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Updated: May 20, 2026

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
Herbal hepatotoxicity: a critical review
Rolf Teschke1, Christian Frenzel, Xaver Glass
1Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, Frankfurt Main, Germany. rolf.teschke@gmx.de
Evaluating herb induced liver injury (HILI) is challenging due to poor quality of herbal products and inconsistent case data. Improving quality standards and prospective causality assessment are crucial for accurate HILI diagnosis.
Area of Science:
- Hepatology
- Toxicology
- Pharmacovigilance
Background:
- Herbal products are frequently implicated in liver injury, termed herb induced liver injury (HILI).
- Evaluating HILI cases is complicated by significant quality issues in herbal products and inconsistent reporting.
- Existing literature often lacks robust data for definitive causality assessment.
Purpose of the Study:
- To critically review the pitfalls in evaluating presumed HILI cases.
- To identify key challenges in attributing causality to herbal products.
- To propose improvements for future HILI assessments.
Main Methods:
- Systematic review of publications on herbal hepatotoxicity.
- Analysis of quality specifications, case data, and causality assessment methods.
- Evaluation of the Council for International Organizations of Medical Sciences (CIOMS) scale.
Main Results:
- Numerous herbs have been linked to liver injury, but quality issues undermine causality.
- Inconsistent case data and lack of validated assessment tools hinder accurate diagnosis.
- Prospective application of the CIOMS scale by physicians is recommended.
Conclusions:
- Addressing quality control in herbal supplements is critical.
- Standardized data collection and validated causality assessment are needed.
- A collaborative approach among manufacturers, physicians, and regulators can improve HILI evaluation.
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