Liver Supporting by Herbal Extracts

1. RunaTea
Dr.Ahmad Ali
Marketing Department
Infinity Pharm EG

2. After studying this course ,
you should be able to:
1. Know what are the function of liver
2. Know what is NAFLD , NASH?
3. Know what’s RUNA mode of actions.
4. Know the selling point of RUNA
5. Hunt and target the interested customer.
6. Know market competitors and make use
of their weakness.

4. Table Of Contents:-
3-Market Competitors
1-Medical Background
2-Product Knowledge

5. 1-Medical Background

6. Definition Of Liver.
The largest solid organ in the
body, situated in the upper part
of the abdomen on the right
side.
The liver has two large
sections, called the right and
the left lobes.
The gallbladder sits under the
liver, along with parts of the
pancreas and intestines.

7. Functions Of Liver.
Stores vitamins, sugar and iron
to help give your body energy.
Controls the production and
removal of cholesterol.
Detoxifies chemicals and
metabolizes drugs. As it does so,
the liver secretes bile that ends
up back in the intestines.

8. Functions Of Liver.
The liver also makes
proteins important for
blood clotting and other
functions
Produces immune factors
and removes bacteria from
the bloodstream to combat
infection.
Releases a substance
called “bile” to help digest
food and absorb important
nutrients.

10. Causes Of Fatty Liver Disorders
Excess Fats
Alcohol
Viruses
Free Radicals “Smoking”
Medications
Malnutrition

11. Fats and Liver…
Certain fats cause excessive free radical formation:
Polyunsaturated fats these are found in many
foods and in many types of oils, such as
sunflower, safflower and corn oils.
They have 2 or more double bonds between
carbons which make them more susceptible to
lipid peroxidation.
This forms significant numbers of free radicals in the
form of lipid peroxide radicals.

12. Fats and Liver…
Hydrogenated fats and saturated fats both make
platelets more sticky, increasing the risk of a clot,
which could lead to a heart attack or stroke.
Hydrogenated fat is much more dangerous than
saturated fat since it interferes with essential fatty
acid functions.
Hydrogenated fats also change the permeability of
cell membranes, which impairs the cell membranes’
protective function.

13. Fats and Liver…
The liver and the whole body does not work
properly if we get too fat.
Fatty liver, or steatosis, is a broad term that
describes the buildup of fats in the liver.
Having fat in your liver is normal, but if more than
five to 10 percent is fat, then it is called fatty
liver disease.

14. Fats and Liver…
The liver commonly repairs itself by rebuilding
new liver cells when the old ones are damaged.
When there is repeated damage to the liver,
permanent scarring takes place. This is called
cirrhosis.
 the liver has become inflamed, there may be
other symptoms, such as poor appetite, weight
loss, and feeling extremely weak, sick, or tired

15. NAFLD Symptoms:-
Fatigue
Weakness
Nausea
Discomfort in abdomen

16. Liver Dysfunction: Common Symptoms
Abnormal metabolism of fats
 Bad LDL cholesterol goes up.
 Good HDL cholesterol goes down.
 Triglycerides (blood fats) go up.
Nutrient malabsorption/ Deficiency.
Blood sugar problems
Digestive problems
Weakened immune system
Over Oxidative Stress

18.  The liver filters and processes blood as
it circulates through the body.
 It metabolizes nutrients, detoxifies
harmful substances, makes blood
clotting proteins, and performs many
other vital functions. The cells in the
liver contain proteins called enzymes
that drive these chemical reactions.

19. When liver cells are damaged or destroyed, the
enzymes in the cells leak out into the blood,
where they can be measured by blood tests.
Liver tests check the blood for two main liver
enzymes:
Aspartate aminotransferase (AST), formerly
called SGOT; the AST enzyme is also found in
muscles and many other tissues besides the
liver.
Alanine aminotransferase (ALT), formerly called
SGPT; ALT is almost exclusively found in the
liver.

20. When bile flow is slow or blocked, blood levels of
certain liver enzymes rise:
 Alkaline phosphatase also found in bone
 5' nucleotidase
 Gamma-glutamyl transpeptidase (GGT)

21. Albumin
• The liver also makes albumin, an essential
protein that circulates in blood.
• Albumin levels are low in people with severe
chronic liver disease, because the liver does
not make normal amounts of albumin.
• However, albumin levels also may fall in a
variety of medical conditions.
• A low albumin level is often temporary, so it is
not a reliable way to diagnose liver disease.

22. • Bilirubin is a waste product from the
breakdown of red blood cells. The liver
processes bilirubin so it can be excreted in
stool. Bilirubin flows through the liver's bile
ducts, dissolved in bile.

23. • Bilirubin
 blood levels may be elevated in people with
impaired bile flow.
 This can occur in severe liver disease,
gallbladder disease, or other bile system
conditions.
 Very high bilirubin levels cause jaundice, in
which the skin and whites of the eyes turn
yellow.
 Bilirubin can be a useful liver function test in
people with a known bile flow problem. An
elevated bilirubin may also be present in people
with a type of anemia, called hemolytic anemia.

25. Non-Alcoholic Fatty Liver Disease(NAFLD)
Fatty liver (Steatosis)
Steatohepatitis
Inflammation/fibrosis
Cirrhosis
Normal liver

27. Types of Fatty Liver…
1-Nonalcoholic Fatty Liver:-
Nonalcoholic fatty liver (NAFL) develops when the
liver has difficulty breaking down fats, which
causes a buildup in the liver tissue.
The cause is not related to alcohol. NAFL is
diagnosed when more than 10 percent of the liver
is fat.

28. Types of Fatty Liver…
2-Alcoholic Fatty Liver:-
Alcoholic fatty liver is the earliest stage of alcohol-
related liver disease.
If the patient abstains from alcohol, the fatty liver
will go away. Within six weeks of being alcohol-
free, the fat will disappear. However, if excessive
alcohol use continues, cirrhosis may develop.

29. Types of Fatty Liver…
• 3-Nonalcoholic Steatohepatitis (NASH)
When the fat builds up enough, it will cause the
liver to swell.
If the original cause is not from alcohol, it is called
NASH.
This disease can impair liver function.
If left untreated, NASH can progress to permanent
scarring of the liver and eventual liver failure.

31. Reactive Oxygen Species

32. Reactive Oxygen Species
 When the molecule loses 1 electron it becomes a free
radical. It is unbalanced and is extremely reactive with
other molecules.
 In order to regain their missing electrons, they steal
electrons from other molecules wherever they can and
they (victim) becomes damaged in the process and
become free radicals themselves.
 The stealing of electrons is a chain reaction.
 If they are not rapidly neutralized by an antioxidant they
may create even more volatile free radicals or cause
damage to the cell membrane, vessel wall, proteins, fats or
even the DNA nucleus of the cell.
 Cell damage by free radicals is called oxidative stress.

33. Reactive Oxygen Species
 Oxidative stress cause chronic degenerative diseases.
When the damaged proteins, fats, cell membranes, and DNA
structures are not properly repaired, they can create further
problems in cell function.
 Damaged lipids lead to rigid cell membranes;
 Oxidized cholesterol often leads to hardening of the
arteries and poorly repaired DNA chains lead to cell
mutation (future generation of cells) as implicated in
cancer and aging.
 As time goes on, our immune systems become less

34. Types of free radicals:-
1. Superoxide, O2
-
2. Hydrogen peroxide, H2O2
3. Hydroxyl radical, OH-
4. Singlet oxygen, 1O2
5. Hydroperoxy radical, HOO-
6. Lipid peroxide radical, ROO-
7. Nitric oxide, NO-
8. peroxynitrite, ONOO-

35. Impacts Of ROS:-

37. Antioxidants:-
 Substances that are able to neutralize
reactive molecules and reduce oxidative
damage.
 Result of metabolic processes and
environmental sources.

38. Lipid peroxidation
Lipid peroxidation refers to the oxidative
degradation of lipids.
It is the process whereby free radicals "steal"
electrons from the lipids in cell membranes,
resulting in cell damage.
This process proceeds by a free radical chain
reaction mechanism. It most often affects
polyunsaturated fatty acids(PUFA).
In addition, end products of lipid peroxidation may
be mutagenic and carcinogenic

39. Glutathione in the Body
Glutathione (GSH) is the body's master
antioxidant and detoxifier.
Glutathione peroxidase (GPx) is
 An enzyme whose main biological role is to
protect the organism from oxidative damage.
Reduce lipid hydro peroxides to their
corresponding alcohols and to reduce
free hydrogen peroxide to water.

40. The Role of Glutathione in the Body
Maintaining other antioxidants like Vitamin
C and E in their active forms.
DNA synthesis and repair.
Regulating apoptosis.
Protein synthesis.
Amino acid transport and enzyme
activation.

41. Methionine
Methionine is a powerful antioxidant.
A methionine deficiency affects serum
cholesterol levels.
High methionine levels in the body increase the
levels of other amino acids such as glutathione.
Methionine prevents excess fat buildup and
normalize Homocystien level
Methionine is the main precursor of the amino
acid cysteine, which is in turn converted into
glutathione, the main detoxification agent in the
body.

43. Cholagouge:-
 The discharge of bile from the system.
 An agent that stimulates gallbladder c
ontraction to promote bile flow.
 Bile or gall is a dark green to yellowish
brown fluid, produced by the liver of
most vertebrates, that aids
the digestion of
lipids in the small intestine.

44. NAFLD Management

45. 2-Product Knowledge
Runa Tea

46. Runa Tea Main Composition:-
Conc.Ingredients
450 mgArtichokes
450 mgChicory Ext.
300 mgSoy Lecithin
450 mgTurmeric
10 mgZinc
20 mcgSelenium
300 mgVit.E

47. Hepatoprotective Effects
• Runa Tea has hepatoprotective Effect:-
• Prevents development
Of NAFLD.
• improve Antioxidants
effect and reduce Lipid
Peroxidation.
• Regenerates Damaged
Tissues.
• Prevents Cell Damage
and enhance Liver
Functions.

48. Limit the increase in liver
serum
0
200
400
600
800
1000
1200
1400
1600
Dose (mg/kg b.wt)AST (U/L)ALT (U/L)ALP(U/L)
Effect of oral administration of Cynara Scolymus leaves extract on serum AST, ALT and ALP
Normal control NDEA-intoxicated G NDEA+Artichoke NDEA+Artichoke NDEA+Silymarin

49. Limit the increase in liver
serum
0
50
100
150
200
250
300
ALT(U/L)AST(U/L)ALP(U/L)
Effect of turmeric on the serum levels of ALT, AST and ALP.
Control TUR (100 mgkg-1) TUR (200 mgkg-1) MTX( 20 mgkg-1) TUR (100 mgkg-1)+MTX TUR (200 mgkg-1)+MTX

50. Stimulate Hepatocytes
• Artichoke(Cynarin):-
• Stimulates the regeneration of damaged
liver tissue Like milk thistle (Silymarin).
• Yerram Raju Behara.Pharmacological studies on artichoke leaf extract -An edible herb of Mediterranean origin.JPBMS, 2011;11(11): 1-6
• Hepatostimulating properties
• Özlem AKSU*, Başar ALTINTERİM.Hepatoprotective effects of artichoke (Cynarascolymus) 2148-0273 Cilt 1, Sayı 2, 2013 / Vol. 1, Issue 2,
2013

51. Cholagogue Effects
• Artichoke(Cynarin):-
cholagogue and choleretic properties as a
gallbladder bile stimulator.
Özlem AKSU*, Başar ALTINTERİM.Hepatoprotective effects of artichoke (Cynarascolymus) 2148-0273 Cilt 1, Sayı 2, 2013 / Vol. 1, Issue 2, 2013

52. Improve Methionine And
normalize Homocystien
• Soylecithin(Choline):-
• Choline is an important methyl donor.
• Choline’s role in maintaining liver function: new evidence for epigenetic mechanisms 2013 May;16(3):339-45

53. Increase Total
Antioxidants
• Turmeric & Selenium& Artichoke&Vit E &Zn:-
• It Has Antioxidant effect.
Protective effect of artichoke leaf extract against paracetamol-induced hepatotoxicity in rats. 2015 Feb;53(2):167-73. doi:
10.3109/13880209.2014.913066. Epub 2014 Sep 22.
• it Reduce lipid peroxidation.
• Özlem AKSU*, Başar ALTINTERİM.Hepatoprotective effects of artichoke (Cynarascolymus) 2148-0273 Cilt 1, Sayı 2, 2013 / Vol. 1, Issue 2, 2013
• Powerful antioxidant which protects against
oxidative stress & prevent Liver cirrhosis.
• Vitamin E in chronic liver diseases and liver fibrosis. 2007;76:551-73.
• Protective role of Vitamin E pre-treatment on N-nitrosodiethylamine induced oxidative stress in rat liver.2005 Oct 20;156(2-3):101-11.

54. 0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
SOD(U/mg protein)GSH-Px (U/mg protein)CAT (U/mg protein)TAS
(mmol Trolox Eq/L)
Effect of turmeric on antioxidant status in liver
Control TUR (100 mgkg-1) TUR (200 mgkg-1)
MTX( 20 mgkg-1) TUR (100 mgkg-1)+MTX TUR (200 mgkg-1)+MTX

55. Glutathione enhancer
• Turmeric & Selenium:-
Improving the activity of glutathione
peroxidase.
• Antioxidant status, immune system, blood metabolites and carcass characteristic of broiler chickens fed turmeric rhizome powder under heat
stress.10.5897/AJB12.1986
Increase the total antioxidant capacity and
glutathione levels in the liver.
Effects of curcumin on antioxidative activities and cytokine production in Jian carp (Cyprinuscarpio var. Jian) with CCl4-induced liver damage. 2015
Mar;43(1):150-7.

56. Source Of Required
Nutritions
• Zn & Se & Vit E & Choline:-
• Malnutrition Is symptom Of NAFLD,Where
Live Functions is impaired and some
Metabolic functions don’t acting normally.

57. Improve Lipid Profile
• Turmeric & Artichoke& Chicory:-
• Decreasing total cholesterol and LDL-
cholesterol.Beneficial effects of artichoke leaf extract supplementation on increasing HDL-cholesterol in subjects with primary mild hypercholesterolaemia: a double-blind, randomized, placebo-
controlled trial. 2013 Feb;64(1):7-15. doi: 10.3109/09637486.2012.700920. Epub 2012 Jun 29.
• Reducing liver triglycerides .
• Curcumin prevents liver fat accumulation and serum fetuin-A increase in rats fed a high-fat diet. 013 Dec;69(4):677-86.
doi: 10.1007/s13105-013-0244-9. Epub 2013 Feb 22
• Decrease triglycerides, and abdominal fat
deposition And protects against liver (steatosis)
Effects of chicory inulin on serum metabolites of uric acid, lipids, glucose, and abdominal fat deposition in quails induced by purine-
rich diets. 2014 Nov;17(11):1214-21. doi: 10.1089/jmf.2013.2991. Epub

58. Runa Tea Actions:-
 Antioxidant effect and anti-apoptotic
properties.
 Decreasing total cholesterol and LDL-
cholesterol.
 cholagogue and choleretic properties as a
gallbladder bile stimulator.
 Improving the activity of glutathione
peroxidase.
 Powerful antioxidant which protects
against oxidative stress & prevent Liver
cirrhosis.

59. Selling points
 Unique Effective Formula with Maximum
Bio-Availability.
 Unique Hepatoprotective and regenerative
effect with powerful cholaguge effect.
 Powerful Anti-Oxidant with Synergistic
actions.
 Sachet Form, Chemically Free With Highly
Safety profile.
 Excellent Patient Compliance With Palatable
Taste.

60. Dosage
Dissolve the content of the sachet in
half glass of water and drink it Once
or Twice daily.
Indications
NAFLD
Hepatoprotective
10 Sachet…22.75 LE

61. Target Audience:-
• Hepatologists
• GP/IM
• Contracts
• Liver Institutes

70. 3-Market Competitors

71. Market Competitors
* Dietary Supplement.
* Composition: Each sachet contains:
Silymarin (70%) 200 mg + Acetylcysteine 200
mg + Alpha tocopherol acetate (50%) 10 mg
(Eq. to Vitamin E 5 IU) +
Beta carotene 0.5454 mg (Eq. to Vitamin A 300
IU) + Ascorbic acid (Vitamin C) 30 mg + Sodium
selenite anhydrous
0.04 mg (Eq. to selenium 18.3 mcg) + Zinc
sulfate monohydrate 10.0375 mg (Eq. to Zinc
3.65 mg).
* Keep at temperature not exceeding 30
degrees C.
* Produced by: SEDICO (South Egypt Drug
Industries Co.) - Egypt
Silymarine Sachets

72. Market Competitors
livamarin (Silymarin) Effervescent
granules 10 sachets. Sugar Free.
Lipotropic.
* Composition: Each 5 gm sachet
contains:
Silymarin 140 mg.
* Store at temperature not exceeding 30
degrees C, away from moisture.
* Produced by: EUROPEAN EGYPTIAN
PHARM. IND. - Alexandria - Egypt.
Livamarine Sachets

73. Market Competitors
INGREDIENTS: each 100gm contains:
Natural sweet potato powder 80 gm + Natural artichoke
powder 20 gm.
* PACKAGE:
200 gm in 10 sachets. sachet net weight 20 gm.
* DOSAGE:
ADULTS: one tablespoonful on 200 ml water or milk or juice
twice daily or one sachet / day
before meals.
CHILDREN: one teaspoonful on 100 ml water or milk or
juice from 2-3 / day.
* STORAGE: keep in a cool dry place. Store below 30
degrees C.
* Nutritional facts: (Chemical analysis vs % According to
2000 calories of daily values):
Energy 337.5 calories (337.5 g,from fats 12.8) -
Carbohydrates 78.24 g (26.1%) - Protein 12.3 g (12.3 g) -
Fats 1.8 g (2.3%) - Fibers 5.72 g (22.08%) - Calcium 523 mg
(32.5%) - Iron 8.2 mg (19.15%) -
Sodium 34.9 mg (1.46%) - Vitamin A 315.2 mcg = 1088 IU
(5.28%) - Sugar 4.8.
* Packed By: Nutrexia - Egypt. For: Unitrade Pharma Grou
GP Plus

74. Market Competitors
Dietary Supplement.
* Composition: Each capsules contains:
Lecithin 300mg + Milk thistle (80% Silymarin)
140mg + L-Glutathione 10 mcg + L-Glutamine
10mg + Protein (Egg Albumin) 100mg +
Protein (Whey) 25mg + Protein (Brewers Yeast)
80mg + Black Radish extract 50mg + Beet leaves
extract 50mg + Betaine HCl 10mg +
Inositol 10mg + L-Methionine 10mg + Vitamin B1
(Thiamine HCl) 10mg + Vitamin B1 (Riboflavin B2)
10mg +
Vitamin B6 (Pyridoxine HCl) B6 10mg + Vitamin
B12 (Cyanocobalamine) 10mcg.
* Indications: Food Supplement to improve liver
functions.
* Dosage: 1-3 capsules daily or as directed by the
physician.
* Store at a temperature not exceeding 25 degrees
C.
* Manufactured by: International Drug Agency For
Pharmaceutical Industry (IDI), for: International
Drug Agencies (IDA).
Liver Albumin Plus

75. Market Competitors
Dietary Supplement.
* Composition: each capsule contains:
Glutathione 50 mg + L-Cysteine 50 mg + N-
Acetyl Cysteine 100 mg + L-Methionine 50 mg +
Vitamin C 250 mg + Selenium 10 mcg.
* Indications: Food supplement to improve liver
function.
* Dose: 2 capsules on an empty stomach or as
prescribed by the physician.
* Store at temperature not exceeding 30 degrees
C.
* Produced by: Marcyrl Pharmaceutical
Industries. For: International Business
Establishment Company (IBE Pharma)
Glutathione Enhancer

76. Market Competitors
* Dietary Supplement.
* Composition: Each Capsule contains:
Milk thistle (Silymarin 80%) 200 mg +
Astragalus root extract (10:1) 20 mg + Lecithin
Powder (2:1) 150 mg (equivalent to 300 mg
Lecithin) +
Zinc Ascorbate 12.5 mg (equivalent to 1.98 mg
zinc) + Selenium Chelate 0.5% - 5.5 mg
(equivalent to 25 mcg Selenium) +
Ascorbic acid 30 mg.
* Dosage:
1-2 capsules daily or as prescribed by
physician.
* Keep at room temperature.
* Manufactured by: Arab Co. For Gelatin &
Pharmaceutical products. Under License of:
The Herbalist New Zealand Ltd,
For: PHARMACARE Co.
Bional Capsules

77. Market Competitors
Composition: Each capsule contains:
Silymarin 70 mg + Essential
Phospholipids 300 mg + Orotic acid (Vit.
B13) 10 mg.
* Store below 30 degrees C away from
direct sunlight.
* Manufactured by: The Egyptian Co. For
Chemicals & Pharmaceuticals (ADWIA
Co.) S.A.E. - Egyp
Hepatic Forte

78. Market Competitors
Each soft gelatin capsule contains:
Milk thistle powdered extract 80% 140 mg (Eq.
to 112 mg silymarin) + Sodium Selenite 54 mcg
(Eq. to 25 mcg Selenium) +
Vitamin A Palmitate 165 mcg (Eq. to 300 I.U.
Vitamin A) + Vitamin C 60 mg + Vitamin E 15 I.U.
+ Glutathione 50 mg.
* Dosage:
1-2 capsules / day or as prescribed by
physician.
* Store at temperature not exceeding 30 degrees
C.
* Manufactured by: ARAB-CAPS (Arab Company
For Gelatin and Pharmaceutical Products),
Alexandria - Egypt.
For: Alpha Medicine - Egypt
Alpha Hepadox