title: Chinese herbs containing aristolochic acid associated with renal failure and urothelial carcinoma: a review from epidemiologic observations to causal inference.
abstract: Herbal remedies containing aristolochic acid (AA) have been designated to be a strong carcinogen. This review summarizes major epidemiologic evidence to argue for the causal association between AA exposure and urothelial carcinoma as well as nephropathy. The exposure scenarios include the following: Belgian women taking slimming pills containing single material Guang Fang Ji, consumptions of mixtures of Chinese herbal products in the general population and patients with chronic renal failure in Taiwan, occupational exposure in Chinese herbalists, and food contamination in farming villages in valleys of the Danube River. Such an association is corroborated by detecting specific DNA adducts in the tumor tissue removed from affected patients. Preventive actions of banning such use and education to the healthcare professionals and public are necessary for the safety of herbal remedies.
authors.affiliation: Department of Occupational Medicine, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Jhongyang Road, Hualien 97002, Taiwan ; School of Medicine, Tzu Chi University, No. 701, Section 3, Jhongyang Road, Hualien 97004, Taiwan.
authors.forename: Hsiao-Yu
authors.initials: HY
authors.lastname: Yang
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, No. 17 Xuzhou Road, Taipei 100, Taiwan ; Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 1 Jen Ai Road, Section 1, Taipei 100, Taiwan.
authors.forename: Pau-Chung
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan ; Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D034341:Aristolochic Acids / Q000633:toxicity*; D002273:Carcinogens / Q000633:toxicity; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology; D018736:DNA Adducts / Q000187:drug effects; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000627:therapeutic use* / Q000633:toxicity; D005260:Female; D006801:Humans; D016273:Occupational Exposure; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000473:pathology; D013624:Taiwan; D019459:Urothelium / Q000187:drug effects / Q000473:pathology
chemical_list: D034341:Aristolochic Acids; D002273:Carcinogens; D018736:DNA Adducts; D004365:Drugs, Chinese Herbal; C000228:aristolochic acid I