JOURNAL SCAN
Article reprinted with the permission of DMV360, June 2013, Veterinary Medicine
is a copyrighted publication of Advanstar. Communications inc. All rights reserved.
Can Milk Thistle be Used
to Treat Liver Disease?
Hackett ES, Twedt DC, Gustafson DL. Milk thistle and its derivative compounds: a review of opportunities for treatment of liver
disease. J Vet Intern Med2013;27(1):10-16.
Summarised by Jennifer L. Garcia, DVM, DACVIM
Why they did it
Natural remedies abound for treating common diseases in people and pets, but what exact role they
should play remains undetermined. This study looked
specifically at the use of milk thistle for helping pets
with liver disease.
What they did
In this article, the authors review the pharmacokinetics and potential treatment applications of Silybum
marianum, or milk thistle. Silibinin is the predominant
compound in silymarin and the compound most often reported in milk thistle formulations.
What they found
Milk thistle has poor oral bioavailability because of
extensive conjugation and biliary excretion. It is often
complexed with phosphatidylcholine to improve oral
bioavailability.
Silibinin is thought to provide benefit via free radical
scavenging and inhibition of lipid peroxidation as well
as through anti-inflammatory effects associated with
inflammatory cytokine suppression and leukotriene
formation inhibition. Silibinin has also demonstrated
antifibrotic properties by interrupting myofibroblast
formation and by limiting fibrous tissue production.
In rats, silibinin has been shown to enhance protein
synthesis that is necessary for hepatic regeneration
and repair after injury. Studies in people and rats or
mice have demonstrated a wide margin of safety for
this drug.
The authors discuss the current therapeutic applications of this drug based on human and animal data:
Intoxication
• It has been shown to be hepatoprotective in dogs
after Amanita phalloidesintoxication by limiting
oxidation and inhibiting uptake of phalloidin toxin
into hepatocytes.
• It has been shown to prevent an increase in hepatic enzyme activity in rats exposed to carbon
tetrachloride, acetaminophen, and arsenic as well
as in studies involving radiation exposure and doxorubicin use.
Hepatitis
• It has been used in people with alcoholic liver disease to decrease ethanol-induced production of
free radicals.
• For nonalcoholic fatty liver disease, it is thought
to limit glutathione depletion and peroxide production and to prevent hepatic mitochondrial
dysfunction.
Cirrhosis
• It is thought to improve antioxidant status, decrease collagen production, and limit glutathione
depletion.
Take-home message
There are no randomized clinical trials evaluating milk
thistle use in clinically affected animals with liver disease, but studies in animal models thus far are promising. It is important to remember that this drug should
not be used as the sole therapy for patients with liver
disease and that there is currently limited pharmacokinetic and pharmacodynamic information about milk
thistle in dogs and cats.
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