{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:08:30Z","timestamp":1791655710046,"version":"4.3.4"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2022,2,6]],"date-time":"2022-02-06T00:00:00Z","timestamp":1644105600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Tinospora cordifolia<\/jats:italic>\n                    (Giloy) is an herbal supplement commonly used in the Indian alternative medicine system Ayurveda. This herb has been promoted to the public in India as an immune booster to prevent novel coronavirus disease 2019. However, small reports have recently shown an association between Giloy use and the development of herb\u2010induced liver injury (HILI) with autoimmune features in some patients. This large retrospective Indian multicenter study spanning 13 centers at nine locations was designed to identify features and outcomes of HILI temporally associated with Giloy use. Chemical and toxicological analyses of retrieved Giloy samples using state\u2010of\u2010the\u2010art methods were also performed. We report 43 patients, of whom more than half were female, with a median time from initial Giloy consumption to symptom onset of 46 days. Patients presented with acute hepatitis, acute worsening of chronic liver disease (CLD, the most common clinical presentation), or acute liver failure. Causality assessment revealed probable liver injury in 67.4%. The most common autoantibody detected was anti\u2010nuclear antibody. Liver biopsy in a subset revealed HILI associated with autoimmune features and hepatocyte and canalicular cholestasis and neutrophilic and eosinophilic infiltration.\n                    <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic>\n                    Giloy is associated with acute hepatitis with autoimmune features and can unmask autoimmune hepatitis (AIH) in people with silent AIH\u2010related CLD. Further studies on the safety (and efficacy) of untested but heavily promoted herbals in alternative systems of medicine are an unmet need in the interests of public health and are especially important during this global health emergency.\n                  <\/jats:p>","DOI":"10.1002\/hep4.1904","type":"journal-article","created":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T05:40:21Z","timestamp":1642398021000},"page":"1289-1300","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":44,"title":["Tinospora Cordifolia (Giloy)\u2013Induced Liver Injury During the COVID\u201019 Pandemic\u2014Multicenter Nationwide Study From India"],"prefix":"10.1097","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1240-1675","authenticated-orcid":false,"given":"Anand V.","family":"Kulkarni","sequence":"first","affiliation":[{"name":"78470,Hepatology and Liver Transplantation,Asian Institute of Gastroenterology,Hyderabad,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavan","family":"Hanchanale","sequence":"additional","affiliation":[{"name":"236749,Department of Gastroenterology and Liver Transplantation,Jupiter Hospital,Pune,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikash","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Hepatology,D\u2019CosMedics Clinic,Kolkata,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetan","family":"Kalal","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Liver Transplantation,Sir H. N. Reliance Foundation Hospital and Research Centre,Mumbai,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithun","family":"Sharma","sequence":"additional","affiliation":[{"name":"78470,Hepatology and Regenerative Medicine,Asian Institute of Gastroenterology,Hyderabad,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4382-9831","authenticated-orcid":false,"given":"Karan","family":"Kumar","sequence":"additional","affiliation":[{"name":"Hepatology and Transplant Medicine,BGS Gleneagles Global Hospitals,Bengaluru,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9001-9463","authenticated-orcid":false,"given":"Saptarshi","family":"Bishnu","sequence":"additional","affiliation":[{"name":"Department of Hepatology,Apollo Hospitals,Chennai,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5177-6595","authenticated-orcid":false,"given":"Aditya V.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology,Antrang Hospital,Kohlapur,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lovkesh","family":"Anand","sequence":"additional","affiliation":[{"name":"74967,Department of Gastroenterology and Hepatology,Manipal Hospitals,Dwarka, New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3274-7462","authenticated-orcid":false,"given":"Ajay Kumar","family":"Patwa","sequence":"additional","affiliation":[{"name":"76140,Gastroenterology Unit,Department of Medicine,King George Medical 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