Hepatotoxicity Induced by "the 3Ks": Kava, Kratom and Khat.
The 3Ks (kava, kratom and khat) are herbals that can potentially induce liver injuries. On the one hand, growing controversial data have been reported about the hepatotoxicity of kratom, while, on the other hand, even though kava and khat hepatotoxicity has been investigated, the hepatotoxic effects are still not clear. Chronic recreational use of kratom has been associated with rare instances of acute liver injury. Several studies and case reports have suggested that khat is hepatotoxic, leading to deranged liver enzymes and also histopathological evidence of acute hepatocellular degeneration. Numerous reports of severe hepatotoxicity potentially induced by kava have also been highlighted, both in the USA and Europe. The aim of this review is to focus on the different patterns and the mechanisms of hepatotoxicity induced by "the 3Ks", while trying to clarify the numerous aspects that still need to be addressed.
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy. flaminia.pantano@uniroma1.it.
Flaminia
F
Pantano
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy. roberta.tittarelli@uniroma1.it.
Roberta
R
Tittarelli
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy. giulio.mannocchi@uniroma1.it.
Giulio
G
Mannocchi
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy. simona.zaami@uniroma1.it.
Simona
S
Zaami
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy. serafino.ricci@uniroma1.it.
Serafino
S
Ricci
Section of Legal Medicine, Università Politecnica delle Marche, 60121 Ancona, Italy. r.giorgetti@univpm.it.
Raffaele
R
Giorgetti
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy. daniela.terranova@uniroma1.it.
Daniela
D
Terranova
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy. fra.busardo@libero.it.
Francesco P
FP
Busardò
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy. enrico.marinelli@uniroma1.it.
Enrico
E
Marinelli
D000818:Animals; D029754:Catha / Q000737:chemistry*; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology*; D032065:Mitragyna / Q000737:chemistry*; D031701:Piper / Q000737:chemistry*; D010936:Plant Extracts / Q000737:chemistry / Q000633:toxicity*; D010946:Plants, Medicinal / Q000737:chemistry / Q000633:toxicity*
D010936:Plant Extracts
hepatotoxicity; herb induced liver injury; herbals; kava; khat; kratom