The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.
Liver Injury Associated with Turmeric—A Growing Problem: Ten Cases from the Drug-Induced Liver Injury Network [DILIN]
Abstract
Background: Turmeric is a commonly used herbal product that has been implicated in causing liver injury. The aim of this case series is to describe the clinical, histologic and human leukocyte antigen (HLA) associations of turmeric-associated liver injury enrolled the U.S. Drug Induced Liver Injury Network (DILIN). Methods: All adjudicated cases enrolled in DILIN between 2004–2022 in which turmeric was an implicated product were reviewed. Causality was assessed using a 5-point expert opinion score. Available products were analyzed for the presence of turmeric using ultra-high-performance liquid chromatography. Genetic analyses included HLA sequencing. Results: Ten cases of turmeric-associated liver injury were found, all enrolled since 2011 and six since 2017. Of the 10 cases, 8 were women, 9 White and median age 56 years (range, 35–71). Liver injury was hepatocellular in 9 patients and mixed in 1. Liver biopsies in 4 patients showed acute hepatitis or mixed cholestatic-hepatitic injury with eosinophils. Five patients were hospitalized, and 1 patient died of acute liver failure. Chemical analysis confirmed the presence of turmeric in all 7 products tested; 3 also contained piperine (black pepper). HLA typing demonstrated that 7 patients carried HLA-B*35:01, 2 of whom were homozygous, yielding an allele frequency of 0.450 compared to population controls of 0.056–0.069. Conclusion: Liver injury due to turmeric appears to be increasing in the United States, perhaps reflecting usage patterns or increased combination with black pepper. Turmeric causes potentially severe liver injury that is typically hepatocellular, with a latency of 1 to 4 months and strong linkage to HLA-B*35:01.
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“Most patients with turmeric hepatotoxicity were female (80%) and presented with an acute hepatocellular injury profile, 50% were hospitalized, and 1 patient (11%) died.”
From The contemporary epidemiology, causes, and management of drug-induced liver injury (2026) · cites this paper as [33]
In the citing paper
“HLA polymorphisms shown to be significantly associated with multiple drugs include HLA-A*02:01 for AC and cefazolin DILI and HLA-B*35:01 for multiple HDS products, including green tea extract, turmeric, and Polygonum multiform.”
From The contemporary epidemiology, causes, and management of drug-induced liver injury (2026) · cites this paper as [33]
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The Essential Medicinal Chemistry of Curcumin
Nelson, K. M., Dahlin, J. L., Bisson, J., Graham, J., Pauli, G. F., & Walters, M. A. (2017) · Journal of Medicinal Chemistry · doi:10.1021/acs.jmedchem.6b00975 · Cited by 1,956
Prasad, S., Tyagi, A. K., & Aggarwal, B. B. (2014) · Cancer Research and Treatment · doi:10.4143/crt.2014.46.1.2 · Cited by 1,061
Sharifi-Rad, J., Rayess, Y. E., Rizk, A. A., Sadaka, C., Zgheib, R., Zam, W., Sestito, S., Rapposelli, S., Neffe-Skocińska, K., Zielińska, D., et al. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.01021 · Cited by 937
Features and outcomes of 899 patients with drug-induced liver injury: the DILIN Prospective Study
Chalasani, N., Bonkovsky, H. L., Fontana, R., Lee, W., Stolz, A., Talwalkar, J., Reddy, K. R., Watkins, P. B., Navarro, V., Barnhart, H., et al. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.03.006 · Cited by 925
Self-citationHerbal Medicine: Biomolecular and Clinical Aspects
Iff, B., & Wachtel-Galor, S. (2011) · Cited by 922
Baum, L., Lam, C. W. K., Cheung, S. K.-K., Kwok, T., Lui, V., Tsoh, J., Lam, L., Leung, V., Hui, E., Ng, C., et al. (2008) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e318160862c · Cited by 592
Ringman, J. M., Frautschy, S. A., Teng, E., Begum, A. N., Bardens, J., Beigi, M., Gylys, K. H., Badmaev, V., Heath, D. D., Apostolova, L. G., et al. (2012) · Alzheimer s Research & Therapy · doi:10.1186/alzrt146 · Cited by 559
Drug-Induced Liver Injury Network (DILIN) Prospective Study: Rationale, Design and Conduct
Fontana, R. J., Watkins, P. B., Bonkovsky, H. L., Chalasani, N., Davern, T., Serrano, J., & Rochon, J. (2009) · Drug Safety · doi:10.2165/00002018-200932010-00005 · Cited by 486
Self-citationLiver injury from herbal and dietary supplements
Navarro, V. J., Khan, I., Björnsson, E., Seeff, L. B., Serrano, J., & Hoofnagle, J. H. (2017) · Hepatology · doi:10.1002/hep.28813 · Cited by 462
Self-citationLiver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network
Navarro, V. J., Barnhart, H., Bonkovsky, H. L., Davern, T., Fontana, R. J., Grant, L., Reddy, R. K., Seeff, L. B., Serrano, J., Sherker, A. H., et al. (2014) · Hepatology · doi:10.1002/hep.27317 · Cited by 418
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Cited by
Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults
Likhitsup, A., Chen, V. L., & Fontana, R. J. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.25822 · Cited by 30
Self-citationThe contemporary epidemiology, causes, and management of drug-induced liver injury
Swanson, L., & Fontana, R. J. (2026) · Hepatology Communications · doi:10.1097/hc9.0000000000001011
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Metadata
- Authors
- Halegoua-DeMarzio, D., Navarro, V., Ahmad, J., Avula, B., Barnhart, H., Barritt, A. S., Bonkovsky, H. L., Fontana, R. J., Ghabril, M. S., Hoofnagle, J. H., Khan, I. A., Kleiner, D. E., Phillips, E., Stolz, A., & Vuppalanchi, R.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2023-02
- Volume
- 136
- Issue
- 2
- Pages
- 200-206
- ISSN
- 0002-9343
- PMC
- PMC9892270
- Cited by
- 119
- References
- 22
- Language
- en
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
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