Milk Thistle (Silymarin)

The use of herbal/botanical products, also referred to as complementary and alternative medicines (CAM), worldwide enjoys increasing popularity. It appears in particular highly prevalent in patient populations already exposed to complex treatment algorithms and polypharmacotherapy, frequently involving narrow therapeutic index drugs. Accordingly, the potential clinical dimension and relevance of herb-drug interactions has received considerable attention over the last years. However, review of pertinent literature indicates that the available clinical evidence in this regard is still limited and sometimes inconclusive. Also, communication of herb-drug interaction data in the biopharmaceutical/medical literature is often complex and confusing, not always unbiased, and in many cases appears not to strive for clear-cut and useful guidance in terms of the clinical relevance of such findings.This systematic review summarizes and interprets the published evidence on clinical herb-drug interaction studies which examined the potential of six popular herbal drugs (Echinacea, garlic, gingko, ginseng, goldenseal, and milk thistle) as perpetrators of pharmacokinetic (PK) drug interactions. Reported effect sizes were systematically categorized according to FDA drug interaction guideline criteria. A total of 66 clinical PK interaction studies, meeting the scope of the present review, were identified. The clinical evidence was found to be most robust and informative for Gingko biloba (GB; 21 studies) and milk thistle/silymarin (MT; 13), and appears still limited for ginseng (9), goldenseal/berberine (GS; 8), garlic (8), and Echinacea (7). Collectively, the available evidence indicates that, at commonly recommended doses, none of these herbs act as potent or moderate inhibitors or inducers of cytochrome P450 (CYP) enzymes or P-glycoprotein (ABCB1). Weak effects in terms of either induction or inhibition were found for GB (presystemic/hepatic CYP3A4 induction/inhibition, CYP2C19 induction at high doses), milk thistle/silymarin (CYP2C9 inhibition), GS/berberine (CYP3A4 and CYP2D6 inhibition), Echinacea (presystemic/hepatic CYP3A4 inhibition/induction, CYP1A2 and CYP2C9 inhibition

BACKGROUND: Hair loss remains a global concern for both men and women. AIMS: This study assessed the efficacy and safety of a proprietary extract of bioactive fatty acids from saw palmetto (Serenoa repens) for treating self-perceived thinning hair in healthy adult men and women (SEREVELLE, Valensa International; Eustis, FL). METHODS: This 6-month, randomized, double-blind, placebo-controlled study assessed the beneficial effects of daily active treatment (n = 40) vs. placebo (n = 20) on several hair growth parameters. RESULTS: Active treatment of SEREVELLE significantly outperformed placebo on all primary endpoints at Day 180. Mean (SD) change in baseline total terminal hair count was +18.6 (29.6) with active vs. -10.1 (30.5) with placebo (p < 0.001; 283% greater improvement). Total vellus hair count increased +6.6 (15.6) vs. -2.1 (15.7) (p < 0.05; 414% greater improvement). Total hair density rose +25.1 (27.7) vs. -12.2 (38.8) (p < 0.001; 306% greater improvement). Subgroup analyses at Day 180 corroborated these advantages: across populations, between-group differences in mean change favored active for subgroup of men, with total terminal hair count (p = 0.003), total vellus hair count (p < 0.001), and total hair density (p < 0.001). In menopausal women, active produced significant placebo-adjusted gains in total terminal hair count (p < 0.05) and total hair density (p < 0.01), with a nonsignificant numerical advantage for total vellus hair count. There were no treatment-related adverse events. CONCLUSION: The daily use of a proprietary saw palmetto (Serenoa repens) extract safely and effectively promotes hair growth in men and women with self-perceived thinning hair. © 2026 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

The trial by Cano Contreras et al examined a proprietary formulation containing Silybum marianum and alpha-lipoic acid (SM-ALA), combined with a Mediterranean diet, in patients with metabolic dysfunction-associated steatotic liver disease. While some metabolic benefits were observed, limitations such as the absence of an SM-ALA-only group, the lack of histological data, and a small sample size reduce the validity of the findings. Future research should follow clinical trial standards for pharmacological studies, including phase 1/2 testing, validated outcomes, and transparency. ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic condition affecting a broad population. This review aimed to identify and summarize the current evidence on bioactive-substance-based interventions for adults with MASLD, formerly known as nonalcoholic fatty liver disease (NAFLD), covering publications from 2000 to 2023. Methods: A search was conducted across six databases (MEDLINE, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Food Science Source, and SPORTDiscus) for randomized controlled trials and other study types (e.g., prospective cohort studies and systematic reviews), reflecting the scoping nature of this review. The search was limited to studies in adults (>18 years old), with an intervention of interest and at least one comparator group. Results: A total of 4572 articles were retrieved, with 201 full-text articles screened for eligibility. Of these, 131 primary studies and 49 systematic reviews were included in the scoping review. The most studied bioactive substances were Curcumin (Turmeric) (n = 25), Silymarin (Milk Thistle) (n = 17), Resveratrol (n = 10), Coffee (n = 7), Green Tea (n = 5), and Berberine (n = 5 each). Moreover, 46 studies reported on 36 other bioactive substances with 2 or fewer articles each. Among the included systematic reviews, 13 focused on Curcumin, 12 on Coffee or Tea, 10 on bioactive substance combinations, 6 on Resveratrol, and 2 each on Silymarin and Artichoke Leaf. The included studies showed substantial heterogeneity in reported outcomes, which primarily focused on hepatic health, body weight, adverse events, glycemic control, blood lipids, and body composition. Conclusions: This scoping review highlights a range of bioactive substances used in the treatment of MASLD. While evidence is abundant for bioactive substances like Curcumin and Silymarin, further research and synthesis of findings is necessary to establish the clinical efficacy of all bioactive substances.

BACKGROUND & AIMS: The search for integrative and natural therapies that favor homeostasis to boost sleep and diet quality took place for young adult populations as a non-pharmacological strategy for long-term good quality of life. Thus, the present pilot study aims to investigate the effects of 90-day consumption of a nutraceutical composition on the neuro-immune-endocrine axis, providing better sleep quality and health improvement. METHODS: For this, from March 2021 to June 2021, twenty-two Brazilian young adult volunteers (women and men) with BMI between 18.5 and 34.9 kg/m2 were divided into three distinct supplementation groups: NSupple; NSupple plus_S, and NSupple plus. Briefly, the supplement compositions included yeast β-glucan, prebiotics, and minerals in different concentrations associated or not with the herbal medicine silymarin. Neither nutritional nor physical activity interventions were performed during this pilot study period. The anthropometrics measures, questionnaires answer data, and harvest blood for metabolic, inflammatory, and hormonal tests were collected at baseline time (day zero-T0) and day 90 (T90) post-supplementation. RESULTS: Our results highlight that the supplementation reduced body mass index (BMI), Waist-to-height ratio (WHtR), waist circumference, AST/ALT ratio, alkaline phosphatase, and HbA1c. Post-supplementation the IL-6 and IL-10 levels and the sleep, humor, and quality of life scores were suggested to improve. Sleep quality improvement seems to predict the reduction of adiposity-related body measures. CONCLUSION: In sum, the nutraceutical supplementation might be related to anthropometric, metabolic, and endocrine parameters after 90 days reflecting on perception of humor, sleep, and life quality enhancement. However, it is important to recognize the limitation of the data presented considering that this was a pilot study. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT04810572 registered on 20th February 2021.

Nutraceutical interventions supporting microbiota and eliciting clinical improvements in metabolic diseases have grown significantly. Chronic stress, gut dysbiosis, and metainflammation have emerged as key factors intertwined with sleep disorders, consequently exacerbating the decline in quality of life. This study aimed to assess the effects of two nutraceutical formulations containing prebiotics (fructooligosaccharides (FOS), galactooligosaccharides (GOS), yeast β-glucans), minerals (Mg, Se, Zn), and the herbal medicine Silybum marianum L. Gaertn., Asteraceae (Milk thistle or Silymarin). These formulations, namely NSupple (without silymarin) and NSupple_Silybum (with silymarin) were tested over 180 days in overweight/obese volunteers from Brazil's southeastern region. We accessed fecal gut microbiota by partial 16S rRNA sequences; cytokines expression by CBA; anthropometrics, quality of life and sleep, as well as metabolic and hormonal parameters, at baseline (T0) and 180 days (T180) post-supplementation. Results demonstrated gut microbiota reshaping at phyla, genera, and species level post-supplementation. The Bacteroidetes phylum, Bacteroides, and Prevotella genera were positively modulated especially in the NSupple_Silybum group. Gut microbiota modulation was associated with improved sleep patterns, quality-of-life perception, cytokines expression, and anthropometric parameters post-supplementation. Our findings suggest that the nutraceutical blends positively enhance cardiometabolic and inflammatory markers. Particularly, NSupple_Silybum modulated microbiota composition, underscoring its potential significance in ameliorating metabolic dysregulation. Clinical trial registry number: NCT04810572. 23/03/2021. © 2024. The Author(s).

INTRODUCTION AND OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease with a high prevalence worldwide and poses serious harm to human health. There is growing evidence suggesting that the administration of specific supplements or nutrients may slow NAFLD progression. Silymarin is a hepatoprotective extract of milk thistle, but its efficacy in NAFLD remains unclear. MATERIALS AND METHODS: Relevant studies were searched in PubMed, Embase, the Cochrane Library, Web of Science, clinicaltrails.gov, and China National Knowledge Infrastructure and were screened according to the eligibility criteria. Data were analyzed using Revman 5.3. Continuous values and dichotomous values were pooled using the standard mean difference (SMD) and odds ratio (OR). Heterogeneity was evaluated using the Cochran's Q test (I2 statistic). A P<0.05 was considered statistically significant. RESULTS: A total of 26 randomized controlled trials involving 2,375 patients were included in this study. Administration of silymarin significantly reduced the levels of TC (SMD[95%CI]=-0.85[-1.23, -0.47]), TG (SMD[95%CI]=-0.62[-1.14, -0.10]), LDL-C (SMD[95%CI]=-0.81[-1.31, -0.31]), FI (SMD[95%CI]=-0.59[-0.91, -0.28]) and HOMA-IR (SMD[95%CI]=-0.37[-0.77, 0.04]), and increased the level of HDL-C (SMD[95%CI]=0.46[0.03, 0.89]). In addition, silymarin attenuated liver injury as indicated by the decreased levels of ALT (SMD[95%CI]=-12.39[-19.69, -5.08]) and AST (SMD[95% CI]=-10.97[-15.51, -6.43]). The levels of fatty liver index (SMD[95%CI]=-6.64[-10.59, -2.69]) and fatty liver score (SMD[95%CI]=-0.51[-0.69, -0.33]) were also decreased. Liver histology of the intervention group revealed significantly improved hepatic steatosis (OR[95%CI]=3.25[1.80, 5.87]). CONCLUSIONS: Silymarin can regulate energy metabolism, attenuate liver damage, and improve liver histology in NAFLD patients. However, the effects of silymarin will need to be confirmed by further research.

BACKGROUND: Brain tissue in Alzheimer's patients is exposed to oxidative stress. Silymarin is an adjunct drug that has anti-inflammatory and antioxidant properties. OBJECTIVE: This study aimed to evaluate the effect of silymarin on biomarkers of oxidative stress, inflammation, and disease severity in Alzheimer's patients. METHODS: This randomized, single-blind clinical trial study was performed on 33 patients with Alzheimer's disease (AD) whose disease was confirmed by DSM-5 criteria and by brain imaging. Patients in the case group received three 250 mg silymarin capsules daily (each containing 150 mg silymarin), as an adjunctive medication in addition to the routine medication regimen. In the placebo group (control), patients received the same amount of placebo. All patients underwent Mini Mental State Exam (MMSE) and a panel of blood tests including malondialdehyde, neopterin, catalase, paraoxonase-1, total oxidative status, and total antioxidant capacity to reevaluate the changes pre/postintervention at the end of the trimester. RESULTS: The catalase and MDA serum levels after the adjunctive silymarin treatment decreased significantly (Catalasebefore silymarin = 9.29 ± 7.02 vs Catalaseafter silymarin = 5.32 ± 2.97, p = 0.007 and MDAbefore silymarin = 4.29 ± 1.90 vs MDAafter silymarin = 1.66 ± 0.84, p < 0.001) while MMSE increased notably (MMSEbefore silymarin = 10.39 ± 6.42 vs MMSEafter silymarin = 13.37 ± 6.81, p < 0.001). CONCLUSION: Silymarin can be effective as an adjunct drug and a powerful antioxidant in reducing oxidative stress and improving the course of AD.

The trail aimed to explore the effect of dietary supplementation of Milk Thistle (MT) extract on growth performance and health status of growing rabbits exposed to serve heat stress condition, considering the economic efficiency of supplementation. A total of 96 weaned male rabbits were divided into 4 groups (24 rabbits/group). The first group received the basal diet without any supplementation and served as a control (MT0), while 2nd, 3rd and 4th groups supplemented with MT at levels of 5 (MT5), 10 (MT10) and 15 (MT15) g/kg diet, respectively, for 10 consecutive weeks. Both of growth performance and feed utilisation were significantly enhanced by the dietary treatment, the optimum dose of MT was 12 g/kg diet for average daily gain, specific growth rate and performance index. However, it was 13 g/kg diet for feed conversation ratio. The polynomial regression analysis showed that the lowest values of rectal temperature and respiration rate were observed at doses of 11 and 13 g/kg diet respectively. The dressing percentage and the relative weights of liver and total edible giblets were significantly improved by the treatment (p = 0.0416, 0.0112 and 0.0032, respectively), maximising in the MT10 group. The MT10 and MT15 groups showed higher erythrocytes and leucocytes counts and lower levels of urea, creatinine and total cholesterol compared to the control (p < 0.05). Liver functions significantly enhanced in aforementioned two treated groups, the liver ultrastructure represented normal cytoplasmic organelles, and nucleus and mitochondria in MT10 group, while the MT15 group showed hepatocytes with dilated nucleus with most cytoplasmic organelles appeared well organised and normal except few small cytoplasms vacuolated. The levels glutathione, superoxide dismutase, catalase and total antioxidant capacity as well as immunoglobulin M, and immunoglobulin G significant improved in the MT-Treated groups compared to the control (p < 0.05). Economically, MT supplemented diets improved the net revenue of fattened rabbits during the summer season. In conclusion, the supplementation of MT extract at levels of 10 or 15 g/kg diet enhanced growth performance, feed utilisation, dr

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent liver diseases globally. Pharmacological treatments for NAFLD are still limited. Silymarin, a compound extracted from Silybum marianum, is an herbal supplement traditionally used in folk medicine for liver disorders. It has been proposed that silymarin may possess hepatoprotective and anti-inflammatory properties. The present trial aims to assess the efficacy of silymarin supplementation in the adjuvant treatment of NAFLD in adult patients. METHOD: This is a randomized double-blind placebo-controlled clinical trial recruiting adult NAFLD patients in therapy on an outpatient basis. Participants are randomized to an intervention (I) or control (C) group. Both groups receive identical capsules and are followed for 12 weeks. I receives 700mg of silymarin + 8mg vitamin E + 50mg phosphatidylcholine daily, while C receives 700mg maltodextrin + 8mg vitamin E + 50mg phosphatidylcholine daily. Patients undergo a computerized tomography (CT) scan and blood tests at the beginning and end of the study. Monthly face-to-face consultations and weekly telephone contact are carried out for all participants. The primary outcome assessed will be change in NAFLD stage, if any, assessed by the difference in attenuation coefficient between liver and spleen, obtained by upper abdomen CT. DISCUSSION: The results of this study may provide a valuable opinion on whether silymarin can be used as adjuvant therapy for the management or treatment of NAFLD. The data presented on the efficacy and safety of silymarin may provide more foundation for further trials and for a possible use in clinical practice. TRIAL REGISTRATION: This study has been approved by the Research Ethics Committee of the Professor Edgard Santos University Hospital Complex, Salvador BA, Brazil, under protocol 2.635.954. The study is carried out according to guidelines and regulatory standards for research involving humans, as set out in Brazilian legislation. Trial registration - ClinicalTrials.gov : NCT03749070. November 21, 2018. © 2023. The Author(s).

PURPOSE: It is known that obesity has a multifactorial etiology that involves genetic and environmental factors. The WHO estimates the worldwide prevalence of 1.9 billion overweight adults and more than 650 million people with obesity. These alarming data highlight the high and growing prevalence of obesity and represent a risk factor for the development and aggravation of other chronic diseases, such as nonalcoholic fatty liver disease (NAFLD) that is frequently considered the hepatic outcome of type 2 diabetes. The use of non-pharmacological therapies such as food supplements, nutraceuticals, and natural integrative therapies has grown as an alternative tool for obesity-related diseases compared to conventional medications. However, it is a still little explored research field and lacks scientific evidence of therapeutic effectiveness. Considering this, the aim is to evaluate whether a new nutraceutical supplement composition can improve and supply essential mineral nutrients, providing an improvement of obesity-related metabolic and endocrine parameters. METHODS: Sedentary volunteers (women and men) with body mass index (BMI) ≤34.9 kg/m2 were divided into two groups: Novel Nutraceutical Supplement_(S) (n = 30) and Novel Nutraceutical Supplement (n = 29), differing in the absence (S) or presence of silymarin, respectively. Volunteers were instructed to take two capsules in the morning and two capsules in the evening. No nutritional intervention was performed during the study period. The data (anthropometrics and anamneses) and harvest blood (biochemistry and hormonal exams) were collected at three different time points: baseline time [day 0 (T0)], day 90 (T90), and day 180 (T180) post-supplementation. RESULTS: In the anthropometric analysis, the waist circumference in middle abdomen (WC-mid) and waist circumference in iliac crest (WC-IC) were reduced. Also, the waist-to-height ratio (WHt R) and waist-to-hip ratio (WHR) seem to slightly decrease alongside the supplementation period with both nutraceutical supplements tested as well as transaminase enzyme ratio [aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR)], a known as a biomarker

BACKGROUND & AIMS: Despite controversies, no study has systematically summarized findings from earlier studies on the effect of berberine (BBR)-silymarin on liver enzymes. Therefore, the current systematic review and meta-analysis aimed to investigate the effect of berberis aristate and Silybum marianum on alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in adults. METHODS: Relevant studies, published up to June 2021, were searched through PubMed/Medline, Scopus, ISI Web of Science, EMBASE and Google Scholar. The mean differences and standard deviations were pooled using a random-effects model. The studies' quality was evaluated using the Cochrane Risk of Bias Tool. RESULTS: Out of 80 citations, 5 trials that enrolled 549 participants were included. Berberis aristate and Silybum marianum resulted in no statistically significant change in ALT (weighted mean differences (WMD): -0.39 mg/dl; 95% CI: -1.67 to 0.89, P = 0.55), and AST (WMD: -0.44 mg/dl; 95% CI: -2.02 to 1.14, P = 0.58). CONCLUSION: We did not find any significant reduction in liver enzymes following BBR-silymarin consumption in adults. Further clinical trials with high quality according to the challenges mentioned seem to be helpful to use BBR-silymarin as a supplement for improving liver function.

Milk thistle (MT; Silybum marianum), a member of the Asteraceae family, is a therapeutic herb with a 2,000-year history of use. MT fruits contain a mixture of flavonolignans collectively known as silymarin, being silybin (also named silibinin) the main component. This article reviews the chemistry of MT, the pharmacokinetics and bioavailability, the pharmacologically relevant actions for liver diseases (e.g., anti-inflammatory, immunomodulating, antifibrotic, antioxidant, and liver-regenerating properties) as well as the clinical potential in patients with alcoholic liver disease, nonalcoholic fatty liver disease, viral hepatitis, drug-induced liver injury, and mushroom poisoning. Overall, literature data suggest that, despite encouraging preclinical data, further well-designed randomized clinical trials are needed to fully substantiate the real value of MT preparations in liver diseases. © 2018 John Wiley & Sons, Ltd.

OBJECTIVE: This randomized clinical trial was conducted to evaluate the effects of silymarin supplementation on glycemic indices and serum lipid profile in type 2 diabetes mellitus (T2DM) patients. METHODS: 40 T2DM patients (twenty male and twenty female), 25-50 years of age and on stable medication, were recruited for the present paralleled, randomized, triple-blinded, placebo-controlled clinical trial. The participants were randomly assigned to the silymarin or placebo groups, in which the patients either received 140 mg of silymarin, thrice daily (n = 20) or placebo (n = 20) for 45 days. Anthropometric and dietary intake data were collected at the baseline and end of the trial. Fasting blood samples were collected, and glycemic indices and lipid profile were determined at baseline, as well as the end of the study. RESULTS: Silymarin supplementation led to significant reduction in fasting blood sugar, serum insulin, homeostatic model assessment for insulin resistance, serum triglyceride and triglyceride to high-density lipoprotein cholesterol ratio as compared to the placebo, by 11.01, 14.35, 25.92, 23.7 and 27.67% respectively. There was significant increase in high-density lipoprotein cholesterol levels and quantitative insulin sensitivity check index in the silymarin group as compared to the placebo group, by 6.88 and 5.64% respectively, (p < 0.05). Total cholesterol and low-density lipoprotein cholesterol concentrations significantly decreased in the silymarin group as compared to the baseline, by 7.93 (p = 0.001) and 7.15% (p = 0.02), respectively. CONCLUSION: Silymarin supplementation may improve the glycemic indices and lipid profiles of T2DM patients. More studies are needed to validate the adjunct use of silymarin for metabolic control of T2DM patients.

PURPOSE: The purpose of this study was to compare the bioavailability between 2 milk thistle-containing dietary supplements, Product B and IsaGenesis, in healthy volunteers. METHODS: Bioavailability between Product B, originally formulated as a powdered capsule, and IsaGenesis, reformulated as a soft gel, were compared by measuring silybin A and silybin B as surrogate pharmacokinetic markers for differences in absorption and bioavailability. For this randomized, open-label, crossover pharmacokinetic study, 12 healthy volunteers consumed a single-dose serving of each supplement separated by at least a 7-day washout period. Serial blood samples were obtained at 0, 0.5, 1, 1.5, 2, 3, 4, 6, and 8 hours and analyzed via LC-MS/MS. FINDINGS: Rapid absorption and elimination of silybin A and silybin B have been observed after oral administration of both Product B and IsaGenesis. However, the absorption rate and extent, as indicated by mean the Cmax and mean plasma AUC, were significantly higher for the IsaGenesis soft gel formulation. The dose-corrected mean Cmax was 365% and 450% greater for silybin A and B, respectively, relative to powdered Product B. The time to Tmax was reached, on average, at least 1 hour earlier with IsaGenesis relative to Product B for both silybin A and silybin B. IMPLICATIONS: The IsaGenesis soft gel formulation provided substantially greater absorption and bioavailability of silybin A and silybin B relative to the powdered Product B supplement. ClinicalTrials.gov Identifier: NCT02529605.

The study aimed to investigate the effects of milk thistle seeds (MTS) and rosemary leaves (RL) both at 5 and 10g/kg diet on reproductive performance, semen quality and blood metabolites of rabbit bucks. A total of 35 rabbit bucks were randomly distributed into five experimental groups (7 bucks/group). All the groups were fed the same basal diet. The 1st group (control) did not have MTS and RL in its basal diet. The 2nd and 3rd groups were supplemented with MTS at 5 and 10g/kg, respectively. The 4th and 5th groups were fed the basal diet supplemented with RL at 5 and 10g/kg, respectively. The sperm concentration (SC), total sperm output (TSO), live sperm (LS), total live sperm (TLS) and total motile sperm (TMS) were significantly greater in the bucks fed MTS at 10 and RL at 5g/kg diet than the control group. Bucks fed MTS at 10g/kg diet had higher fertility than the control. Also, RL 5g/kg group showed higher testosterone and fertility than the control, but the MTS 10g/kg group showed the highest value for both parameters. In conclusion, MTS and RL at 10 and 5g/kg, respectively, significantly improved the semen quality and the fertility and MTS also increased the economic efficiency of rabbit bucks.

The use of botanical dietary supplements has grown steadily over the last 20 years despite incomplete information regarding active constituents, mechanisms of action, efficacy, and safety. An important but underinvestigated safety concern is the potential for popular botanical dietary supplements to interfere with the absorption, transport, and/or metabolism of pharmaceutical agents. Clinical trials of drug-botanical interactions are the gold standard and are usually carried out only when indicated by unexpected consumer side effects or, preferably, by predictive preclinical studies. For example, phase 1 clinical trials have confirmed preclinical studies and clinical case reports that St. John's wort (Hypericum perforatum) induces CYP3A4/CYP3A5. However, clinical studies of most botanicals that were predicted to interact with drugs have shown no clinically significant effects. For example, clinical trials did not substantiate preclinical predictions that milk thistle (Silybum marianum) would inhibit CYP1A2, CYP2C9, CYP2D6, CYP2E1, and/or CYP3A4. Here, we highlight discrepancies between preclinical and clinical data concerning drug-botanical interactions and critically evaluate why some preclinical models perform better than others in predicting the potential for drug-botanical interactions. Gaps in knowledge are also highlighted for the potential of some popular botanical dietary supplements to interact with therapeutic agents with respect to absorption, transport, and metabolism.

Primiparous sows frequently fail to meet lactation nutrient demands, but direct comparisons of plant-derived feed additives are scarce. Eighty primiparous Yorkshire sows were assigned to four treatments from 14-day pre-farrowing to 21-day weaning: control (CON), milk thistle extract (MTE, 1% in 100 g/d), fenugreek seed extract (FSE, 1% in 100 g/d), and mannan oligosaccharide (MOS, 1.4% prepartum and 1.8% postpartum in 100 g/d). Production traits were recorded; mechanistic assays were confined to CON and MTE, the group that performed best in the production screen, and are reported as an exploratory, hypothesis-generating comparison. Lactation feed intake differed among groups (p = 0.047): MTE sows ate 4.16 kg/d compared to 3.51 kg/d for CON, while FSE (3.73) and MOS (3.47) were intermediate and similar to CON. Only MTE improved litter performance, raising weaning litter weight (+10.6%), piglet weight (+15.4%), and calculated milk yield (+13.1%) versus CON (p < 0.05); FSE and MOS showed no significant effects. MTE also increased prolactin (at farrowing and d-14) and catalase (at farrowing) but lowered d-14 cholesterol and HDL. In this two-step trial, MTE was the sole additive enhancing lactational performance, with endocrine and redox changes consistent with improved lactation.

BACKGROUND: Liver diseases in dogs are often diagnosed at advanced stages due to the organ's high functional reserve. Early supportive therapy with hepatoprotective nutraceuticals may help slow disease progression in dogs with asymptomatic elevation of liver parameters. AIM: The aim of this pilot study was to evaluate the hepatoprotective effect of a multi-component preparation containing phospholipids, selected amino acids, betaine, and milk thistle extract in client-owned dogs with asymptomatic elevation of liver parameters. MATERIALS AND METHODS: Seventeen dogs were included in the open-label study. The animals received Hepatiale Forte Advanced (Vet Expert) for 8 weeks at the manufacturer's recommended dose. Liver enzyme activities (ALT, AST, ALP, GGT), total bilirubin, serum bile acids, hematological parameters, and abdominal ultrasonography were assessed at baseline and after 8 weeks. RESULTS: Supplementation resulted in statistically significant reductions in ALT (p = 0.004), AST (p = 0.004), ALP (p = 0.001), total bilirubin (p = 0.001) and serum bile acids (p = 0.007). A trend toward a decrease was observed for GGT (p = 0.052). Hematological parameters remained stable, and the preparation was well tolerated with no adverse effects reported. Ultrasonographic findings were mostly stable or improved (resolution of biliary sludge in some cases). CONCLUSION: Eight-week supplementation with the multi-component hepatop

BACKGROUND: Herbal extracts are increasingly being utilized in veterinary medicine, with milk thistle extract being recognized for its significant role in animal health, and milk thistle extract is widely acknowledged for its crucial contribution in supporting liver function. Camels are among the animals whose liver enzymes are often altered, which can have a detrimental effect on their health. AIM: This study investigated the therapeutic effects of milk thistle extract on body scores and hematological and biochemical parameters in dromedary camels with elevated liver enzyme levels. METHODS: This study was conducted on 18 dromedary camels (eight males and ten females). The camels were divided into two groups: the first group consisted of five healthy camels with normal liver enzyme levels, and the second group consisted of 13 camels with elevated liver enzyme levels. The prepared milk thistle extract from seeds was subjected to phytochemical and Gas Chromatography-Mass Spectrometry (GC-MS) MS analyses. The camel in the second group orally received milk thistle extract, which was calculated based on Silymarin concentration, for 6 weeks. The clinical score and hematological and biochemical analyses were performed in control and diseased camels before and after treatment. RESULTS: The health and appetite scores showed significant improvements after treatment. The percentage of lymphocytes increased in diseased camels following treatment, whereas the percentage of eosinophils decreased in healthy

Silymarin is a mixture of bioactive natural products from milk thistle (Silybum marianum) fruit extracts, which have a long history as a phytotherapeutic agent in treating various liver-related ailments. Even though important pharmacological effects of silymarin, such as the antioxidative properties, have been proven, the exact molecular mechanisms for its liver-protective action remain elusive. Here, we provide in vitro pharmacological data showing that silymarin, as a mixture and also its individual flavanonol lignans, antagonize liver X receptor (LXR). In HepG2 cells, the isolated silymarin flavanonol lignans showed LXR-mediated anti-steatotic effects that may play a crucial role in the hepatoprotective action of silymarin. Our findings underscore the potential of silymarin, both as a mixture and in the form of its isolated flavanonol lignans, as therapeutic agents for liver disorders, including metabolic dysfunction-associated steatotic liver disease (MASLD). There is an urgent need for well-designed clinical trials engaging standardized milk thistle fruit extract to explore its efficacy in MASLD. © 2026 Deutsche Pharmazeutische Gesellschaft.

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) lacks treatment options, with few evidence-based choices beyond lifestyle modification. This is the first clinical study to assess the efficacy of an organic liquid oral nutraceutical composed of turmeric extract, dandelion powder, milk thistle extract, and ginger powder in MASLD. METHODS: This was a randomized, double-blind, placebo-controlled, preliminary phase 2 exploratory trial conducted at a single center (Sanjivani Super Speciality Hospitals Pvt. Ltd., Gujarat, India) between September 7, 2021 and November 25, 2021. Individuals aged 18-70 years and diagnosed with fatty liver (grades 1-3) were eligible to participate. Participants were randomized 1:1 to receive the test product or placebo, which were both provided as a 60 mL oral solution to be consumed twice daily with a meal for 60 days. The primary endpoint was proportion of participants with improvement in ultrasonography-based fatty liver grading from baseline to Day 60. RESULTS: Fifteen patients each were enrolled in the test product and placebo groups. The mean [standard deviation (SD)] age was 40.6 (10.8) years and 83.3% were male. A significantly higher proportion of patients in the nutraceutical product group had fatty liver grade improvement at Day 60 vs. placebo [60.0% (9/15) vs. 13.3% (2/15); p = 0.008]. Mean (SD) change in fatty liver grading was -0.60 (0.51) and -0.13 (0.35) for test product vs. placebo (p = 0.007). Adverse events were mild with similar incidence in both groups. The results are limited by the small sample size, si

This study investigated the impact of including an anti-mycotoxin additive on the performance and health parameters of Holstein cattle in the rearing phase, fed diets contaminated with multiple mycotoxins. A diet contaminated with aflatoxins (200 ppb), fumonisins (15 ppm), zearalenone (500 ppb), deoxynivalenol (1.5 ppm), ochratoxin A (100 ppb), and T-2 toxin (300 ppb) was fed to growing cattle for 87 days. The experiment involved 24 cattle divided into three groups: negative control (CONT), positive control (MYCO: with mycotoxin blend), and test group (MYCO+ADDI: with mycotoxin blend + anti-mycotoxin additive). The additive’s formulation contained yeast cell wall, bentonite, modified montmorillonite, activated charcoal, milk thistle extract (Silybum marianum), and a selenium-amino acid complex. At strategic points, production performance data (weight gain, daily intake, and feed efficiency) and animal health biomarkers (hematology, clinical biochemistry, and oxidative stress markers

BACKGROUND/OBJECTIVES: The milk thistle plant (Silybum marianum) is known for its hepatoprotective properties. However, the poor water solubility of silymarin limits its dissolution in the intestinal tract and restricts its bioavailability following oral administration. METHODS: To improve bioavailability, special formulations, in particular micellar solubilization, are explored. In this study, we examined the transport rate of silymarin in a krill oil-based formulation across a Caco-2 epithelial barrier after upstream digestion simulation in vitro. Furthermore, in a randomized cross-over design study the bioavailability of the krill oil-based formulation was investigated after single dose intake in fasting conditions in healthy participants. RESULTS: We could demonstrate that the apparent transport coefficient of silybin, measured as lead substance of milk thistle extract, across the epithelium is efficiently boosted by a krill oil formulation, resulting in a 28% increase compared to silymarin powder. Consistent with these findings, a significant enhancement of bioavailability (P < 0.0001) was demonstrated for the krill oil-based formulation in comparison to the milk thistle extract resulting in an 8.59-fold higher AUC0-8h and a 15.08-fold greater Cmax of silybin and faster uptake kinetic after single dose intake. DISCUSSION AND CONCLUSIONS: These findings suggest that phospholipid-based delivery systems offer a promising strategy for improving the efficacy of lipophilic bioactives. Furthermore, the combination of krill oil with milk thistle extracts efficiently provides

This study aimed to determine the effect of lactic acid fermentation with Lactiplantibacillus plantarum on the bioactive compound composition and fatty acid profile of black cumin, camelina, milk thistle, and evening primrose cakes, as well as to evaluate their application as ingredients in wheat bread production (9% of wheat flour substitution). Fermentation increased the content of flavonoids and phenolic acids in camelina cake by approximately 30%, while causing a 30% decrease in carotenoid content. In black cumin cake, an eightfold increase in 4-hydroxybenzoic acid content and a 10% reduction in thymoquinone were observed. For milk thistle, silymarin content decreased by approximately 10%. Fermentation increased the proportion of saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs), reducing polyunsaturated fatty acids (PUFAs) in all analyzed cakes. Breads containing 9% fermented cakes exhibited lower specific volume and greater hardness (22-80%), gumminess (17-64%), and chewiness (8-48%), compared to the breads with unfermented cakes. The contents of bioactive compounds in breads depended on the type of cake adde

BACKGROUND: Doxorubicin (DOX) and methotrexate (MXT) are strong anticancer agents and gold standard therapy for several malignancies, with efficacy restricted by cardiotoxicity. Milk thistle extract (MTE) has demonstrated strong antioxidant and cytoprotective properties; we sought to determine the role of MTE in protection against Dox or MXT-induced cardiac damage. METHODS: A total of 35 white albino rats were divided into five groups: control, Dox alone (1.66mg/kg/48hr, IP) group, MXT alone (oral 0.5mg/kg/48hr, oral) group, Dox+MTE group (1.66mg/kg/48hr Dox IP+150mg/kg/day MTE oral), and MXT+MTE (0.5mg/kg/48hr MXT oral +150mg/kg/day MTE oral) group. The duration of experiment were seven days. A histopathological examination was done at the end of experimentation. RESULTS: Dox and MXT use in the rat model has induced severe cardiotoxicity with inflammatory cell infiltration, structural damage of cardiac tissue, and morphological changes. Milk thistle pretreatment extensively saved cardiac architecture. CONCLUSIONS: MTE use with Dox or MXT demonstrated marked cardioprotection potential via reduced inflammatory cell infiltration and cardiac tissue protection, suggesting that MTE could potentially emerge as a valuable tool to block cardiac complications in Dox- or MXT-treated patients.

Due to its superior antioxidant and anti-inflammatory properties, milk thistle has been widely used in various applications. In the present study, the effects of milk thistle seeds (MTS) powder and its ethanolic bioactive compounds extract on fermented goat milk were investigated. Fresh goat milk was enriched with 0.5%, 1%, and 2% of MTS powder and its extract, and the obtained product was analyzed after 1 and 14 d of cold storage. The MTS bioactive compound-ethanolic extract displayed higher antioxidant activities (DPPH•, ABTS•+, and ferric reducing antioxidant power) and total phenolic compounds compared with those extracted by using homogenization, ultrasonication, or microwave. The fatty acid composition analysis of MTS oil revealed that linoleic, oleic, palmitic, and stearic were the predominant fatty acids. The results also show that the addition of MTS significantly affected different yogurt characteristics. The MTS extract-enriched samples had higher moisture content than MTS powder-enriched and the control samples. Yogurt color, texture, and volatile compound profile were also influenced by the inclusion of MTS into yogurt formulation. The control yogurt samples displaye

During the grain and cereal production process, whether during harvesting, processing, or storage, errors can occur, compromising product quality and potentially leading to contamination by fungi, which produce toxic substances known as mycotoxins. When fed to animals, these contaminated grains and cereals can cause several negative effects on animal health, impacting their production performance, including immunosuppression, hepatotoxicity, nephrotoxicity, and reproductive problems. To minimize the problems caused by mycotoxins, anti-mycotoxin additives, also known as adsorbents, are used. These are inert materials that bind to mycotoxins and are excreted in feces, preventing their action within the animal's body. Therefore, the objective of this study was to evaluate the effectiveness of an anti-mycotoxin product based on bentonite, activated charcoal, milk thistle extract, and yeast cell wall in the diet of mycotoxin-contaminated lambs on animal health and performance. Thirty lambs were divided into three homogeneous groups: control (without mycotoxins or additives), mycotoxin (with myc

Milk thistle (Silybum marianum L.) is an essential medicinal plant belonging to the family Asteraceae. The active ingredient of milk thistle is silymarin, a key component used to treat numerous physical and biological ailments. This study aimed to compare the nutritional composition, total phenolic, flavonoid, and tannin contents, and the antimicrobial activities of S. marianum stems, leaves, and flowers extracted using five different solvents. Phytochemical assays were used to evaluate the total phenolic, flavonoid, and tannin contents in petroleum ether, ethyl acetate, acetone, methanol, and water extracts from different plant parts. The proximate composition showed that the leaves had a higher percentage of moisture (11.53%). In contrast, the flowers showed increased lipid content, carbohydrate, and protein concentration (5.17, 69.86, and 10.03%, respectively), and stems showed elevated ash content (28.67%) compared to leaves and flowers. In S. marianum, the highest yield was obtained from the flowers, while the leaves and stems produced progressively lower amounts, respectively. Among the solvents tested, extraction with water made the largest yield, followed in decreasing order by methanol, acetone, ethyl acetate, and petroleum ether. The findings of the study revealed that alkaloids, tannins, flavonoids, glycosides, steroids, quinones, phenols, anthraquinones, cardiac glycosides, and terpenoids were found by phytochemical analysis of S. marianum in different parts. At the same time, saponins and anthocyanins were completely absent in all parts. On the other hand, coumarins are present in leaves and flowers and are completely lacking in stems. The highest levels

This study evaluated the impact of aflatoxin B1 (AFB1) and ochratoxin A (OTA) on growth performance, organ health, lipid profiles, and immunity in broiler chickens. It also assessed the potential of dietary additives, a commercial toxin binder (1000 mg/kg), yeast cell wall (YCW; 1000 mg/kg), Lactobacillus fermentum (LF; 1000 mg/kg, a total bacterial count of 1 × 109 CFU/kg), and milk thistle extract (MTE; 200 mg/kg), to mitigate the harmful effects of AFB1 and OTA. A total of 280 one-day-old broiler chicks were assigned to seven treatments: negative control (NC), positive control (PC, fed a diet contaminated with AFB1 and OTA), PC + a commercial toxin binder, PC + YCW, PC + LF, PC + MTE, and PC + (YCW + LF + MTE). The experiment lasted for 42 days. Results indicated that AFB1 and OTA significantly reduced growth performance parameters, increased liver and kidney biomarkers, such as serum aspartate aminotransferase, alanine aminotransferase, and creatinine levels (P < 0.05), indicative of organ damage. Blood lipid profiles were also adversely affected, as demonstrated by increased serum low-density lipoprotein, and decreased high-density lipoprotein levels (P < 0.05). Immune function was compromised by AFB1 and OTA, as indicated by lower serum total protein and globulin concentrations, and relative weights of Bursa of Fabricius (P < 0.05). Dietary supplementation with YCW,

Biocompatible silver nanoparticles (AgNPs) are employed with an active ingredient of milk thistle extract, silybin (SIB), to treat cancers. Strong cytotoxic effects of SIB-AgNPs against two distinct cell lines (MCF-7 and HepG2) are observed on a stable nano-platform that contains spherical nanoparticles within a limited size range. With a high radiochemical purity, radioiodination of SIB-AgNPs was accomplished. The investigation on the biodistribution of [131I]iodo-SIB-AgNPs in mice-bearing tumors showed that SIB-AgNPs prefer localization in tumor tissue. In conclusion, this work strengthens the case for [131I]iodo-SIB-AgNPs as an effective theranostic agent for tumor imaging and treatment. © 2025 Deutsche Pharmazeutische Gesellschaft.

The current study evaluated the effects of milk thistle extract supplementation in laying hens' fed diets lacking choline chloride addition. A total of 60 Isa-brown laying hens were randomly allocated into T1: control diet, 0% extract supplementation; T2: control diet with 1% extract; T3: control diet with 2.5% extract; and T4: control diet with 4% extract. Egg quality parameters, yolk lipid oxidation, malondialdehyde (MDA) content, and fatty acid profile were assessed. Livers were examined grossly and histologically to evaluate hepatocellular lesions such as vacuolization (lipidosis), reticular stromal architecture, the amount of collagenous connective tissue, and vascular wall changes. Groups T3 and T4 showed darker yolks compared to both control group and T2 (p = 0.001) and redness of the egg yolk (p < 0.001). The MDA was lowest in T2 group which had improved gross appearance with lower degrees of hepatic vacuolization than other groups. Liver discoloration was milder in T3 (43.8%) compared to the T1 and T4 groups (18.8% and 12.5%, respectively, p = 0.013). Reticulin loss was correlated with the degree of hepatic vacuolization (r = 0.751, p < 0.001). Supplementation with MT extract in diets lacking choline c

This work focused on grafting milk thistle extract (MTE)-loaded liposomes with antioxidant and UV protection properties onto nonwoven cotton fabric by layer-by-layer (LbL) self-assembly. Liposome vesicles were manufactured using the double solvent displacement (DSD) method and characterized based on particle size, polydispersity, and zeta potential measurements. In the coating process, chitosan served as a biocompatible and biodegradable polymer to provide the positive charge required for electrostatic LbL self-assembly. The findings showed that the liposomal population was ∼223 nm in average particle size, with a low polydispersity index of 0.398, indicating high particle homogeneity. Additionally, the zeta potentials of liposomes and chitosan were determined to be -28 and + 68.23, respectively. SEM-EDX findings revealed that the elements of the liposomes on the fabric changed with the increase of the assembled layers, while ATR-FTIR provided evidence that the liposomes were successfully loaded on the nonwoven cotton fabric. The findings showed significant levels of tyrosinase inhibitory activity and antioxidant ability in fabrics coated with chitosan-enriched MTE phenolics. Moreover, when compared with untreated and pretreated fabrics, the fabric with coated MTE exhibited very good sun protection ability with a UPF value of 30.55.

Erratum in Drug Metab Dispos. 2026 Mar;54(3):100245. doi: 10.1016/j.dmd.2026.100245. Silybin, a milk thistle extract, is a flavonolignan compound with hepatoprotective effect. It is commonly used in dietary supplements, functional foods, and nutraceuticals. However, the metabolism of silybin has not been systematically characterized in organisms to date. Therefore, we established a novel high-performance liquid chromatography quadrupole time-of-flight mass spectrometry method to analyze and identify the prototype and metabolites of silybin in rats. In total, 29 (of 32) new metabolic pathways and 56 (of 59) unreported metabolite products were detected. Moreover, we found that the liver had a high first-pass effect of 63.30% ± 13.01% for silybin, and only 1 metabolite was detected. Moreover, the metabolites identified in gastrointestinal tract possessed 88% of all unreported metabolite products (52 of 59). At the same time, the high concentration of silybin in the liver also indicated that

The fast industrialization and mounting pollution have necessitated the need for advanced materials in order to degrade pollutants efficiently. Metal oxide-based and graphene-derivative photocatalytic nanocomposites are excellent for harnessing light energy in environmental remediation. Among them, ZnO-based nanocomposites have drawn considerable attention because of their high photocatalytic activity and stability. However, improving the performance of these nanocomposites is still necessary for their wide applications. This study explores the green synthesis, detailed characterization, and enhanced photocatalytic efficiency of reduced graphene oxide rGO/ZnO/Fe3O4 nanocomposites. The nanocomposites were synthesized via a hydrothermal method, utilizing milk thistle extract as a natural reducing agent, representing a novel and sustainable approach to fabricating magnetic rGO/Fe3O4 nanocomposites. These composites were further integrated with zinc oxide to produce a multifunctional material, exhibiting high surface area, superior electrical and thermal conductivity, and robust mechanical strength. The photocatalytic performance was significantly enhanced due to the synergistic interaction between graphene and metal oxide

Silibinin, a bioactive component found in milk thistle extract (Silybum marianum), is known to have significant therapeutic potential in the treatment of various liver diseases. It is considered a key element of silymarin, which is traditionally used to support liver function. The main mechanisms of action of silibinin are attributed to its antioxidant properties protecting liver cells from damage caused by free radicals. Experimental studies conducted in vitro and in vivo have confirmed its ability to inhibit inflammatory and fibrotic processes, as well as promote the regeneration of damaged liver tissue. Therefore, silibinin represents a promising tool for the treatment of liver diseases. Since the silibinin molecule is insoluble in water and has poor bioavailability in vivo, new perspectives on solving this problem are being sought. The two most promising approaches are the water-soluble derivative silibinin-C-2',3-dihydrogen succinate, disodium salt, and the silibinin-phosphatidylcholine complex. Both drugs are currently under evaluation in liver disease clinical trials. Nevertheless, the mechanism underlying silibinin biological activity is still elusive and its more detailed understanding would undoubtedly increase its potential in the development of effective therapeutic strategies against liver diseases. This review is focused on the therapeutic potential of silibinin and its derivates, approaches to increase the bioavailability and the benefits in the treatment of liver diseases that have been achieved so far. The

Milk thistle is one of the most popular ingredients in the liver protection products market. Silymarin is the main component of milk thistle and contains multiple isomers. There have been few studies focusing on the compositional ratios of silymarin isomers. In this study, we developed an HPLC method for the separation and quantification of silymarin isomers, thereby elucidating their compositional ratios. Through the analysis of more than 40 milk thistle extract products on the market, we found that the ratios, specifically Ratio 1 (the silybin B content to the silybin A content, SBNB/SBNA) and Ratio 2 (the sum of the contents of silybin B and isosilybin B to the sum of the contents of silybin A and isosilybin A, (SBNB + IBNB)/(SBNA + IBNA)), are highly consistent across milk thistle extracts, averaging approximately 1.58 and 1.28, respectively. Furthermore, such ratios were verified in milk thistle seed samples. This study introduces significant findings concerning the stable ratios among silymarin isomers in milk thistle extracts and seeds, thereby offering an innovative approach for quality assurance of milk thistle extracts.

Extracts prepared from the seeds of the medicinal plant milk thistle [Silybum marianum (L.) Gaertn. (Asteraceae)] are widely used as dietary supplements due to anti-inflammatory, antitumor, and hepatoprotective effects. Called silymarin, the main components of lipophilic extracts of milk thistle seeds are flavonoids and flavonolignans including silybin A, silybin B, isosilybin A, isosilybin B, silydianin, silychristin, taxifolin, and 2,3-dehydrosilybins. The aim of this study was to develop a method based on UHPLC-MS/MS for the chemical authentication and standardization of milk thistle silymarin. Validation included the method of standard addition to account for the lack of a blank matrix. Potential matrix effects were investigated by analyzing silymarin standards dissolved only in the initial UHPLC mobile phase. Measurements of six flavonolignans and taxifolin in the milk thistle extract using UHPLC-MS/MS with standard addition or external standard calibration produced similar results for all analytes except silydianin and 2,3-dehydrosilybin B, which showed significant peak enhancement during negative ion electrospray due to botanical matrix effects. The UHPLC-MS/MS-based method of standard addition requires <10 min per injection and is suitable for the standardization of silymarin from milk thistle in support of preclinical and clinical studies of safety and efficacy.

Chronic liver disease (CLD) is a significant global health concern and generally leads to fibrosis, cirrhosis and hepatocellular carcinoma. Various factors, such as metabolic abnormalities, viral infections, alcoholism, genetics and autoimmune responses, contribute to liver damage. CLD is characterized by different phenotypes, including non-alcoholic fatty liver disease, metabolic-associated fatty liver disease, drug-induced liver injury and alcoholic liver disease. These conditions have seen an increase in comorbidities and hospitalizations over the past decade, imposing a substantial burden on patients and healthcare systems. Understanding the underlying mechanisms of liver injury is crucial for effective management and reducing the clinical and economic burden of CLD. Although several attempts have been evaluated to find a drug therapy option for the management of non-alcoholic fatty liver disease and metabolic-associated fatty liver disease, there is no effective drug approved to date. However, different studies have demonstrated that silymarin, the milk thistle extract, could exert hepatoprotective, antioxidant, anti-inflammatory and antifibrotic properties and should therefore be considered an efficacious, tolerable and promising herbal product for the management of liver activity in CLDs. This review discusses the clinical features, diagnosis and available treatments for major liver diseases, acting as an introduction to a clinical case collection based on the management and treatment of major liver diseases with silymarin. This article is part of the Current clinical use of silymarin in the treatment of toxic liver diseases: a case series Special Issue: https://www.drugsincontext.com/special_issues/current-clinical-use-of-silymarin-in-the-treatment-of-toxic-liver-diseases-a-case-series.

23. Adv Exp Med Biol. 2024;1440:45-55. doi: 10.1007/978-3-031-43883-7_3. Chemical and Biochemical Features of Spinasterol and Schottenol. Khallouki F(1)(2), Ksila M(3)(4), Ghzaiel I(3)(5), Essadek S(3)(6), Joutey MT(3)(6), Maaloul S(3)(7), Zennouhi W(1), Benbacer L(8), Bourhia M(9), Hajji L(2), Zarrouk A(5), Rezig L(10)(11), Rup-Jacques S(12), Abdellaoui R(7), Ghrairi T(4), Masmoudi-Kouki O(4), Nasser B(6), Andreoletti P(3), Mustapha-Cherkaoui-Malki(3), Samadi M(12), Vejux A(3), Lizard G(13). Author information: (1)Biology Department, Faculté des Sciences et Techniques, Moulay Ismail University of Meknes, Errachidia, Morocco. (2)Biology Department, Faculty of Sciences, Moulay Ismail University of Meknes, Meknes, Morocco. (3)Bio-PeroxIL Laboratory, EA7270, University of Bourgogne & Inserm, Dijon, France. (4)Laboratory of Neurophysiology, Cellular Physiopathology and Valorisation of Biomolecules, (LR18ES03), Department of Biology, Faculty of Sciences, University Tunis El Manar, Tunis, Tunisia. (5)Faculty of Medicine, Laboratory 'Nutrition, Functional Food and Vascular Health' (LR12ES05), University of Monastir, Monastir, Tunisia. (6)Laboratory of Biochimistry, Neuroscience, Natural Resources and Environment, Faculty of Science and Technology, University Hassan I, Settat, Morocco. (7)Laboratory of Rangeland Ecosystems and Valorization of Spontaneous Plants and Associated Microorganisms (LR16IRA03), Arid Regions Institute, University of Gabes, Medenine, Tunisia. (8)Unité de Biologie et Recherches Moléculaires, Département Sciences du Vivant, Centre National de l'Energie, des Sciences et Techniques Nucléaires (CNESTEN), Rabat, Morocco. (9)Faculty of Medicine and Pharmacy, Ibn Zohr University, Laayoune, Morocco. (10)LIP-MB 'Laboratory of Protein Engineering and Bioactive Molecules', National Institute of Applied Sciences and Technology, LR11ES26, University of Carthage, Tunis, Tunisia. (11)High Institute of Food Industries, University of Carthage, Tunis, Tunisia. (12)Laboratory of Chemistry and Physics Multi-Scale Approach to Complex Environments, Department of Chemistry, University Lorraine, Metz, France. (13)Bio-PeroxIL Laboratory, EA7270, Unive

BACKGROUND: Obesity in common marmosets (Callithrix jacchus) can lead to various liver pathologies. In other species, reduced caloric intake and weight loss improve prognosis, and, often, hepatoprotectants are used to halt or reverse hepatocellular damage from fat deposition in the liver. There are no published therapies for reducing hepatocellular damage in obese marmosets. METHODS: Fifteen obese marmosets were used to evaluate the ability of caloric restriction and pharmacologic therapy (S-adenosylmethionine + milk thistle extract, or SMT), alone and combined, to reduce elevated liver enzymes. Body weight and serum chemistries were measured every 4 weeks for 6 months. RESULTS: Across treatment groups, there was a significant reduction in liver enzymes ALT and AST over time. SMT alone significantly reduced liver enzymes ALT and AST at 6 months from baseline. CONCLUSIONS: Caloric restriction and SMT, alone and combined, are effective at reducing liver enzyme levels in obese marmosets. © 2023 The Authors. Journal of Medical Primatology published by John Wiley & Sons Ltd.