Indian childhood cirrhosis (ICC) is a deadly condition and usually affects children of younger age groups. The condition appears to be increasingly common in the first child. While the etiology of ICC is not very clear, alpha-I-antitrypsin (Alpha-I-AT) deficiency has often been implicated in the disease pathogenesis.

A study by Agarwal et al assessed the impact of an herbal hepatotonic in ICC and also ascertained if it had any correlation with Alpha-I-AT in these cases. The herbal compound consisted of Capparis spinosa, Cichorium intybus, Solanum nigrum, Cassia occidentalis, Terminalia arjuna, Achillea millefolium and Tamarix gallica.

The study enroled 23 patients - 20 males and 3 females - median age being 2.13 ± 0.69. All the patients were thoroughly examined and liver function tests were done. Alpha-I-AT was also estimated. The patients received the herbal formulation in daily doses of 20 drops orally, thrice a day for a period of 1 year. During this period, no other drugs were given to these patients.

Among the 23 enroled patients, a family history of the disease could be traced in 30.4% of the cases. Nearly 87% cases had Grade 3 disease while 13% were Grade 2 cases. Mean Alpha-I-AT level in the study population was 161.5 ± 76.8 mg/100 ml. Eight cases had Alpha-I-AT deficiency. Six of these were heterozygous while 2 were homozygous. The mean Alpha-I-AT level among the non-deficient group was 193.4±32.6 mg%; in the heterozygous and homozygous groups, the levels were 120.5±39.6 mg% and 41.0 mg%, respectively.

In all, 15 patients (65.2%) completed the full course of the study. Of these, 13 cases (56.5%) showed an overall improvement within one year while 2 cases (8.6%) showed no notable improvement. Eight patients (34.9%) expired during the period. With the herbal therapy, jaundice was relieved in 55% cases. Symptoms of vomiting, diarrhea and abdominal distension were absent after one year of treatment. About 82% of the cases had improved appetite. The liver regressed in 39% and the spleen was not palpable in 60%.

The herbal treatment led to a significant reduction in serum bilirubin, serum alkaline phosphatase, total leukocyte count, ESR and gamma globulin. There was a significant increase in hemoglobin, total serum proteins and serum albumin levels. The albumin: globulin ratios also came back to normal values. Additionally, serial estimations of Alpha-I-AT also exhibited an overall increase in deficient and non-deficient cases following treatment. The Alpha-I-AT levels were increased significantly in the heterozygous deficient group (Table 1). In the homozygous cases, Alpha-I-AT levels could not be repeated as both the patients passed away within a week.

Table 1. Alpha-I-AT levels prior to and after herbal therapy

p value <0.01

The herbal formulation was, therefore, found to be effective and well-tolerated in the management of ICC. The herbal formulation also led to a significant escalation in Alpha-I-AT levels.

Source: Agarwal NK, Prasad R, Sharma M, Sharma BB. Role of Liv.52 in Indian Childhood Cirrhosis, with Special Reference to its Effect on Alpha-I-Antitrypsin Levels. Asian Medical Journal 1982;9: 647.