ReviewActa pharmacologica Sinica2021
Tu-San-Qi (Gynura japonica): the culprit behind pyrrolizidine alkaloid-induced liver injury in China.
Review in Acta pharmacologica Sinica, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers.
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Who cites it
36 citing papers in PubMed, 74 citations in OpenAlex.
- Development of a Drum Tower Severity Scoring (DTSS) system for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome.Hepatology international · 2022Trial
- Clinicopathological Evolution of Pyrrolizidine Alkaloid-induced Liver Injury: Transition From SOS to PSVD?Journal of clinical and translational hepatology · 2026Article
- Red blood cell damage defines the etiology of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids.Acta pharmaceutica Sinica. B · 2026Article
- Serpine1 as a potential therapeutic target in pyrrolidine alkaloids-induced hepatic sinusoidal obstruction syndrome.JHEP reports : innovation in hepatology · 2026Article
- Transjugular intrahepatic portosystemic shunt improves survival in anticoagulation-resistant hepatic sinusoidal obstructive syndrome patients: A multicenter retrospective study.World journal of hepatology · 2026Article
- Hepatic sinusoidal obstruction syndrome caused by Gynura japonica once misdiagnosed as pancreatitis: a case report and review of literature.Journal of medical case reports · 2026Review
- Transjugular liver biopsy in patients with unexplained liver dysfunction and bleeding tendency: a safety and efficacy analysis.BMC gastroenterology · 2026Article
- Hepatic Sinusoidal Obstruction Syndrome Induced by Pyrrolizidine Alkaloids fromMolecules (Basel, Switzerland) · 2026Review
- Unraveling pyrrolizidine alkaloid-induced liver damage with an integrative spatial lipidomics framework.Journal of pharmaceutical analysis · 2026Article
- Holistic concept guided quality control of traditional Chinese medicines for optimizing bioavailability.Chinese medicine · 2025Review
- Serum ascites albumin gradient in predicting the severity of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids.Clinical and experimental hepatology · 2025Article
- Quantitative Analysis of Pyrrolizidine Alkaloids in Food Matrices and Plant-Derived Samples Using UHPLC-MS/MS.Foods (Basel, Switzerland) · 2025Article
- Drug-induced hepatic sinusoidal obstruction syndrome: current advances and future perspectives.Archives of toxicology · 2025Review
- Changes in gut microbiota inFrontiers in microbiology · 2025Article
- Rivaroxaban alleviates hepatic sinusoidal obstruction syndrome in mice by modulating the gut microbiota and inhibiting the PI3K/Akt signaling pathway.Frontiers in microbiology · 2025Article
- Functional metabolomics characterizes the contribution of farnesoid X receptor in pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome.Archives of toxicology · 2024Article
- Idiopathic hypereosinophilic syndrome with hepatic sinusoidal obstruction syndrome: A case report and literature review.World journal of gastrointestinal surgery · 2023Article
- Transjugular Intrahepatic Portosystemic Shunt Benefits for Hepatic Sinusoidal Obstruction Syndrome Associated with Consumption of Gynura Segetum: a Propensity Score-Matched Analysis.Cardiovascular and interventional radiology · 2023Article
- [Comparative analysis of clinical diagnosis and treatment guidelines for drug-induced liver injury at home and abroad].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2023Article
- Comparison of the prognostic models for mortality in idiosyncratic drug-induced liver injury.Hepatology international · 2023Article
Corrections and comments
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Authors and funding
10 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Herbs and dietary supplement-induced liver injury (HILI) is the leading cause of drug-induced liver injury in China. Among different hepatotoxic herbs, the pyrrolizidine alkaloid (PA)-producing herb Gynura japonica contributes significantly to HILI by inducing hepatic sinusoidal obstruction syndrome (HSOS), a liver disorder characterized by hepatomegaly, hyperbilirubinemia, and ascites. In China, G. japonica has been used as one of the plant species for Tu-San-Qi and is often misused with non-PA-producing Tu-San-Qi (Sedum aizoon) or even San-Qi (Panax notoginseng) for self-medication. It has been reported that over 50% of HSOS cases are caused by the intake of PA-producing G. japonica. In this review, we provide comprehensive information to distinguish these Tu-San-Qi-related herbal plant species in terms of plant/medicinal part morphologies, medicinal indications, and chemical profiles. Approximately 2156 Tu-San-Qi-associated HSOS cases reported in China from 1980 to 2019 are systematically reviewed in terms of their clinical manifestation, diagnostic workups, therapeutic interventions, and outcomes. In addition, based on the application of our developed mechanism-based biomarker of PA exposure, our clinical findings on the definitive diagnosis of 58 PA-producing Tu-San-Qi-induced HSOS patients are also elaborated. Therefore, this review article provides the first comprehensive report on 2214 PA-producing Tu-San-Qi (G. japonica)-induced HSOS cases in China, and the information presented will improve public awareness of the significant incidence of PA-producing Tu-San-Qi (G. japonica)-induced HSOS and facilitate future prevention and better clinical management of this severe HILI.
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