Hepatoprotective activity of Natural Products
Department of Pharmacology, JNTU Hyderabad, Andhra Pradesh, India
- *Corresponding Author:
Abhinaya. N Department of Pharmacology, JNTU Hyderabad, Andhra Pradesh, India.
Received: 06 March 2015 Accepted: 08 April 2015
Visit for more related articles at Research & Reviews: Journal of Medical and Health Sciences
India is the most eminent in production of medicinal plants or natural products. About 45,000 plant species are available widely, among them several thousand plants are used for many treatments. With the advancements in science and technology wide range of synthetic drugs came into existences. There may be huge advantages and contains some life threating disadvantages in those drugs. Since from several decades existing in the use of traditional medicine. Advancements in investigations of medicinal plants and formulating the crude drugs become important.
Liver is main essential organ system in the body. It purifies and eliminates the unnecessary material through urine. So it cases more stress to the liver and gets damages due toxin substances. By using medicinal plants can tremendously cure the hepatotoxicity. While using the chemical or synthetic drugs, may cure but causes severe adverse effects. Hence utilizing the medicinal plants, we can achieve the treatment in Hepatoprotective and minimize the adverse effects.
Heptoprotective; Liver; adverse effects; medicinal plants; hepatotoxicity
Liver is that the key organ control equilibrium within the body. It’s committed the majority the organic chemistry pathways associated with growth, fight against illness, nutrient offer, energy production and replica. Attributable to its distinctive metabolism and relationship to the digestive tube, the liver is a vital target of the toxicity of medicine, xenobiotic and aerophilous stresses [1,5]. Over 900 medicine, toxins and herbs are according to cause liver injury and medicines account for two hundredth - four-hundredth of all instances of sudden liver failure. Within the absence of reliable liver protection medicine in trendy drugs, an oversized range of healthful preparations square measure suggested for the treatment of liver disorders and very often claimed to supply important relief [6-10]. Makes an attempt square measure being created globally to induce scientific evidences for this historically according flavoring medicine. This situation proves a severe necessity to hold out analysis works associated with hepatotoxicity [11-14].
Aerophilous stress has been known to be the most important explanation for hepatotoxicity that provides that plants with anti-oxidant chemical constituents would be helpful during this regard. Plants have many natural substances, flavonoids, terpinoids and other substituents [15-18]. They can be widely curing the toxicity. Anciently Ayurveda treatment has the milestone, with the many formulations of natural products changes and existence of life span of ancient people [19-21].
Liver is the largest internal organ in the human body and is very much essential for survival. It is the biggest reticulo-endothelial organ in the body which maintains the survival of individual [22-25].
It is the largest gland of the body enclosed within the right lower rib cage beneath the diaphragm. The liver is a soft, pinkish brown triangular organ that normally weighs between 1.4 – 1.6 kg (Robbins, 2007). Liver is divided in two principle lobes, a large right lobe and a smaller left lobe separated by falciform ligament [26-29]. The right lobe is considered by many anatomists to include an inferior quadrate lobe and a posterior caudate lobe [30-34].
The lobes of liver are made up of many functional units called lobules. A lobule consists of specialized epithelial cells called hepatic cells or hepatocytes arranged in irregular, branching, interconnected plates around the central vein [35-39]. Rather than capillaries liver has larger space lined by endothelium called sinusoids through which blood passes. The sinusoids are also partly lined with stellate reticuloendothellial (Kupffer’s) cells. These phagocytes destroy worn out white and red blood cells, bacteria and toxic substances [40-45].
Figure 1: Anatomy of Liver (Image Courtesy: http://www.shutterstock.com/s/liver/search.html )
Functions of Liver
i. Secretion and excretion of bile:
The hepatic cells secrete 800-1000 ml of bile, a yellow, brownish or olive green liquid of pH 7.6-8.6. Bile is partially an excretory product and partially a digestive secretion. The principle bile pigment is bilirubin. Bile mainly consists of water, bile salts, cholesterol, lecithin, bile pigments, and several ions [46-49].
ii. Metabolic functions:
Liver maintains the normal blood glucose level. It can convert glucose to glycogen (glycogenesis) when blood sugar level is high and breakdown of glycogen to glucose (glycogenolysis) when blood sugar level is low. Also liver can converts amino acid and lactic acid to glucose (gluconeogenesis) when sugar level is low [50-54].
Liver stores some triglycerides (neutral fat) and breaks down fatty acids into acetyl coenzyme-A. This process is called as β-oxidation and converts excess acetyl coenzyme A into ketone bodies (ketogenesis). It synthesizes lipoproteins, cholesterol and uses cholesterol to make bile salts [55-58].
The liver deaminates (remove the amino group, NH2) amino acids so that they can be used for ATP production. It converts the resulting toxic ammonia (NH3) into much less toxic urea for excretion in urine. Hepatic cells synthesize plasma proteins such as alpha and beta globulins, albumin, prothrombin, and fibrinogen [59-62].
Liver plays a vital role in biotransformation of drugs. It converts drug molecules from non-polar to polar. These non-polar drugs can be conjugated with more polar compounds, which make them water soluble for the urinary excretion [63-67].
Patterns of Hepatic Injury
There many cases of injuries in liver, some are mentioned as below.
i. Damage and intra cellular accumulation:
Damage from toxic and immunologic insult may cause swelling of hepatocytes. In cholestasis liver injury, retained biliary matter may impart a diffuse foamy appearance to the swollen hepatocytes (feathery degeneration). Accumulation occurs in viable hepatocytes, which include iron and copper the accumulation of triglycerides within the hepatocytes is called as steatosis [68-71].
ii. Necrosis and apoptosis:
Any significant insult to the liver can cause hepatocyte necrosis. In apoptotic cell death, isolated hepatocytes round up to form shrunken, pyknotic, and intensely eosinophilic cells containing fragmented nuclei. Hepatocytes may also osmotically swell and rupture, it is called lytic necrosis [72-76].
Necrosis frequently exhibits a zonal distribution. The most common is necrosis of hepatocytes immediately around the terminal hepatic vein, an injury that is characteristic of ischemic injury and a number of drug and toxic reactions [77-79].
Injury to the liver associated with the acute or chronic inflammatory cells is termed hepatitis. In viral hepatitis, quiescent lymphocytes may collect in portal tracts as a reflection of mild inflammation; spill over into the perioral parenchyma as activated lymphocytes causing a moderately active hepatitis [80-84].
Hepatocytes have long life spans, and they proliferate in response to tissue resection or cell death. Hepatocellular proliferation is marked by mitosis, thickening of the hepatocyte cords, and some disorganization of the parenchymal structure [85-89].
Fibrous tissue is formed in response to inflammation or direct toxic insult to the liver. Fibrosis is generally irreversible hepatic damage. Deposition of collagen has lasting consequences on patterns of hepatic blood flow and perfusion of hepatocytes. In the initial stages fibrosis may develop around portal tracts or they may be directly deposited within the space. With continuing fibrosis the liver is subdivided into nodules of proliferating hepatocytes surrounded by scar tissue called “cirrhosis” [90-92].
i. Hepatic failure:
The most severe clinical consequence of liver disease is hepatic failure. It forms into three main categories:
Massive hepatic necrosis:
Acetaminophen, anti-tubercular drugs, anti-depressant, and industrial chemicals such as carbon tetra-chloride and poisoning drugs collectively tend the Massive Hepatic necrosis . The mechanism may be direct toxic damage to hepatocytes but more often is a variable combination of toxicity and inflammation with immune mediated hepatocytes destruction [94-96].
Chronic liver disease:
This is the most common route to hepatic failure and is the end point of relentless chronic hepatitis ending in cirrhosis.
Hepatic dysfunction without overt necrosis:
It causes Reye’s syndrome, tetracycline toxicity, and acute fatty liver of pregnancy.
The clinical signs of hepatic failure include jaundice, hypoalbuminemia, hyperammonemia, fetor hepaticas, impaired estrogenic metabolism and consequent hyperestrogenemia leading to palmar erythema and spider angioma. In males, hyperestrogenemia may lead to hypogonadism and gynaecomastia. Hepatic failure is life threatening and cause multiple organ damages. Respiratory failure with pneumonia and sepsis combine with renal failure to claim the lives of many patients with hepatic failure.
Cirrhosis is the serious condition, causes death in top countries with the ranking of 10. It is mainly due to alcohol and viral hepatitis. Cirrhosis as the end-stage of chronic liver disease is defined by three characteristics.
Increased resistance to portal blood flow may develop in a variety of circumstances, which can be divided into prehepatic, intrahepatic and posthepatic causes. The major prehepatic conditions are obstructive thrombosis and narrowing of the portal vein before it ramifies within the liver. The major post hepatic causes are severe right sided heart failure, constrictive pericarditis and hepatic vein outflow obstruction. The dominant intrahepatic cause is cirrhosis, accounting for most cases of hypertension.
Jaundice is characterized by the yellow coloration of the skin and sclerae due to the retention of pigmented bilirubin, and as cholestasis characterized by systemic retention of not only bilirubin but also other solutes eliminated in bile.
Cholestatic conditions which result from hepatocellular dysfunction or intrahepatic or extrahepatic biliary obstruction also may present with jaundice. Pruritis is a presenting symptom related to the elevation in plasma bile acids and their deposition in peripheral tissues particularly skin. Skin xanthomas sometimes vitamins A, D or K improve the results.
Appear as the result of hyperlipidemia and impaired excretion of cholesterol. Vitamin suppliments like Viral hepatitis caused by group of virus having a particular affinity to the liver. These include Infectious mononucleosis, Cytomegalovirus and Yellow fever
Autoimmune hepatitis is a chronic hepatitis that produce Female predominance particularly in young and postmenopausal problems in women, absence of viral serological marker, Elevated serum IgG and γ-globulin levels, High serum titers of autoantibodies including antinuclear (ANA), antismooth muscle (SMA) and antiliver/kidney microsome antibodies (anti-LKMI)b and Negative antimitochondrial antibody.
Alcoholic liver disease:
Excessive alcohol consumption is the major cause of liver diseases in most developing and developed countries.
Metabolic liver diseases:
These include Nonalcoholic fatty liver disease and steatohepatitis, Hemochromatosis, Wilson’s disease, α1-Antitrypsin deficiency and Neonatal cholestasis.
Intrahepatic biliary tract diseases:
Primary biliary cirrhosis, which is a chronic, progressive, and often fatal cholestatic liver disease characterized by the destruction of intrahepatic bile ducts, portal inflammation and scarring, and the eventual development of cirrhosis and liver failure.
Primary sclerosing cholangitis that is characterized by the inflammation and obliterative fibrosis of intrahepatic and extrahepatic bile ducts, with dilation of preserved segments [97-98].
Hepatic disease associated with pregnancy:
i. Maternal hypertension, proteinuria, peripheral edema, coagulation abnormalities and varying degrees of disseminated intravascular coagulation
ii. Acute fatty liver of pregnancy which exhibits subclinical hepatic dysfunction to hepatic failure, coma and death.
iii. Intrahepatic cholestasis of pregnancy characterized by pruritis in the third trimester followed by the darkening of urine and occasionally light stools and jaundice.
Nodules and tumors:
Hepatic masses may come to attention for a variety of reasons. These include Nodular hyperplasia, benign neoplasms, malignant tumors, Hepatocellular carcinoma, Cholangiocarcinoma and Metastatic tumors
Life threatening complications:
Hepatic failure include multiple organ failure, coagulopathy, hepatic encephalopathy, hepatorenal syndrome rupture Malignancy with chronic disease include hepatocellular carcinoma
Liver plays a major role in detoxification and excretion of many endogenous and exogenous compounds, any injury or impairment of its function may lead to several implications on one’s health. In treating the hepatoprotective activity many significant medicinal plant extracts are tremendously cure the liver diseases. With the medicinal plant treatment we can reduce the adverse effects of the drugs, as these drugs are naturally available, these may not cause toxicity. Prolong use of medicinal plants may causes some toxicity, but we can cure or minimize the side effects. The drugs Tetracycline, Salicylates, ethanolic agents may causes hepatotoxicity and various adverse effects, comparatively by using medicinal plants may not cause any injury to tissues and other organs.
- Sharma B, Siddiqui S, Ram G, Chaudhary M, Sharma G (2013) Hypoglycemic and Hepatoprotective Effects of ProcessedAloe veraGel in a Mice Model of Alloxan Induced Diabetes Mellitus. J Diabetes Metab 4:303.
- Wang N, Wang Y, Li P, Peng W, Xie T, et al. (2009) The Bioavaliability of Hepatoprotective Flavoniods in Hypericum Japonicum Extract. J Bioanal Biomed 1: 033-038.
- Kumar MD, Deepmala J, Sangeeta S (2012) Hepatoprotective Effects of Polygonum Bistorta and Its Active Principles on Albino Rats Intoxicated with Carbon Tetrachloride and Paracetamol.
- Burczynski FJ, Yan J, Gong Y, Nguyen D, Wang G, et al. (2013) The Hepatoprotective Effect of Diltiazem and Silymarin. Nat Prod Chem Res 1:111.
- Gaweesh A, Sengab AENB, El-Hefnawy HM, Osman SM, Abdou AM (2015) Phytoconstituents, Cytotoxic, Antioxidant and Hepatoprotective Activities of the Aerial Parts of Lycium shawii R. Growing in Egypt. Med Aromat Plants 4:180.
- Joselin J, Jeeva S (2014) Andrographis paniculata: A Review of its Traditional Uses, Phytochemistry and Pharmacology. Med Aromat Plants 3:169.
- Haidry MT, Malik A (2014) Hepatoprotective and Antioxidative Effects ofTerminalia Arjuna againstCadmium Provoked Toxicity in Albino Rats (Ratus Norvigicus). Biochem Pharmacol 3:130.
- Al-Hadiya BM, AlAjmi MF, El Tahir KEH (2013) Myrica rubra Fruit Drink Sub-Chronic Toxicity and Hepatoprotective Effect in Rats. Adv Pharmacoepidem Drug Safety 2:127.
- Gaweesh A, Sengab AENB, El-Hefnawy HM, Osman SM, Abdou AM (2015) Phytoconstituents, Cytotoxic, Antioxidant and Hepatoprotective Activities of the Aerial Parts of Lycium shawii R. Growing in Egypt. Med Aromat Plants 4:180.
- Naseemuddin R, Singal AK (2015) Liver Transplantation for Alcoholic Hepatitis: Light at the End of Tunnel. J Liver 4:e110.
- Ravindran S, Quaglia A, Baker A (2015) Eosinophilic GI Disorders (EGID) following Immunosuppression for Liver Transplantation. J Liver 4:175
- Ibrahim AA, Mahmoud Salem HE, Zaky DZ, El-Sayed EA, Hamed AM, et al. (2015) Dietary Patterns in Egyptian Patients with Chronic Hepatitis C Related Liver Disease: A Cross-Sectional Study. J Liver 4:176.
- Salah Debes Md (2015) Non Alcoholic Fatty Liver Overview. J Liver 4:177.
- Nada SA, Gowifel AMH, El-Denshary EES, Salama AA, Khalil MG, et al. (2015) Protective Effect of Grape Seed Extract and/or Silymarin Against Thioacetamide-induced Hepatic Fibrosis in Rats . J Liver 4:178.
- Nguyen NTT, Harring TR, Goss JA, O’Mahony CA (2015) Biliary Reconstruction in Pediatric Liver Transplantation: A Case Report of Biliary Complications and Review of the Literature. J Liver 4:179.
- Ueda K, Omori H (2015) Successful Generation of Hepatitis B virus (HBV) Pseudotype Particle; A Versatile Tool for Identification of the HBV Receptor and Investigation of HBV Infectivity. J Liver 4:169.
- Sherer F, Van Simaeys G, Kers J, Yuan Q, Doumont G, et al. (2015) Dynamic Molecular Imaging for Hepatic Function Assessment in Mice: Evaluation in Endotoxin-Induced and Warm Ischemia-Reperfusion Models of Acute Liver Failure. J Liver 4:170.
- Patel JN, Gupta S, Fauzdar M, Patel N, Chaturvedi S (2015) Congenital Hepatic Fibrosis Associated with Polycystic Kidney Disease. J Liver 4:171.
- Wiederkehr JC, Wiederkehr HA, Erbano BO, Wiederkehr BA, de Carvalho CA (2015) W Technique for Biliary Anastomosis in Liver Transplantation. J Liver 4:172.
- Vahidi-eyrisofla N, Ahmadifar M, Eini AM, Kalami A (2015) The Study of Levofloxacin Effects on Liver Tissue in Wistar Rat. J Liver 4:173.
- Carvalho CF, Jerico MM, Cogliati B, Cintra TCF, Chammas MC (2015) Association of Doppler Wave Pattern of Hepatic Veins and Fatty Liver Disease Degree. J Liver 4:174.
- Dukova D, Kotzev I (2014) Clinical Analysis of 75 Patients with Primary Biliary Cirrhosis. J Liver 3:161.
- Ennaifer R, Elleuch N, Romdhane H, Hefaiedh R, Cheikh M, et al. (2014) Refractory Ascites in Cirrhosis: Prevalence and Predictive Factors. J Liver 3:162.
- Hassan EA, Abd El-Rehim ASE, Ahmed AO, Elsherbiny NM, Abo Elhagag NAE (2014) The Impact of Serum Interleukin-17 on Chronic Hepatitis C and Its Sequelae. J Liver 3:163
- Chen LY, Wang K, Chen Z (2014) Complete Response of Hepatocellular Carcinoma to Sorafenib: A Case Report and Review of Literatures. J Liver 3:164.
- Morsy KH, Ghaliony MAA, Mohamed HS, ElMelegy TTH (2014) Diagnostic Value of Serum Ascites Lipid Gradients in Patients with Ascites. J Liver 3:165.
- Riediger C, Bachmann J, Hapfelmeier A, Kleeff J, Friess H, et al. (2014) Low Postoperative Platelet Count is Associated with Higher Morbidity after Liver Surgery for Colorectal Metastases. J Liver 3:166.
- Otto W, Krol M, Maciaszczyk M, Najnigier B, Sierdzinski J, et al. (2014) Levels and Values of Circulating Hematopoietic and Endothelial Progenitor Cells in Patients with Hepatocellular Carcinoma . J Liver 3:167.
- Makipour K, Modiri A, Makipour H (2014) A Rare Cause of Biliary Obstruction. J Liver 3:168.
- Kamkamidze G, Kikvidze T, Butsashvili M, Chubinishvili O (2014) Factors Associated with Persistence of Hepatitis B Virus Infection. J Liver 3:153.
- Shizuma T (2014) Coexistence of Primary Biliary Cirrhosis and Inflammatory Bowel Disease. J Liver 3:154.
- Ikezaki H, Furusyo N, Ogawa E, Shimizu M, Hiramine S, et al. (2014) Efficacy and Tolerance of Interferon ß Plus Ribavirin Treatment for Chronic Hepatitis C Patients with Depression or Thrombocytopenia Comparison with Pegylated Interferon a Plus Ribavirin Treatment. J Liver 3:155.
- Schwartz L, Coldwell D (2014) Is Liver Disease Caused by Increased Pressure? Interstitial Pressure as a Causative Mechanism in Carcinogenesis and in the Differential Blood Supply in Liver Tumors from the Hepatic Artery. J Liver 3:156.
- Appleby VJ, Hutchinson JM, Davies MH (2014) Safety and Efficacy of Long Term Nasobiliary Drainage to Treat Intractable Pruritus in Cholestatic Liver Disease. J Liver 3:157.
- Qureshi HA, Pearl JA, Anderson KA, Green RM (2014) Fibroblast Growth Factor 19 Activates the Unfolded Protein Response and Mitogen-Activated Protein Kinase Phosphorylation in H-69 Cholangiocyte Cells. J Liver 3:158.
- Fernandes L, Lungato L, Zaros T, Marinho R, Cavalcante-SIlva V, et al. (2014) Detraining Leads to Weight Gain and a Decrease in Hepatic Glycogen after 8 Weeks of Training. J Liver 3:159.
- Nour E, Rym E, Rym E, Hayfa R, Rania H, Myriam C, Wassila B, Houda BN, Najet BH (2014) Overlap Syndrome of Primary Biliary Cirrhosis and Autoimmune Hepatitis with Unusual Initial Presentation as an Acute Hepatic Failure. J Liver 3:160.
- Shalmani HM, Ranjbar M, Alizadeh AHM (2013) Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease. J Liver 3:147.
- Salem EH, Taha M, Aziz A, Alsebaey A, El-Ella KA, et al. (2014) Recurrent Hepatitis C Virus (Genotype 4) Infection after Living Donor Liver Transplantation: Risk Factors and Outcome. J Liver 3:148.
- Zunga PM (2014) “Entecavir in Severe Acute Hepatitis B”. J Liver 3:149.
- Abdelraouf A, Hamdy H, Ezzat H, Hassan AMA, Elsebae MM (2014) Initial Experience of Surgical Microwave Tissue Precoagulation in Liver Resection for Hepatocellular Carcinoma in Cirrhotic Liver. J Liver 3:150.
- Jayaraj M, Villaluz JE, Seth M, Cronin J (2014) Emerging Infectious Liver Disease - Metastasizing Klebsiella pneumoniae Liver Abscess. J Liver 3:151.
- Kanayama K, Ishii K (2014) Amino Acid 70 Substitution in the Core Region of Hepatitis C Virus in Serum Lipid Markers of Patients with Chronic Hepatitis C Genotype 1b. J Liver 3:152.
- Parvez MK, Ali R (2014) Hepatitis E Virus Cross-Reactivity and False-Seropositivity: Challenges to Diagnosis. J Liver 3:e109.
- Cernichiaro-Espinosa Linda A, Segura-Ortega Jorge E, Panduro A, Moreno-Luna Laura E (2014) Amebic Liver Abscess: A New Perspective on the Prognosis of Patients in an Endemic Area Regional Referral Center. J Liver 3:142.
- Gupta S, Misra S, Goyal M, Kumar V, Chaturvedi A, et al. (2014) Prognostic significance of AgNOR Proliferative Index in gallbladder carcinoma - A potential alternative to frozen section analysis. J Liver 3:143.
- Nichols TW (2013) A Review of Fatty Liver/NASH and Liver Cirrhosis: Genetics, Prevention, Nutritional, Behavioral Modification, Exercise, Pharmaceutical, Biophysics and Biotech Therapy. J Liver 3: 144.
- Sato M, Flanders KC, Matsubara T, Muragaki Y, Saika S, et al. (2014) Smad3 Deficiency Counteracts Hepatocyte Apoptosis and Portal Fibrogenesis Induced By Bile Duct Ligation. J Liver 3:145.
- Fede G, Spadaro L, Purrello F (2014) Review: Adrenal Insufficiency in Liver Disease. J Liver 3: 146.
- Wu J, Ingham M (2013) Immunotherapy and Hepatocellular Carcinoma. J Liver 2:e108.
- Luna LEM (2013) Have we Failed Informing the Population the Negative Health Effects of Alcohol? Lessons from the Tobacco Campaigns. J Liver 2:e107.
- Hernanda PY, Gonzalez AP, van der Laan LJW, Hoogduijn MJ, Peppelenbosch MP, et al. (2013) Mesenchymal Stem/Stromal Cells Exert Trophic Effect on Colorectal Cancer Metastasis to the Liver. J Liver 2:135.
- Plaschke K, Schneider J, Kopitz J (2013) Surgery under Propofol Anesthesia Induced Behavioral Changes Associated With Increased Cerebral Apoptosis in Rats. J Liver 2:136.
- de Moura LP, Gomes RJ, de Almeida Leme JAC, de AraÃºjo MB, de Mello MAR (2013) Hepatic Steatosis Markers in Diabetic Rats Trained at the Aerobic/ Anaerobic Transition. J Liver 2:137.
- Alizadeh AHM, Khah MM, damghani NS, Talaee R, Nia HR, et al. (2013) Metabolic Syndrome in Patients with Gallstone. J Liver 2:138.
- Nielsen K, Van der Sluis WB, Scheffer HJ, Meijerink MR, Comans EFI, et al. (2013) Stereotactic Ablative Radiotherapy to Treat Colorectal Liver Metastases: Ready for Prime-Time? J Liver 2: 139.
- Sato T, Kitagawa S, Kimura M (2013) Evaluation of Duodenal Angioectasia with Portal Hypertension. J Liver 2: 140.
- Mizuguchi T, Kawamoto M, Meguro M, Ota S, Ishii M (2013) Left Lateral Sectionectomy Performed Under Minimal Open Access after the Completion of Hand-Assisted Laparoscopic Mobilization. J Liver 2:141.
- Marzio DHD (2013) Epigallocatechin-3-Gallate (EGCG) as a Potential Chemopreventative and Chemotherapeutic Agents in Hepatocarcinogenesis. J Liver 2:e106.
- Elaffandi A, Nada H, Mohamed S, Farahat A, Mohamed G, et al. (2013) Gallbladder Stone Migrating in the Liver and Mimicking Gallbladder Cancer (GBCA). J Liver 2:131.
- Dabiri R, Bastani A, Alizadeh AHM (2013) Detection of Undiagnosed Wilson's Disease after Hepatitis A Virus Infection. J Liver 2:130.
- LeÃ³n HD, BouÃ© S, Peitsch MC, Hoeng J (2013) Modulation of the Hepatic Lipidome and Transcriptome of Apoe-/-Mice in Response to Smoking Cessation. J Liver 2:132.
- Oldani A, Garavoglia M (2013) Hepatocellular Cancer Arising From Ectopic Liver Tissue on Diaphragm in Association with Desmoid Mesenteric Tumor. J Liver 2:133.
- Vitale A, Salinas F, Zanus G, Lombardi G, Senzolo M, et al. (2013) Could Sorafenib Disclose New Prospects as Bridging Therapy to Liver Transplantation in Patients with Hepatocellular Carcinoma? J Liver 2:134.
- Nacif LS, Andraus W, de Paiva Haddad LB, Pinheiro RS, D'Albuquerque LAC (2013) MELD Era Increases the Number of Combined Liver and Kidney Transplantations. J Liver 2:124.
- Hassan EA,El-Rehim ASDA, Sayed ZEAA, Abdelhafez HA, Abdelhameed MR (2013) N-Terminal Pro-Brain Natriuretic Peptide: Prognostic Potential in End Stage Liver Cirrhosis in a Cohort Free of Heart Failure; an Egyptian Insight. J Liver 2:125.
- Siricilla M, Rasheed K, Avery RA (2013) Primary Malignant Epithelioid Hemangioendothelioma of the Liver in a Young Man. J Liver 2:126
- Notarnicola M, Tutino V, Osella AR, Bonfiglio C, Guerra V, et al. (2013) Increased Serum Levels of Oxidative Stress Markers in Patients with Liver Steatosis. J Liver 2:127.
- Iadevaia M, Del Prete A, Cotticelli G, De Sio I, Niglio A, et al. (2013) Budd- Chiari Syndrome as a Manifestation of Antiphospholipid Antibody Syndrome during Oral Contraceptive Therapy: More to Think About. J Liver 2:129.
- Gramenzi A, Dall'agata M, Biselli M, Bernardi M (2013) Direct Antiviral Agents for the Treatment of Hcv Reinfection after Liver Transplantation. J Liver 2:118.
- Dhanunjaya Y, Usha Anand, Anand CV (2013) A Study of Plasma D-Dimer Levels in Various Stages of Liver Disease. J Liver 2:119.
- Abdelaal EM, Saad M, Badra GA (2013) Demographic and Clinico-Pathological Characteristics of Egyptian Patients with Cholangiocarcinoma. J Liver 2:120.
- Elshimi E, Darwish HA, Abdelaal EM, Sherify ME, Morad W, et al. (2013) Switch On/Off of Hepatitis C and Major Chronic Skin Diseases in Egyptian Patients: Study of Prevalence, the Impact of, Gender, Viral Load and the Severity of Liver Disease. J Liver 2:121.
- Juan S, Alexis L, Daniel C, Daniel A, Claude T (2013) “Combined Laparoscopic and Trans-Thoracic Approach” for Limited Liver Resections. J Liver 2:123.
- Bei R (2013) Are Alpha-Fetoprotein Based-Vaccines Potential Tools for Liver Cancer Therapy? J Liver 2:e103.
- Wu J (2013) Prognostic Factors for Hepatocellular Carcinoma: Is it ready for Primetime? J Liver 2:e104.
- Bellizzi A, Tommasi S (2013) Cancer Cells with Stem Cell-Like Phenotypes and Liver Metastasis from Colon Carcinoma. J Liver 2:114.
- Prima V, Cao M, I Svetlov S (2013) ASS and SULT2A1 are Novel and Sensitive Biomarkers of Acute Hepatic Injury-A Comparative Study in Animal Models. J Liver 2: 115.
- Sheir Z, Badra G, Salama O, Gomaa AI, Saber W (2013) Effect of Combination of Some Natural Products and Chloroquine on HCV Infection in Egyptian Patients: Pilot Study. J Liver 2:116.
- Leu JIJ, Murphy ME, George DL (2013) The p53 Codon 72 Polymorphism Modifies the Cellular Response to Inflammatory Challenge in the Liver. J Liver 2:117.
- Makhlouf NA, Azeem AA, Makhlouf HA, Moustafa EA, Ghany MA (2012) Hepatopulomnary Syndrome among Cirrhotic Patients in Upper Egypt: Prevalence, Clinical Presentations and Laboratory Features. J Liver 1:108
- Saidi RF, Yoon V, Jabbour N, Shah SA, Bozorgzadeh A (2012) Liver Transplantation from a Donor with Multiple Biliary Hamartomata. J Liver 1:109.
- Celikbilek M, Dogan S, Selcuk H (2012) A New Test Required Instead of Tuberculin Skin Test in Liver Transplant Recipients. J Liver 1:110.
- El-Shafei HM (2012) Incidence of Chronic Hepatitis B and C Virus Infection in Damietta, Egypt. J Liver 1:111.
- Ousmane KA, Boillot O, Adham M, Pittau G, Gelas T (2012) Biliary Complications after Choledochocholedochostomy without T-tube in Whole-Size Liver Transplantation in Adults. J Liver 1:112.
- Kogame M, Ishii K, Kanayama K, Shinohara MI, Sumino Y (2012) Elevation of Serum Apolipoprotein B after Successful Eradication of Hepatitis C Virus in Patients with Chronic Hepatitis C Treated by IFN-Based Therapy. J Liver 1:113.
- Kniepeiss D (2012) Genotype-Guided Immunosuppression after Liver Transplantation: Chance for Individualizing Therapy?. J Liver 1:e102.
- Saidi RF, Leduc M, Lee H, Anwar N, Shah S, et al. (2012) A Case of Idiopathic Non-Cirrhotic Portal Hypertension. J Liver 1:104.
- Munoz J, Sheqwara J, Hanbali A, Wollner I (2012) Fulminant Malignant Hepatic Failure. J Liver 1:105.
- Yamagiwa K, Iizawa Y, Kobayashi M, Shinkai T, Hamada T, et al. (2012) Evaluation of Biliary Secretory Immunoglobulin-A in Recipients of Living-Donor Liver Transplantation. J Liver 1:106.
- Chen H, Ma Y, Ying L, Chen D, Liu Y, et al. (2012) Effects of Ginseng Polysaccharides on Hepatocellular Energy Metabolism in Hepatic Ischemia Reperfusion Injury in Rabbits. J Liver 1:107.
- LeBrun DG, Yu X, Li M (2011) The Future of MicroRNAs in Liver Cancer. J Liver 1:e101.
- Dua K, Pabreja K (2011) Investigation on Dissolution Pattern and Mathematical Modeling of Drug Release of UDCA by Complextaion with b-Cyclodextrin-Choline Dichloride Coprecipitate. J Liver 1:101.
- Zheng MH, Sun DQ, Jiang Q, Shi KQ, Wu AM, et al. (2011) Pharmacotherapy for Hepatic encephalopathy: view of Evidence-Based Medicine. J Liver 1:102.
- Chan AC (2011) Common Peroneal Nerve Palsy after Liver Transplantation. J Liver 1:103.
- Huynh D, Nguyen NQ (2015) Gastrointestinal Dysfunction in Chronic Liver Disease. J Gastrointest Dig Syst 5:257.
- Sidiq T, Khan N (2014) Protein Calorie Malnutrition in Liver Cirrhosis. J Nutr Food Sci 5:337.
- Alou-El-Makarem MM, Moustafa MM, Fahmy MA, Abdel-Hamed AM, Elfayomy KN, et al. (2014) Evaluation of Carbonylated Proteins in Hepatitis C Virus Patients. Mod Chem appl 2:130.