bilirubin in ethanolic and aqueous
extracts treated rats after administration of paracetamol in alcoholic and aqueous treated rats
Paracetamol causes a severe liver toxicity which was higher than that treated with both extracts and
vehicle alone The level of conjugated bilirubin in alcoholic treated rats at 431 mgkg was
comparable with that of the control
Fig 15 Conjugated Billirubin Level in the treated rats
0
2
4
6
8
10
12
14
16
VEHICLE CONTROL
PARACETAMOL CONTROL
LIV 52(R) (1mlkg
PO) + PARA (350mgkg)
AQ EXT (215mgkg) +
PARA (350mgkg)
ALC EXT (215mgkg) +
PARA (350mgkg)
AQ EXT (431mgkg) +
PARA (350mgkg)
ALC EXT (431mgkg) +
PARA (350mgkg)
Treatment
Level of Congugated
Billirubin
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
62
Pretreatment with ethanolic and aqueous extracts (215 mgkg and 431 mgkg) and Liv 52(R)
significantly reduced the level of AST ALT ALP and serum billirubin after intoxication with
paracetamol
Histological studies of liver give a visual assessment of the hepatic structure Comparing the normal
liver with that with induced hepatotoxicity clearly showed degeneration of hepatocytes necrotic
areas and non visible portal tract resulting from the hepatokin (paracetamol) Fig 16 f-j show the
representative photomicrographs of liver section of rats
Histopathological examinations of the liver tissues showed severe congestion of blood vessels mild
hydropic degeneration pyknosis of nucleus and occasional necrosis in PCM treated animals (Fig 16
g) Animals treated with ethanolic and aqueous extract of Millettia aboensis showed mild hydropic
degeneration and there was no pyknosis or congestion (Fig 16 i and j
f g
h i j
Fig 16 Photographs of liver section taken from rats of group-1 (f) group-3 (g) group-4 (h)
group-12 (i) and group-13 (j)
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
63
The mice treated with a vehicle control (group- 1) (Fig 16f) show normal hepatic structure and
visible portal tract Treatment of animals with paracetamol (350mgkg) (group- 3) results acute
hepatotoxicity as can be observed in fig 16g where it shows as necrotic patches and degenerative
hepatocytes with mild inflammation and unremarkable portal tract Pre-treatment of animals with
alcoholic extract of Millettia aboensis (431mgkg group 12) resulted in heptoprotection as in
fig16i Similar results were observed with pre-treatment of animals with aqueous extract at
431mgkg (group 13) (Fig 16 j)
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
64
VEHICLE CCL4 PARACETAMOL CONTROL CONTROL CONTROL
From the graph CCl4 has more hepatotoxicity effect than paracetamol as seen in biomarker enzyme
Fig 17 Level of AST ALT ALP Total Billirubin and
Conjugated Billirubin in that order Vs various Controls
0
50
100
150
200
250
300
350
400
AST ALT ALP TOTAL BILLIRUBIN
CONJUGATED BILLIRUBIN
Treatment Controls
Level of Various Bioche- micals
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
65
35 DISCUSSION
351 PHYTOCHEMICAL COMPOSITION
The results of phytochemical analysis of both extracts of Millettia aboensis root are shown in table
2 The aqueous extract contained high amount of saponnins resins proteins and amino acid and
carbohydrate while ethanolic extract has high amount of flavonoids alkaloids steroids and
terpenoids Both extracts have equal amount of glycosides and reducing sugar and absence of
tannins acid compounds and fats and oil
Saponnins have varing properties which include haemolytic activity cholester of binding properties
and bitterness [60]
The properties bestow high medicinal importance on Millettia aboensis Most
natural alkaloids and their derivatives are used as basic medicinal agents for their analgesic and
antibacterial effects [60]
They exibit marked physiological activity when administered to animals
Flavonoids are potent water soluble antioxidants and free radical scavengers which prevent oxidative
cell damage [61] [60]
Flavonoids in the intestinal tract lower the risk of diseases associated with
oxidation (heart disease) [60]
Reports have indicated that flavonoids contributed to the
hepatoprotective effect of the plant extracts
352 ACUTE ORAL TOXICITY
The evaluation of plant extracts orally administered in mice showed no toxic effect at doses less or
equal to 5000mgkg This suggests that the crude extract is relatively safe for consumption and that
LD50 is greater than 5000mgkg
353 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS
Assessment of the liver was made by estimating the activities of AST ALT ALP total bilirubin and
conjugated bilirubin there are enzymes originally present in higher concentration in cytoplasm when
there is hpatopathy These enzymes leak into the blood stream in conformity with the extent of liver
damage [62]
The increase in level of these biomarker enzymes observed in groups treated with CCl4
and paracetamol indicate some extent of liver damage
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
66
The reduction in enzyme level with respect to the group treated with CCl4 when compared with
other groups is dose dependent as seen above
From the result it is well established that CCl4 induces hepatotoxicity by metabolic activation
Therefore it selectively causes toxicity in liver cells [63]
CCl4 is biotransformed by cytochrome P450
system in the endoplasmic reticulum to produce CCl3 free radical When combined with cellular
lipids and proteins in the presence of O2 it forms CCl3 peroxyl radical which may attack lipids on
the membrane of endoplasmic reticulum faster than CCl3 free radical Therefore CCl3 elicit lipid
peroxidation the destruction of Ca2+
homeostasis and finally result in cells death [64] [65] [66]
In this study the administration of CCl4 and paracetamol increases the level of AST ALT ALP total
bilirubin and conjugated bilirubin
Millettia aboensis treated animals showed a protection against the injurious effects of CCl4 and
paracetamol resulting in the hindrance of formation of hepatotoxic free radicals
The tendency of these marker enzymes to return to near normal in group treated with higher dose of
the extracts treated animal was a clear suggestion that the extracts have an anti hepatotoxic effects
The ethanolic and aqueous extracts of Millettia aboensis roots showed significant hepatoprotective
activity at dose dependent level The effect produced by ethanolic extract (431 mgkg) of Millettia
aboensis was almost similar to that produced by Liv 52(R)
(1mlkg po) a well known
hepatoprotective agent CCl4 is one of the most commonly used hepatoxins in the experimental study
of liver diseases The hepatotoxic effects of CCl4 are largely due to generation of free radicals [67]
Drugs having antioxidant activity are effective in treating CCl4 induced hepatotoxicity It is known
that PCM induces liver injury through the action of its toxic metabolite N-acetyl-p-
benzoquinoneimine produced by the action of cytochrome P-450 through saturation of sulfate and
glucuronide pathways As a result hepatocellular supplies of glutathione (GSH) become depleted
as demand for GSH is higher than its regeneration NAPQI therefore remains in its toxic form in the
liver and reacts with cellular membrane molecules resulting in hepatocyte damage and death leading
to acute hepatic necrosis [68]
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
67
Damage induced in the liver is accompanied by the increase in the activity of some serum
enzymes The anti-hepatotoxic action of both extracts (215mgkg amp 431 mgkg po) was
substantiated by significant attenuation of the increased levels of serum enzymes in rats intoxicated
with PCM
Drugs having antioxidant activity are also effective in treating paracetamol induced hepatotoxicity
by scavenging the free radicals produced by PCM metabolism thereby preventing the liver damage
induced by both PCM metabolite and due to depletion of glutathione
As mentioned earlier Millettia aboensis is a known antioxidant and this activity may be responsible
for its effect in PCM induced hepatotoxic model The PCM induced a significant increase in liver
weight which was due to the blocking of secretion of hepatic triglycerides into the plasma
Ethanolic and Aqueous extract of Millettia aboensis prevented the increase in liver weight of rats
pretreated with PCM
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
68
CHAPTER FOUR
CONCLUSIONS
The aqueous extract and alcoholic extract of Millettia aboensis root have shown promising
hepatoprotective activity at the administered dose of 215 mgkg and 431 mgkg body weight orally
Both the extracts showed dose dependant activity Higher dose of alcoholic extract (431 mgkg) has
shown the protective activity that is comparable to the reference drug LIV-52 CCl4 a well known
hepatotoxin produces liver toxicity due to generation of free radicals
The protective activity shown by Millettia aboensis root extracts may be due to their antioxidant
activity since the extracts have shown the presence of flavanoids which is an antioxidant
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
69
REFERENCES
1 Ostapowicz GI Fontana RJ Schiodt FV (2002) Results of a Prospective Study of
Acute Liver Failure at 17 Tertiary Centres in the United States The journal of Medicine
137 (12) 1-947-954
2 Finland R C Farnsworth N R (1996) Biological and phytochemical screening of plants
The journal of pharmaceutical sciences 55 225
3 Keay RWS Onochie CFA and Stanfield DP (1964) Federal Department of Forest of
Research Ibadan Nigeria National Press Ltd Ibadan 329 and 33287ndash93
4 Larson A M Polson J Fontana RJ Davern TJ Lalani E Hynan LS Reisch JS Schiodt
FV Ostapowicz G Shakil AO Lee WM (2005) Acute liver study group Acetominophen
ndash induced acute liver failure The journal of hepatology 42 (6) 1346-72
5 Ryder SD Beckingham IJ (2001) ldquoABC of diseases of liver pancrease and biliary
syatem Other causes of parenchymal liver diseaserdquo BMJ ( clinical researched) 322 (7281)
290-2
6 Dart RC Erdman AR Olson KR Christianson G Manoguerra AS Chvka PA Caravati
EM Wax PM Keyes DC Woolf AD Scharman EJ Booze LL Troutman WG (2006)
Acetominophen poisoning an evidenced based consensus guideline for out of hospital
management American Association of poison control centres Philldelphia 44 (1)
7 Daly FF Fountain JS Murray L Graudins A Buckley NA (2008) Guidelines for the
management of paracetomal poisoning in Australia and new zeal and-explanation and
elaborationA consensus statement from chcalemical toxicologists consulting to the
Australasian poisons information centresThe medical journal of Australia 188(5)296-301
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
70
8 Watkins PBkaplowit3 Nslaltery JT(2006)rdquoAminotrous ferase elevations in healthy
adults receiving 4 grams of acetaminophen daily a randonised controlled trialThe journal of
the American medical Association 296(1)
9 Dart RC Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver
failurerdquo Pharmacotherapy 27 (9) 1219ndash30
10 Daly FF OMalley GF Heard K Bogdan GM Dart RC (2004) Prospective evaluation of
repeated supratherapeutic acetaminophen (paracetamol) ingestion Journals of emergency
medicine 44 (4) 393ndash8
11 Dai Y Cederbaum A I (1995) Cytotoxicity of acetaminophen in human cytochrome
P4502E1-transfected HepG2 cells The journal of pharmacology and experimental
therapeutics 273 (3) 1497ndash505
12 Zimmerman H J Maddrey W C (1995) Acetaminophen (paracetamol) hepatotoxicity with
regular intake of alcohol analysis of instances of therapeutic misadventure The journal of
Hepatology 22 (3) 767ndash73
13 Dargan P I Jones A L Buckley N A Srinivasan J (2002) Should a lower treatment line
be used when treating paracetamol poisoning in patients with chronic alcoholism a case
against Drug safety an international journal of medical toxicology and drug experience 25
(9) 619 ndash 24 625ndash32
14 Schmidt LE Dalhoff K Poulsen H E (April 2002) Acute versus chronic alcohol
consumption in acetaminophen-induced hepatotoxicity The journal of Hepatology 35 (4)
876ndash82
15 Moerman DE (1991) The Medicinal Flora of Native North America An Analysis Journal
of Ethano Pharmacology 31142
16 Crippin JS (April 1993) Acetaminophen hepatotoxicity potentiation by isoniazid The
American journal of gastroenterology 88 (4) 590ndash2
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
71
17 Nolan C M Sandblom R E Thummel K E Slattery J T Nelson S D (1994)
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug
therapy for tuberculosis The journal Chest 105 (2) 408ndash11
18 Manfred R Wilhelm L Gerhard P Adolf T Eberhard L D Ernst L Heinz J Peter K
Heinz S Richard C Uwe B Karl A L Theodore R T Eckhard L Klaus K B (2006)
ldquoChlorinated Hydrocarbonsrdquo (chapter one) in Ullmanns Encyclopedia of Industrial
Chemistry Wiley-VCH Publisher Weinheim pg 6_233
19 Mitchell JR Jollow D J Potter W Z Gillette J R Brodie B B (1973) Acetominophen ndash
induced hepatotic necrosis The journal of pharmacology and experimental therapeutics 187
(1) 211 ndash 7
20 Hawkins LC Edwards JN Dargan PI (2007) Impact of restricting paracetamol packs
sizes on paracetamol poisoning in the United Kingdom a review of the literature Drug
safety an international journal of medical toxicology and drug experience 30 (6) 465ndash79
21 Recknagel RO Glende EA Dolak JA Waller RL (1989) Mechanism of
Carbontetrachloride Toxicity The journal of Pharmacology Therapeutics 43 (43) 139ndash154
22 Recknagel RO (1967) Carbon tetrachloride hepatotoxicity The journal of Pharmacol
Rev 19 (2) 145ndash208
23 Masuda Y (2006) Learning toxicology from carbon tetrachloride ndash induced heptotoxicity
The journal of pharmacology and toxicology 126 (10) 885 ndash 99
24 wwwhimalayahealthcarecom
25 Rood A S McGavran P D Aanenson J W Till J E (2001) Stochastic estimatesof
exposure and cancer risk from carbon tetrachloride released to the air from the Rocky flats
plant Risk anal journal 21 (4) 675ndash95
26 Hill E B Useful plants and plant products McGarw- Hill Book Company Inc NewYork
(1952) Pp 55
27 Arts I C W and Hollman P C H (2005) Polyphenols and disease risk in
epidemiologic studies The journal of Clinical Nutrition 81 317ndash325
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
72
28 Lambert J D Hong J Yang G Liao J and Yang C S (2005) Inhibition of
carcinogenesis by polyphenols evidence from laboratory investigations The journal
Clinical Nutrition 81 284ndash291
29 Joseph JA Shukitt-Hale B and Casadesus G (2005) Reversing the deleterious
effects of aging on neuronal communication and behavior beneficial properties of fruit
polyphenolic Compounds Am J Clin Nutr 81 313ndash 316
30 Keen CL Holt RR Oteiza PI Fraga C G Schmitz HH (2005) Cocoa antioxidants and
cardiovascular health Am J Clin Nutr 81 298-303
31 Sies H Schewe T Heiss C Kelm M (2005) Cocoa polyphenol and
inflammatory mediators Am J Clin Nutr 1 305-312
32 Vita JA (2005) Polyphenols and cardiovascular disease effects on endothelial and platelet
function Am J Clin Nutr 81 292ndash297
33 Scalbert A Manach C Morand C Reacutemeacutesy C and Jimeacutenez L (2005) Dietary polyphenols
and the prevention of diseases Critical Rev The journal of Food Sci Nutr 45(4) 287-306
34 Benjamin L Shneider S Philip M Pediatric Gastrointestinal Disease Connecticut
publication PMPH-USA (2008) pp 751 ISBN 1-55009-364-9
35 Enomoto N Takse S Yasuhura Takada A (1991) Acetaldehyde metabolism in different
aldehyde 2 dehydrogenase 2 genotypes Alcohol Clin Exp Res 15 141
36 Frezza M Padova C Pozzato G (1990) High blood alcohol levels in women The role of
decreased gastric alcohol dehydrogenase activity and first-pass metabolism The journal
Medicine 56 (45) 32295
37 Thuluvath P Wojno K J Yardley J H Mezey E(1994) Effects of Helicobacter pylori
infection and gastritis on gastric alcohol dehydrogenase activity Journal of clinical
pharmacy 18795
38 Zakim D Boyer TD Montgomery C (1990) Alcoholic liver disease In Hepatology
Textbook of Liver Disease Saunders Philadelphia p 821
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
73
39 Lelbach WK (1975) Cirrhosis in the alcoholic and its relation to the volume of alcohol
abuse Ann N Y Acad Sci 25285
40 Zakim D Alexander D Sleisenger MH (1965) The effect of ethanol on hepatic secretion of
41 trigylcerides into plasma Journal of Clinical pharmacy Invest 441115
42 Adachi M Brenner D A (2005) Clinical syndromes of alcoholic liver disease Journal of
medicine 23255
43 You M Fischer M Deeg M A Crabb D W (2002) Ethanol induces fatty acid synthesis
pathways by activation of sterol regulatory element-binding protein Journal of Biol Chem
27729342
44 Ryder S Beckingham (2001) ldquoABC of diseases of liver pancreas and billary system Acute
hepatitisrdquo BMJ 322 (7279) 151-153
45 Nadir A Reddy D Van Thiel D H (2000) ldquoCascara segrada-induced intrahepatic
cholestasis causing portal hypertension case report and review of herbal hepatotoxicityrdquo
Am J Gastroenterol 95 (12) 3634-7
46 Hamaguchi M Kojima T Takeda N Nakagawa T Taniguchi Hi Fujii K Omatsu T
Nakajima T Sarui H Shimazaki M Kato T Okuda J Ida K (2005) ldquoThe metabolic
syndrome as a predictor of nonalcoholic fatty liver diseaserdquo Ann Intern Med journal 143
(10) 722-8
47 Parveen MD Michael M D Some causes of acute parenchymal damage WB Saunders
Company Philadephia (2005) 7020-27
48 Scott Moses MD Acute Hepatitis causes Family practice notebookcom
49 Hepatitis as a result of chemicals and drugsrdquo httpwwwhealthatozcomhealthatoz
50 Lim JR Faught PR Chalasani NP Molleston J P (2006) ldquoSevere liver injury
After initiating therapy with atomoxetine in two childrenrdquo Journal of Pediatrics 148 (6)
831-4
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
74
51 Bastida G Nos P Aguas M Beltran B Rubin A Dasi F Ponce J (2005) ldquoIncidence risk
factors and clinical course of thiopurine-induced liver injury in patients with inflammatory
bowel diseaserdquo Aliment Pharmacol journal 22 (9)775-82
52 Millettia In Flora of Pakistan Page 51 Published by Science Press (Beijing) and
Missouri Botanical Garden Press Online at EFlorasorg [Back]
53 Trease G E and Evans (1989) Pharmacognosy 13th
Edition ELBBS Oxford university
press London UK Pp 245-263
54 World Health organization (1991) Guidelines for the assessment of herbal Medicines
Programme on traditional medicines Geneva 34-36
55 Kind P R and King E J (1954) Estimation of plasma phosphates by determination of
hydrolysed phenol with antipyrin J Clin Pathol 7322-326
56 Lutterodt G D (1992) Inhibition of Microlax-induced experimental diarrhea with narcotics
like extracts of Psidium guajava in rats J Ethnopharmacol 37151-157
57 Roll FJ Perez HD Serhan CN Characterization of novel arachidonic acid-derived
neutrophil chemoattractant Biochem Biophys Res Commun 1992 186269
58 Triger R A (1981) Practical management of liver Disease Oxford Blackwell Scientific
59 Lim JR Faught PR Chalasani NP Molleston JP (2006) Severe liver injury after
initiating therapy with atomoxetine in two children J Pediatr 148 (6) 831ndash4
60 Kaplowitz N Shinohara M J C (2007) Endoplasmic recticulum stress and livery injury J
Semin Liver Dis 27367
61 Lieber C S (1993) Biochemical factors in alcoholic liver disease J Semin Liver Dis
13136
62 Bosron WF Ehrig T Li TK (1993) Genetic factors in alcohol metabolism and alcoholism
J Semin Liver Dis 13126
63 Okwu D E (2004) Phytochemicals and vitamin content of indigenous species of South east
Nigeria J Sustain Agric Environ 6 30 ndash 37
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
75
64 Salah N Miller N J Pagange G Tburg L Bolwell G P Rice E Evans C (1995)
Polyphenolic flavonoids as scanvengers of aqueous phase radical as chain breaking
antioxidant Arch Biochem Bioph 2 339 ndash 346
65 Nkosi C Z Okpoku A R Terblanche S T (2005) Effect of pumpkin seed (Cucurbita pepo)
protein isolate on the activity levels of certain plasma enzymes in CCl4 induced liver injury in
low protein fed rats Phy Res 19 341-345
66 Mujunmaddar A K Upadhyne A S Pradhan A M (1998) Effects of Azadtragta indica
leafextrct in CCl4 induced hepatic damage in albino rats Ind J pharm
67 Okpoku A R Ndlovel I M Terbalanche S E Hutching A H (2007) In invitro
hepatoprotective effects of Rhoicissus tridentate sub species Cuneifolia a traditional Zulu
medical plant against CCl4 induced acute liver injury in rats South Africa J Bot 73 372-
377
68 Johnson DE Kroening C (1998) Mechanism of early CCl4 toxicity in cultured rat
hepatocytes Pharmacol Toxicol 83 231-239
69 Srivastara SP Chen NO Holtzman JL (1990) The invitro NADPH- dependent inhibition
by CCl4 of ATP- dependent calcium uptake of hepatic microsomes from male rats in the
status on the mechanism of inactivation of the hepatic microsomal calcium pump of the CCl3
radical J Biol Chem 265 8392-8399
76
76