PMID- 29932143
OWN - NLM
STAT- MEDLINE
DCOM- 20190107
LR  - 20230928
IS  - 2072-6643 (Electronic)
IS  - 2072-6643 (Linking)
VI  - 10
IP  - 7
DP  - 2018 Jun 22
TI  - A Balanced Risk-Benefit Analysis to Determine Human Risks Associated with 
      Pyrrolizidine Alkaloids (PA)-The Case of Herbal Medicinal Products Containing St. 
      John's Wort Extracts (SJW).
LID - 10.3390/nu10070804 [doi]
LID - 804
AB  - OBJECTIVES: Pyrrolizidine alkaloids (PA) exist ubiquitously in our environment. 
      More than 6000 plants, about 3% of the world’s flowering plants, are known 
      to synthesize PA. As a consequence, many herbal ingredients, including St. 
      John’s wort (SJW), are contaminated with PA that can possess acute and 
      subchronic toxic effects as well as mutagenic and genotoxic properties. 
      Therefore, the possible benefits of SJW as an herbal remedy against depression 
      need to be weighed against the possible risks of unwanted PA intake. METHODS: We 
      searched the literature regarding the current knowledge on PA and evaluated the 
      evidence on the antidepressant effects of quantified SJW extract based on a 
      Cochrane Review and the current practice guidelines on depression. Risks are 
      depicted in form of a risk ladder and benefits in form of an icon array. RESULTS: 
      Evidence from clinical studies indicates that quantified SJW extract is an 
      effective treatment option for mild to moderate depression with fewer side 
      effects than conventional antidepressants. Health statistics from different 
      countries do not quantify cases of death caused by PA intake. However, deaths due 
      to suicide, often triggered by depression, are common (11 in 1000 in Germany in 
      2015) and rank between fatalities due to liver diseases (16 in 1000) and 
      household accidents (10 in 1000). CONCLUSIONS: Quantified SJW extract is a safe 
      and effective treatment option, and its potential of treating depression 
      outweighs the (hypothetical) risk of unwanted PA intake.
FAU - Habs, Michael
AU  - Habs M
AD  - Faculty of Medicine, LMU-University of Munich, 80336 Munich, Germany. 
      info@michael-habs.de.
FAU - Binder, Karin
AU  - Binder K
AUID- ORCID: 0000-0003-0416-3029
AD  - Didactics of Mathematics, University of Regensburg, 93053 Regensburg, Germany. 
      karin.binder@mathematik.uni-regensburg.de.
FAU - Krauss, Stefan
AU  - Krauss S
AD  - Didactics of Mathematics, University of Regensburg, 93053 Regensburg, Germany. 
      stefan.krauss@mathematik.uni-regensburg.de.
FAU - Muller, Karolina
AU  - Muller K
AD  - Center for Clinical Studies, University Hospital Regensburg, 93053 Regensburg, 
      Germany. karolina.mueller@ukr.de.
FAU - Ernst, Brigitte
AU  - Ernst B
AD  - General Medicine Unit, University Hospital Regensburg, 93053 Regensburg, Germany. 
      dr.b.ernst@t-online.de.
FAU - Valentini, Luzia
AU  - Valentini L
AD  - Institute of Evidence-Based Dietetics, University of Applied Sciences 
      Neubrandenburg, 17033 Neubrandenburg, Germany. valentini@hs-nb.de.
FAU - Koller, Michael
AU  - Koller M
AD  - Center for Clinical Studies, University Hospital Regensburg, 93053 Regensburg, 
      Germany. michael.koller@ukr.de.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180622
PL  - Switzerland
TA  - Nutrients
JT  - Nutrients
JID - 101521595
RN  - 0 (Antidepressive Agents)
RN  - 0 (Plant Extracts)
RN  - 0 (Pyrrolizidine Alkaloids)
SB  - IM
MH  - Antidepressive Agents/*administration & dosage/adverse effects
MH  - Depression/drug therapy
MH  - Humans
MH  - Hypericum/*chemistry
MH  - *Phytotherapy
MH  - Plant Extracts/*administration & dosage/adverse effects
MH  - Plants, Medicinal/*chemistry
MH  - Pyrrolizidine Alkaloids/*administration & dosage/adverse effects
MH  - Risk Assessment
MH  - Treatment Outcome
PMC - PMC6073194
OTO - NOTNLM
OT  - St. John's wort extract (SJW)
OT  - pyrrolizidine alkaloids (PA)
OT  - risk-benefit analysis
COIS- The authors declare no conflict of interest.
EDAT- 2018/06/23 06:00
MHDA- 2019/01/08 06:00
PMCR- 2018/07/01
CRDT- 2018/06/23 06:00
PHST- 2018/05/18 00:00 [received]
PHST- 2018/06/08 00:00 [revised]
PHST- 2018/06/19 00:00 [accepted]
PHST- 2018/06/23 06:00 [entrez]
PHST- 2018/06/23 06:00 [pubmed]
PHST- 2019/01/08 06:00 [medline]
PHST- 2018/07/01 00:00 [pmc-release]
AID - nu10070804 [pii]
AID - nutrients-10-00804 [pii]
AID - 10.3390/nu10070804 [doi]
PST - epublish
SO  - Nutrients. 2018 Jun 22;10(7):804. doi: 10.3390/nu10070804.