76
1 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS (Hook.F) BAKER. BY UGWUEZE MERCY EBERE REGISTRATION NUMBER: PG/M.PHARM/09/51630 DEPARTMENT OF PHARMACEUTICS FACULTY OF PHARMACEUTICAL SCIENCES, UNIVERSITY OF NIGERIA, NSUKKA NOVEMBER, 2011 HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS (Hook. F) BAKER

HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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Page 1: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

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

Page 2: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

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

Page 3: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 4: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 5: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 6: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 7: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 8: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

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

Page 9: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 10: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 11: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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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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

Page 12: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 13: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 14: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 15: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 16: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 17: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 18: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 19: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

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

Page 20: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 21: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 22: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 23: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

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elaborationA consensus statement from chcalemical toxicologists consulting to 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

Page 24: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 25: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 26: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 27: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 28: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 29: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 30: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 31: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 32: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 33: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 34: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 35: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 36: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 37: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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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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

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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

Page 38: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 39: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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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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

Page 40: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 41: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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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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

Page 42: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 43: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 44: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 45: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 46: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 47: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 48: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Australasian poisons information centresThe medical journal of Australia 188(5)296-301

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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

Page 49: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 50: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 51: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 52: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 53: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 54: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 55: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 56: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 57: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 58: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 59: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 60: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 61: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 62: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 63: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 64: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 65: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 66: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 67: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 68: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 69: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 70: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 71: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 72: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 73: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 74: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 75: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

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

Page 76: HEPATOPROTECTIVE EFFECT OF MILLETTIA ABOENSIS MERCY EBERE.… · hepatoprotective effect of millettia aboensis (hook.f) baker. by ugwueze mercy ebere registration number: pg/m.pharm/09/51630

76