Laboratoire de Pharmacognosie, UMR 8638 COMETE CNRS, Faculté de Pharmacie de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, F-75006, France.
Centre Antipoison de Paris, AP-HP Hôpital Lariboisière-Fernand Widal, Paris, F-75010, France.
Sci Rep. 2018 Sep 10;8(1):13520. doi: 10.1038/s41598-018-31815-6.
Tinospora crispa is a popular traditional herbal plant commonly used throughout the world for treatment of various diseases, in particular type 2 diabetes mellitus. We report here a new case of toxic hepatitis in a 57-year old male patient in the French West Indies following the consumption of two aqueous extracts of fresh Tinospora crispa stems. It thus differs from two previously reported cases that concerned the chronic intake of powdered dry stems delivered in solid oral dosage forms (i.e. pellets and tablets). Liquid Chromatography-Diode Array Detection-Mass Spectrometry (LC/DAD/MS) analyses were performed on an aqueous extract of the offending sample that mimics the swallowed preparation. They revealed the presence of species-specific molecular marker borapetoside C (1) and thus enabled an unambiguous phytochemical identification. The exploration of tandem MS/MS data obtained by ultra-high performance liquid chromatography/electrospray ionization quadrupole time-of-flight mass spectrometry (UHPLC-ESI-QTOF-HRMS) allowed the identification of 17 additional cis-clerodane-type furanoditerpenoid lactones, analogues of 1. These results support the hypothesis that the mechanisms underlying hepatotoxicity of Tinospora crispa are the same as those encountered with furanoditerpenoids-containing plants such as Teucrium chamaedrys or Dioscorea bulbifera. In the context of type 2 diabetes treatment, we recommend that Tinospora crispa intake should be more closely monitored for signs of hepatotoxicity.
钩吻是一种流行的传统草药植物，在世界各地广泛用于治疗各种疾病，特别是 2 型糖尿病。我们在此报告了法属西印度群岛的一名 57 岁男性患者在摄入两种新鲜钩吻茎的水提物后发生中毒性肝炎的新病例。这与之前报告的两例慢性摄入以固体口服剂型（即丸剂和片剂）提供的干茎粉末的病例不同。对模拟吞下制剂的可疑样品的水提物进行了液相色谱-二极管阵列检测-质谱（LC/DAD/MS）分析。它们揭示了特定于物种的分子标记物博雷柏苷 C（1）的存在，从而能够进行明确的植物化学鉴定。通过超高效液相色谱/电喷雾电离四极杆飞行时间质谱（UHPLC-ESI-QTOF-HRMS）获得的串联 MS/MS 数据的探索允许鉴定 17 种另外的顺式- clerodane 型呋喃二萜内酯，为 1 的类似物。这些结果支持了钩吻肝毒性的机制与含呋喃二萜类植物（如 Teucrium chamaedrys 或 Dioscorea bulbifera）相同的假设。在 2 型糖尿病治疗方面，我们建议应更密切监测钩吻摄入是否有肝毒性的迹象。
