Drug-induced liver injury is a growing concern worldwide, accounting for nearly 25 percent of fulminant hepatic failure cases. One of the major contributors to this problem is the over-the-counter drug acetaminophen, which also goes by the names Tylenol, Actamin, or Mapap. This drug is widely used due to its ability to reduce pain and fevers but when taken excessively, it leads to fatal liver necrosis and liver failure. Studies have shown that there are various mechanisms through which acetaminophen causes hepatic problems. These include the induction of cytochrome P450 isoforms, depletion of intracellular glutathione, and oxidative stress, which are all attributed to the formation of a highly reactive and toxic metabolite called N-acetyl-P-benzoquinone imine (NAPQI).
Plants are great sources of bioactive compounds with antioxidant properties that can be used to relieve drug-induced liver injury. One example of a plant-derived compound that has been proven to be effective for this purpose is silymarin, which comes from milk thistle (Silybum marianum). Prior to this study, other researchers have shown that moringa has antioxidant potential. However, this was only limited to an in vitro setup and was not associated with possible hepatoprotective effects.
In this study, which was published in the African Journal of Traditional, Complementary and Alternative Medicines, the team determined the hepatoprotective effects of moringa in relation to its antioxidant potential. To do this, they first collected extracts from dried moringa leaves and determined its phytochemical content. They then proceeded to acquire 60 female albino rats, which they divided into five groups with 12 rats each. The first and second group served as the negative and positive control so they received only water and acetaminophen, respectively. The third and fourth group also received acetaminophen but the rats were also given moringa extracts and silymarin, respectively. Lastly, the fifth group received acetaminophen, moringa extract, and silymarin.
To determine the effects of the treatments, the researchers measured serum liver enzyme levels specifically of alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT). These enzymes serve as markers for liver damage so it was not surprising that the positive control exhibited an increase in these enzymes. On the contrary, the groups treated with moringa extracts, silymarin, or both exhibited a decrease in the levels of these enzymes. Although there was a decrease in serum liver enzyme levels in the fifth group, there was no observed synergistic effect between the two extracts. However, the two of them exhibited comparable effects.
The researchers also observed impressive antioxidant potential through free radical scavenging assays. They attributed this property for the potent hepatoprotective effects that they observed in the rats. Furthermore, they identified a number of flavonoids an phenolic compounds that possibly have antioxidant properties. These include rutin, naringin, quercetin, 3-OH-tyrosol, protocatechin, and epicatechin.
From these results, the team concluded that moringa is rich in antioxidants that allow it to protect the liver from oxidative damage induced by acetaminophen. Furthermore, its hepatoprotective effects were observed to be at par with silymarin. (Related: Milk thistle is a powerful herbal remedy that offers significant protection against liver disease.)
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