World Journal of Medical Sciences 2 (1): 28-32, 2007ISSN 1817-3055 - PDF document

World Journal of Medical Sciences 2 (1): 28-32, 2007ISSN 1817-3055© IDOSI Publications, 2007Corresponding Author:Mr.T.Oduola,Department of Haematology, Special Investigations Laboratory, Obafemi AwolowoUniversity Teaching Hospitals Complex, Ile-Ife, NigeriaEvaluation of the Effects of Intake of Extract of Unripe Pawpaw (Carica Papaya) on Liver Function in Sickle Cell PatientsT. Oduola, F.A.A. Adeniyi, E.O. Ogunyemi, T.O. Idowu and I.S. Bello12345 antisickling agent bilirubin prothrombin transaminases unripepawpawINTRODUCTIONSickle cell disease is a life-long haemolytic anaemia ) chain of World J. Med. Sci., 2 (1): 28-32, 2007others to form a bundle, distorting the red cell into classicgrammes was soaked in 100ml of water for 72 hours atcrescent or sickled forms. These shapes interfere witharoom temperature. The extract was sieved into a cleancritical erythrocyte feature; its deformability [6]. Thesebottle.rigid sickle cells are responsible for the vaso-occlusivephenomenon that are characteristic of this disorder. TheCategory of patients: Patients were categorized into threepresence of other haemoglobins in the red blood cell,based on their age as follows: There were fifteen patientssuch as haemoglobin F, haemoglobin A, haemoglobinCin each group. and haemoglobin D, in that order, has antisickling effecton the polymerization of HbS [7, 8].Category oneCarica papaya is used in many countries in differentChildren: 2 to 6years-One teaspoonful (5 ml) of extractways. It is eaten as ripe fruit and as an ingredient in jellies,of unripe pawpaw was ingested 3 times daily for 6 months.preserves, juice as a beverage; young leaves, shoots andfruitscooked as a vegetable. Latex used to removeCategory twofreckles, bark for making rope, leaves as a soap substituteChildren: 6 to 2years: Two teaspoonful (10ml) of theto remove stains and flowers eaten in Java [9]. Papain, theextract of unripe pawpaw was ingested 3 times daily for 6proteolytic enzyme from carica papaya is used in medicinemonths.for the treatment of dyspepsia, digestive disorders andreducing enlarged tonsils. The root infusion is used forAdults: 12 years and above-Three teaspoonful (15ml) ofsyphilis in Africa, leaf smoked for asthma relief in variousthe extract was ingested 3 times daily for 6 months.remote areas. Flowers have been used for jaundice andinnerbark used for sore throat. AnnonaceousCollection of specimen: Ten millilitres of blood wasacetogeninsderived from the extracts of the twigs of thecollected from each of the patients before extractpawpaw tree may be good chemotherapeutic agents foringestion through clean venepuncture, 4.5 ml of bloodcanceras these compounds inhibit enzymes necessarywas dispensed into 0.5ml 3.8% Sodium citrate bottle forfor metabolic processes in tumour cells [10-15]. PT and APTT; and 5ml of blood was dispensed intoTheextract of unripe pawpaw has been reported tolithium heparin bottle for other liver function tests.possess antisickling properties [16] and it is being used asBlood collection was repeated 24hours, 1 week, 2 weeks,anantisickling agent by some sickle cell patients in3 weeks, I month, 2 months, 3 months, 4 months, 5 monthsWesternNigeria. The minimum concentration of theand6 months after daily ingestion of the extractextract that achieved maximum antisickling effect wasthroughout the period of the study. Blood samples wereestablished to be lg/ml of saline and the antisickling agentanalysed on the day of blood collection. was found to be located in the ethyl acetate fraction of theextract [17]. The extract of unripe pawpaw has beenAnalytical procedure: Total bilirubin, conjugatedshown to possess no adverse effect on the functions ofbilirubin, total protein albumin, globulin, AST, ALT, Alk.liver, kidney and bone marrow in rats [18]. Although liverPhos and cholesterol were estimated using standardfunction was reported to be normal in seven-year oldtechniques [19] PT and APTT were performed usingsickle cell children that ingested the extract for seven daysstandard techniques [20].[16], data on safety on long term ingestion of the extracton liver function and in different age groups of sickle cellStatistics: The mean and standard deviation and the levelpatients are lacking, hence the present study is designedofsignificance for the differences between means wereto investigate the effect of ingestion of extract of unripecomputed by students test SPSS 6. pawpaw on liver function of sickle cell patients ofdifferent age groups over a relatively long period. RESULTSMATERIALS AND METHODS The effects of intake of extract of unripe pawpaw onPreparation of extract for ingestion: Matured freshgroups were presentesd in tables 1, 2 and 3. In all ages theunripepawpaw was plucked, peeled cut into pieces andplasma levels of total and conjugated bilirubins afterthe cream-coloured seeds inside discarded. One hundred6 months of intake were significantly lower (p0.05) thanliver function tests in sickle cell patients of different age World J. Med. Sci., 2 (1): 28-32, 2007Table 1: Effect of intake of extract of unripe pawpaw on liver function test in sickle cell patients (2- 6 years)TBCBTPALBGlobASTALTAlK PhosCholeReferenceUmoI L UmoI L g L g L g L IU L IU L IU L mmoI L PT secAPTT sec1111111rangeup to 20558-8035-5020-45up to 18up to 2260-1702.5-6.511-1430-40IntervalsBefore Intake19.80±9.709.73±5.8760.33±6.5236.26±3.1724.07±4.7414.60±4.2212.07±4.9678.20±6.913.01±0.2712.53±0.9433.72±2.6024 hours after16.53±7.848.27±4.1560.53±5.6440.07±2.8120.46±4.0013.80±3.9711.27±4.7379.73±7.872.97±0.2212.79±0.6835.07±2.561week after12.40±3.405.67±2.5064.07±4.8841.20±2.4024.87±4.5213.13±3.2010.53±3.9886.33±12.533.10±0.2512.02±0.5233.51±2.422 weeks after10.47±1.774.47±1.9264.40±6.2342.13±3.9225.27±4.2014.72±2.6610.16±3.1089.13±16.433.08±0.2512.82±0.7734.77±1.773 weeks after9.87±1.644.47±1.9664.33±6.6444.67±4.6424.67±3.7510.87±2.729.89±2.0591.33±14.263.15±0.2212.27±0.4633.53±2.481 month after9.00±2.074.00±1.4668.20±5.2143.53±3.9824.67±2.8910.00±2.0711.03±2.0194.27±14.003.25±0.2612.35±0.5133.87±2.692 months after8.93±2.223.07±1.6772.13±6.2943.87±11.9624.93±3.8610.80±2.1110.91±1.9599.20±16.033.30±0.2313.02±0.8334.84±2.273 moths after7.80±1.322.60±0.9970.07±5.6644.93±4.3725.13±3.8111.61±1.8011.23±1.80100.33±14.893.37±0.2513.03±0.6434.01±2.804 months after6.80±1.012.47±0.9272.60±5.7046.60±3.6025.00±4.5111.35±1.9410.92±1.66104.27±15.223,32±0.1812.75±0.7434.55±2.455 months after7.87±2.072.67±1.3572.60±3.9446.67±3.2024.93±3.0813.36±1.759.99±1.51106.13±15.133.47±0.2913.01±0.5634.92±2.126 months after7.33±2.192.53±1.1971.40±3.8346.40±4.1625.00±3.4212.63±2.0010.37±1.77108.67±14.973.45±0.3212.24±0.5135.01±2.17Table 2: Effect of intake of extract of unripe pawpaw on liver function test in sickle cell patients (612years)TBCBTPALBGlobASTALTAlK PhosCholeUmoI L UmoI L g L g L g L IU L IU L IU L mmoI L PT secAPTT sec111111111up to 20558-8035-5020-45up to 18up to 2260-1702.5-6.511-1430-40IntervalsBefore Intake75.73±31.8633.07±12.3765.80±5.4340.40±3.3125.40±4.6615.67±3.4016.53±4.2297.40±22.463.23±0.3713.05±0.7434.91±3.4424 hours later 74.07±32.2734.53±15.1865.67±5.2339.67±3.2226.00±3.8716.33±3.5516.60±3.9498.07±22.793.23±0.4013.19±0.5535.79±3.18I week after18.00±4.267.33±2.5267.47±4.4940.80±3.2626.67±3.5815.60±3.6217.40±4.30100.93±22.913.20±0.4313.16±0.4434.80±2.172 weeks after13.93±3.036.00±1.7368.20±4.8442.27±2.8725.93±4.3014.93±3.3415.47±3.18103.00±22.603.26±0.4212.97±0.7535.02±2.733 weeks after 13.33±3.895.47±1.3669.33±5.3442.20±2.4827.13±4.9314.60±3.3315.47±3.38106.00±22.983.20±0.4613.29±0.5134.76±2.291 month after11.47±3.385.07±1.0070.47±4.8442.93±2.0527.53±4.0714.87±4.4115.40±3.91108.20±22.943.11±0.4413.25±0.5935.01±2.032 months after11.13±3.144.07±0.0771.27±4.4643.73±2.1927.60±3.7414.40±3.3315.13±5.14109.40±21.993.16±0.5012.97±0.5335.04±2.543 months after 9.87±2.593.60±1.0673.20±4.6044.47±1.6029.07±3.4014.27±4.1715.07±4.59111.27±23.363.24±0.4813.07±0.5834.81±2.844 months after10.02±2.373.40±0.6372.13±3.8744.27±1.2227.87±3.7413.33±4.5614.87±4.56114.27±23.353.17±0.4713.05±0.6736.64±1.485 months after9.40±3.683.07±0.8873.40±3.3344.67±2.4128.73±3.3713.36±4.9614.00±4.02117.20±23.953.23±0.4512.93±0.4334.47±2.406 months after9.00±2.882.80±0.9473.60±2.8546.33±6.9827.27±2.5813.53±4.5514.13±3.85118.47±24.923.32±0.4613.28±0.4834.37±1.88Table 3: Effect of intake of extract of unripe pawpaw on liver function test in sickle cell patients (12 years and above)TBCBTPALBGlobASTALTAlK PhosCholeUmoI L UmoI L g L g L g L IU L IU L IU L mmoI L PT secAPTT sec111111111up to 20558-8035-5020-45up to 18up to 2260-1702.5-6.511-1430-40IntervalsBefore intake49.00±9.5224.73±9.1863.13±5.8939.40±3.8923.73±4.4013.80±3.1015.00±3.8390.60±14.663.20±0.3412.93±0.6132.87±2.5824 hours later 47.07±9.5923.67±8.1362.47±6.1039.47±3.9123.00±4.2113.67±2.9414.13±4.1691.47±14.743.24±0.3212.51±0.5332.99±2.45I week after18.40±7.139.20±4.6664.67±5.5440.80±3.9723.87±4.4713.27±3.2214.73±3.6995.20±15.173.25±0.3112.66±0.7133.16±2.442 weeks after13.27±3.536.33±1.8866.40±5.4741.73±3.5624.67±3.6411.87±3.9614.13±3.29100.33±16.423.32±0.3412.83±0.6833.40±2.443 weeks after12.73±2.155.33±1.1866.53±5.8542.33±3.1124.20±4.8912.53±3.9313.93±3.45102.07±17.173.30±0.4012.93±0.5433.54±1.811 month after 11.47±1.815.20±1.0868.47±6.3242.67±3.0625.93±4.5612.27±4.3713.07±4.56104.00±17.753.31`±0.3813.00±0.5134.73±2.132 months after10.33±1.544.40±0.9969.20±6.6343.47±3.1125.80±5.0212.13±3.4212.73±4.17107.80±18.703.30±0.3712.83±0.6334.40±1.563 months after9.53±1.463.47±0.8370.40±6.7944.39±2.9925.07±5.8211.53±4.5512.53±4.94110.47±18.503.28±0.3313.17±0.4934.57±2.024 month after9.53±1.773.40±0.6372.13±3.8744.27±1.2227.87±3.7413.33±4.5614.87±4.56114.27±23.353.17±0.4712.96±0.4334.23±1.915 month after9.93±1.943.67±0.8270.47±4.6745.07±3.7325.40±3.9111.47±4.7612.20±5.01114.13±18.633.39±0.2813.01±0.5434.23±1.596 months after10.07±1.623.20±0.7772.20±3.3945.87±3.6826.33±3.7711.53±5.1912.87±5.00115.73±18.023.41±0.2713.07±0.5335.07±2.12 World J. Med. Sci., 2 (1): 28-32, 2007values obtained before extract intake. The values of totalACKNOWLEDGEMENTproteins, albumin and globulins were significantly higher(p0.05) after 6 months of extract intake than the valuesobtained before intake. The values of AST, ALT, alk.phosand cholesterol were all within the reference range beforeand after extract intake for 6 months PT and APTT werewithin the reference range before and after extract intakefor 6 months.DISCUSSIONThe reduction in plasma bilirubin levels soon after thecommencement of intake of the extract of unripe pawpawprovided scientific justification for its use by herbalists asa treatment for jaundice. There were hyperbilirubinaemiain the age group 6 to 12 years and adult before intake ofthe extract, the bilirubin levels were on the high sidein children of 2 to 6 years in all the age groups, thebilirubin levels returned to normal levels within a week ofintake of extract. Thiswas maintained throughout the periodofthe study. The reduction and maintainance of bilirubinlevels within the reference range was an indication thatthere was no haemolysis of red cells. The exactmechanism of antihaemolytic action of the extract isnot yet known.The plasma concentration of total protein wereincreased although within the reference range, afterintake of the extract for 6 months. This increase wasmajorly due to increase in albumin, an indication thatthe synthetic function of the liver was improved. Thenormal PT and APTT that were recorded before intakeandthroughout the study period also showed thatthe synthetic function of the liver was not impairedbecause most of the coagulation factors aresynthesized by the liver. The plasma levels of ASTandALT before extract intake and throughout the studyperiodremained normal, a pointer that the extract did notdamage liver cell. The plasma levels of alkalinephosphatase were increased although within thereference range, after intake of the extract. 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