Monday, 7 June 2004 05:30 PM GMT
A German study which appeared in last month's Digestive Disease Week (DDW 2004), Louisiana shows over 40% response rates.
Hepatitis C patients may respond to a combination of green tomatoes and mistletoe extracts when interferon fails according to a German study which appeared in last month's Digestive Disease Week (DDW 2004), Louisiana.
Harald Matthes, MD, medical director and chief of the Department of Gastroenterology at Havelhohe Hospital for Anthroposophically Extended Medicine in Berlin, Germany, presented the findings on May 16th at Digestive Disease Week 2004 (DDW).
He found that treatment with a mix of herbs that includes extracts of mistletoe and green tomato may lead to a sustained response in patients with hepatitis C (HCV) for whom treatment with pegylated interferon?alpha has failed or is contraindicated.
Hepatitis C is a disease featuring inflammation of the liver due to infection with hepatitis C virus. Hepatitis C infects an estimated 170 million persons worldwide and 4 million persons in the United States. Currently, the preferred treatment is pegylated interferon together with ribavirin. Studies have shown sustained cure rates of 75% or better in people with genotypes 2 or 3 HCV (which is easier to treat) and about 50% in those with genotype 1.
The new combination
Mistletoes are parasitic plants with a root-like system imbedded in their host to extract food and water. The extracts used were mistletoe extract (Viscum album), and oral extracts of green tomato (Solanum lycopersicum) and Hepatodoron (Fragaria vesca and Tritis vinifer).
The mistletoe extract is thought to activate CD4 T helper?1 cells to induce an HCV?specific immune response, and the Hepatodoron stimulates liver regeneration.
The green tomato contains alkaloids that induce apoptosis through the caspase 8 pathway. This is important because HCV blocks heaptocyte apoptosis, which is required to clear infected cells from the liver.
The objective of the current German study is to achieve HCV-RNA-PCR negativity after 1 or 2 years of treatment and 6 months of follow up, documentation of side effects, fibrosis -parameter (PIIIP) and the quantitative course of HCV-RNA-PCR.
Up to now, 85 patients with chronic hepatitis C (> 6 months) with increased transaminases and positive HCV-RNA-PCR values have been included. 43 patients had a liver biopsy before therapy; 27 patients failed interferon therapy. Genotype was determined in all patients.
Initially mistletoe was administered 3 times per week subcutaneously; concomitantly, Hepatodoron 3 x 2 tablets were given. After 14 days Solanum lycopersicum Herba D3-4 tablets were applied. Duration of therapy was 12 (78 patients) - 24 months (64 patients).
78 of 85 patients terminated the therapy. 14 patients (18%) were HCV-RNA-PCR negative after 12 months. After 24 months 20 patients (25%) showed a sustained response. 44 patients (56%) were non-responders. No essential side effects were observed.
Transaminases and PIIIP-values decreased significantly during therapy (p<0,05). Virus load did not decrease continuously but in those patients with HCV-RNA-PCR negativity it decreased below the limit of detection, independent of the initial level. 2 patients had shown a so-called 'break through' phenomenon.
After 12 months, 18% were complete responders, 49% were partial responders and 33% were nonresponders. After 1 more year of treatment and an additional 6 months' follow?up, the corresponding rates were 44%, 28% and 28%.
The advantage of mistletoe therapy is the absence of side effects and
its cost effectiveness.
About 60% of patients exhibited local responses to the injection, but otherwise adverse events were mild and uncommon. Mistletoe is used in the treatment of about 60 percent of cancer patients in Germany, so its safety profile is well established.
The researchers estimate that the cost to treat each patient who achieves a complete and sustained response is $5,600 with the herbal extracts, compared with $28,000 for interferon therapy. However, some experts cautioned mistletoe treatment could induce heaptocyte apoptosis, which could be quite dangerous for patients with an impaired hepatic reserve.
In the US subcutaneous injections of mistletoe are considered a drug rather than a dietary substance, and have not been approved by the FDA.
Digestive Disease Week is jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association, the American Society for gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.
Dr. Tamer Fouad, M.D.
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