Capparis; A Candidate for Therapy in Patients with Hepatopulmonary Syndrome


Saeed Sardari 1 , Faramarz Fallahi 2 , Fatemeh Emadi 1 , Narjes Khavasi 3 , Seied Saeid Esmaeili 1 , *

1 Department of Iranian Traditional Medicine, Faculty of Medicine, Shahed University, Tehran, Iran

2 Department of Cardiology Mostafa Khomeini Hospital, Faculty of Medicine, Shahed University, Tehran, Iran

3 Department of Iranian Traditional medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran

How to Cite: Sardari S, Fallahi F, Emadi F, Khavasi N, Esmaeili S S. Capparis; A Candidate for Therapy in Patients with Hepatopulmonary Syndrome, Iran Red Crescent Med J. 2018 ; 20(5):e67096. doi: 10.5812/ircmj.67096.


Iranian Red Crescent Medical Journal: 20 (5); e67096
Published Online: September 4, 2018
Article Type: Letter
Received: February 4, 2018
Revised: April 17, 2018
Accepted: July 21, 2018





Capparis spinosa Hepatopulmonary Syndrome, Iranian Traditional Medicine

Copyright © 2018, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited

Dear Editor,

Hepatopulmonary syndrome (HPS) is commonly a pulmonary manifestation described as the triad of liver disease, arterial hypoxia, and intra-pulmonary vasodilatation. Dyspnea and cyanosis are the most common complaints of patients with HPS (1). The pathogenesis of HPS is not well known, but the treatment procedure is based on four pathophysiological mechanisms including inactivation of endothelin-1 (ET-1), inhibition of pulmonary angiogenesis, blockage of nitric oxide synthesis, and inhibition of bacterial translocation. Currently, liver transplantation is the only certain treatment of HPS (2).

One of the physicians of Iranian traditional medicine (ITM), Saleh Nasolah Halabi, characterized the disease (without mentioning the name) by stiffness of the left side of the abdomen, splenomegaly, weight loss, body weakness, cyanosis, dyspepsia, shortness of breath, edema, and wounds in the legs. He believed that it is lethal; symptoms, processes, and prognosis are similar to those of HPS. His suggested treatment in the early stages of the disease is the application of Caparis spinosa and its products (2).

Previous researches pointed out that pulmonary vascular angiogenesis can be inhibited by Quercetin, due to involvement in Akt/NF-κB and VEGFA/VEGFR-2 pathways (3). Moreover, Quercetin antioxidant activity and its ability to modulate the TLR2/TLR4 and MAPK/NF-κB signaling pathways inhibit CCl4-induced inflammation in rat (4) similar to some medicinal plants such as C. spinosa (5).

Caper (C. spinosa) has pharmaceutical properties due to a rich source of flavonoids including Quercetin, kaempferol, and anthocyanins. C. spinosa has hepatoprotective, antioxidant, and anti-inflammatory effects. Furthermore, it has a positive effect on organs such as the lung, heart, liver, and spleen (6, 7). Previously undertaken clinical trials suggest that C. spinosa can have positive effects on liver regeneration (8).

According to ITM, some diseases in an organ may occur due to complications in another organ without any clear communication. Spleen and pancreas are the main sources of liver diseases. Splenomegaly leads to a decrease in the liver span and body weight. C. spinosa may have beneficial effects on liver through improvement of spleen function (9). In a recent study, the relationship between spleen, metabolic disorders, liver (as liver spleen axes) cirrhosis, splenomegaly, and HPS is reported (10-12).

A limitation of this viewpoint is the attitude of ITM towards the application of such medications in the early stages of the disease (2).

Carrying out of animal model and also in vitro studies at an early stage of the hepatopulmonary syndrome with the application of C. spinosa can be helpful merely via meticulous consideration of the process.


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