Vuppalanchi, RajBonkovsky, Herbert L.Ahmad, JawadBarnhart, HuimanDurazo, FranciscoFontana, Robert J.Gu, JiezhunKhan, IkhlasKleiner, David E.Koh, ChristopherRockey, Don C.Phillips, Elizabeth J.Li, Yi-JuSerrano, JoseStolz, AndrewTillmann, Hans L.Seeff, Leonard B.Hoofnagle, Jay H.Navarro, Victor J.2022-02-112022-02-112021Vuppalanchi, R., Bonkovsky, H. L., Ahmad, J., Barnhart, H., Durazo, F., Fontana, R. J., Gu, J., Khan, I., Kleiner, D. E., Koh, C., Rockey, D. C., Phillips, E. J., Li, Y.-J., Serrano, J., Stolz, A., Tillmann, H. L., Seeff, L. B., Hoofnagle, J. H., & Navarro, V. J. (2021). Garcinia cambogia, Either Alone or in Combination With Green Tea, Causes Moderate to Severe Liver Injury. Clinical Gastroenterology and Hepatology, S1542356521008715. https://doi.org/10.1016/j.cgh.2021.08.01515423565https://hdl.handle.net/1805/27788Background & Aims Garcinia cambogia, either alone or with green tea, is commonly promoted for weight loss. Sporadic cases of liver failure from G cambogia have been reported, but its role in liver injury is controversial. Methods Among 1418 patients enrolled in the Drug-Induced Liver Injury Network (DILIN) from 2004 to 2018, we identified 22 cases (adjudicated with high confidence) of liver injury from G cambogia either alone (n = 5) or in combination with green tea (n = 16) or Ashwagandha (n = 1). Control groups consisted of 57 patients with liver injury from herbal and dietary supplements (HDS) containing green tea without G cambogia and 103 patients from other HDS. Results Patients who took G cambogia were between 17 and 54 years, with liver injury arising 13–223 days (median = 51) after the start. One patient died, one required liver transplantation, and 91% were hospitalized. The liver injury was hepatocellular with jaundice. Although the peak values of aminotransferases were significantly higher (2001 ± 1386 U/L) in G cambogia group (P < .018), the median time for improvement in total bilirubin was significantly lower compared with the control groups (10 vs 17 and 13 days; P = .03). The presence of HLA-B∗35:01 allele was significantly higher in the G cambogia containing HDS (55%) compared with patients because of other HDS (19%) (P = .002) and those with acute liver injury from conventional drugs (12%) (P = 2.55 × 10–6). Conclusions The liver injury caused by G cambogia and green tea is clinically indistinguishable. The possible association with HLA-B∗35:01 allele suggests an immune-mediated mechanism of injury. Clinical Trials.gov number: NCT00345930.en-USPublisher PolicyHerbal and Dietary SupplementHepatotoxicityWeight Loss SupplementArticle