Efficacy and safety of Prunus mume and choline in patients with abnormal level of liver function test

Muhammad N. Aslam, Anwar Ali, Suresh Kumar

Abstract

Background: The objectives of the study were to determine the efficacy and safety of Prunus mume and choline in patients with abnormal liver function test.

Methods: This open labelled, multi-centered observational study was done for a from May 2019 to December 2019. Patients of either gender, above 18 years of age having elevated levels of aspartate aminotransferase, alanine transaminase or gamma-glutamyltransferase were included in the study after taking informed consent. One to two tablets of revolic per day were given preferably in the morning with breakfast or as per instructions of the physician. Patient follow-ups were done at 2nd and 4th week after treatment. SPSS version 20.0 was used for analysis. Frequency and percentages and for quantitative data, mean, standard deviation, median and interquartile range were recorded. Wilcoxon signed ranks test was applied with p value of <0.05 as significant level.

Results: Among 247 patients, male to female ratio was 2:1 with overall mean age of 42.8±12.6 years. Total bilirubin decreased from baseline to week-4 in treatment with Prunus mume extract and choline (p=0.04). Median and IQR of alanine transaminase levels also reduced substantially from 99 (52) to 42 (36.5) I/U. Aspartate aminotransferase levels significantly decreased from 78.5 (57) to 40 (29) I/U. Overall at the end of treatment on week-4, 26 (10.5%) patients experienced gastrointestinal distress, 25 (10.1%) anorexia, 14 (5.7%) excessive salivation and 29 (11.7%) patients experienced excessive sweating.

Conclusions: This study reported significant improvement in alanine transaminase and aspartate aminotransferase levels after treatment with Prunus mume extract and choline (revolic). It is safe and effective to use them for deranged liver functions tests.

Keywords

Prunus mume extract, Choline, Liver function tests

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References

Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.

Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524-30.

Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57.

Cichoż-Lach H, Michalak A. Oxidative stress as a crucial factor in liver diseases. World J Gastroenterol. 2014;20(25):8082-91.

Hassan HA, El-Gharib NE, Azhari AF. Role of natural antioxidants in the therapeutic management of hepatocellular carcinoma. Hepatoma Res. 2016;2:216-3.

Mitani T, Horinishi A, Kishida K. Phenolics profile of mume, Japanese apricot (Prunus mume Sieb. etZucc.) fruit. Biosci Biotechn olBiochem 2013;77:1623.

Yan XT, Lee SH, Li W. Evaluation of the antioxidant and anti-osteoporosis activities of chemical constituents of the fruits of Prunusmume. Food Chem 2014;156:408-15.

Khan A, Pan JH, Cho S, Lee S, Kim YJ, Park YH. Investigation of the hepatoprotective effect of PrunusmumeSieb. etZucc extract in a mouse model of alcoholic liver injury through high-resolution metabolomics. J Med Food. 2017;20(8):734-43.

Zhang Q, Chen W, Sun L, Zhao F, Huang B, Yang W, et al. The genome of Prunusmume. Nature Communications. 2012;3:1318-26.

Jin HL, Lee BR, Lim KJ, Debnath T, Shin HM, Lim BO. Anti-inflammatory effects of Prunusmume mixture in colitis induced by dextran sodium sulfate. Korean J Med Crop Sci. 2011;19(1):16-23.

Sherriff JL, O'Sullivan TA, Properzi C, Oddo JL, Adams LA. Choline, its potential role in nonalcoholic fatty liver disease, and the case for human and bacterial genes. Adv Nutr. 2016;7(1):5-13.

Mokhtari Z, Gibson DL, Hekmatdoost A. Nonalcoholic fatty liver disease, the gut microbiome, and diet. Adv Nutr. 2017;8(2):240-52.

Perumpail BJ, Cholankeril R, Yoo ER, Kim D, Ahmed A. An overview of dietary interventions and strategies to optimize the management of non-alcoholic fatty liver disease. Diseases. 2017;5(4):23-34.

B Hollenbeck C. An introduction to the nutrition and metabolism of choline. Central Nervous System Agents Med Chem. 2012;12(2):100-13.

Fagone P, Jackowski S. Phosphatidylcholine and the CDP-choline cycle. Biochim Biophys Acta. 2013;1831(3):523-32.

Beretta A, Accinni R, Dellanoce C, Tonini A, Cardot JM, Bussière A. Efficacy of a Standardized Extract of Prunus mume in Liver Protection and Redox Homeostasis: A Randomized, Double‐Blind, Placebo‐Controlled Study. Phytotherapy Res. 2016;30(6):949-55.

Xia D, Shi J, Gong J, Wu X, Yang Q, Zhang Y. Antioxidant activity of Chinese mei (Prunusmume) and its active phytochemicals. J Med Plants Res. 2010;4(12):1156-60.

Hokari A, Ishikawa T, Tajiri H, Matsuda T, Ishii O, Matsumoto N, et al. Efficacy of MK615 for the treatment of patients with liver disorders. World J Gastroenterol. 2012;18(31):4118-26.

Yan XT, Lee SH, Li W, Sun YN, Yang SY, Jang HD, et al. Evaluation of the antioxidant and anti-osteoporosis activities of chemical constituents of the fruits of Prunusmume. Food Chem. 2014;156:408-15.

Caballero F, Fernandez A, Matias N. Specific contribution of methionine and choline in nutritional nonalcoholicsteatohepatitis: impact on mitochondrial S-adenosyl-L-methionine and glutathione. J Biol Chem. 2010;285:18528-36.

Spencer MD, Hamp TJ, Reid RW, Fischer LM, Zeisel SH, Fodor AA. Association between composition of the human gastrointestinal microbiome and development of fatty liver with choline deficiency. Gastroenterology. 2011;140(3):976-86.

Yu D, Shu XO, Xiang YB, Li H, Yang G, Gao YT, et al. Higher dietary choline intake is associated with lower risk of nonalcoholic fatty liver in normal-weight Chinese women. J Nutr. 2014;144(12):2034-40.

Nagi HM, Amin WS, Zaki SA. The potential effect of fruits and vegetables on liver functions and liver alterations induced by acrylamide in mice. InProceedings of 3rd International Conference on Nutrition and Food Sciences (ICNFS 2014), Singapore: IACSIT Press. 2014;71:5-9.

Khan A, Pan JH, Cho S, Lee S, Kim YJ, Park YH. Investigation of the hepatoprotective effect of PrunusmumeSieb. etZucc extract in a mouse model of alcoholic liver injury through high-resolution metabolomics. J Med Food. 2017;20(8):734-43.

Beretta A, Accinni R, Dellanoce C, Tonini A, Cardot JM, Bussière A. Efficacy of a Standardized Extract of Prunusmume in Liver Protection and Redox Homeostasis: A Randomized, Double‐Blind, Placebo‐Controlled Study. Phytotherap Res. 2016;30(6):949-55.

Schugar RC, Huang X, Moll AR, Brunt EM, Crawford PA. Role of choline deficiency in the Fatty liver phenotype of mice fed a low protein, very low carbohydrate ketogenic diet. PloS one. 2013;8(8):74806-21.

Guerrerio AL, Colvin RM, Schwartz AK, Molleston JP, Murray KF, Diehl A, et al. Choline intake in a large cohort of patients with nonalcoholic fatty liver disease. Am J Clin Nutr. 2012;95(4):892-900.

Ueland PM. Choline and betaine in health and disease. J Inherited Metabol Dis. 2011;34(1):3-15.