Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis

Stickel, Felix; Droz, Sara; Patsenker, Eleonora; Bögli-Stuber, Katja; Aebi, Beat; Leib, Stephen L. (2009). Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis. Journal of hepatology, 50(1), pp. 111-117. Amsterdam: Elsevier 10.1016/j.jhep.2008.08.017

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BACKGROUND/AIMS: Nutritional supplements are widely used. Recently, liver injury after consumption of Herbalife preparations was reported but the underlying pathogenesis remained cryptic. METHODS: Two patients presented with cholestatic hepatitis and pruritus, and cirrhosis, respectively. Viral, alcoholic, metabolic, autoimmune, neoplastic, vascular liver diseases and synthetic drugs as the precipitating causes of liver injury were excluded. However, both patients reported long-term consumption of Herbalife products. All Herbalife products were tested for contamination with drugs, pesticides, heavy metals, and softeners, and examined for microbial contamination according to standard laboratory procedures. Bacteria isolated from the samples were identified as Bacillus subtilis by sequencing the 16S rRNA and gyrB genes. RESULTS: Causality between consumption of Herbalife products and disease according to CIOMS was scored "probable" in both cases. Histology showed cholestatic and lobular/portal hepatitis with cirrhosis in one patient, and biliary fibrosis with ductopenia in the other. No contamination with chemicals or heavy metals was detected, and immunological testing showed no drug hypersensitivity. However, samples of Herbalife products ingested by both patients showed growth of Bacillus subtilis of which culture supernatants showed dose- and time-dependent hepatotoxicity. CONCLUSIONS: Two novel incidents of severe hepatic injury following intake of Herbalife products contaminated with Bacillus subtilis emphasize its potential hepatotoxicity.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute of Clinical Pharmacology and Visceral Research (discontinued)
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases

UniBE Contributor:

Stickel, Felix; Patsenker, Eleanora and Leib, Stephen

ISSN:

0168-8278

ISBN:

19010564

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:07

Last Modified:

24 Jul 2015 09:31

Publisher DOI:

10.1016/j.jhep.2008.08.017

PubMed ID:

19010564

Web of Science ID:

000261902900015

BORIS DOI:

10.7892/boris.29578

URI:

https://boris.unibe.ch/id/eprint/29578 (FactScience: 146660)

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