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Tinospora crispa  is a popular traditional herbal plant commonly used throughout the world for treatment of various diseases, in particular type 2 diabetes mellitus. We report here a new case of toxic hepatitis in a 57-year old male patient in the French West Indies following the consumption of two aqueous extracts of fresh  Tinospora crispa  stems. It thus differs from two previously reported cases that concerned the chronic intake of powdered dry stems delivered in solid oral dosage forms ( i.e . pellets and tablets). Liquid Chromatography-Diode Array Detection-Mass Spectrometry (LC/DAD/MS) analyses were performed on an aqueous extract of the offending sample that mimics the swallowed preparation. They revealed the presence of species-specific molecular marker borapetoside C ( 1 ) and thus enabled an unambiguous phytochemical identification. The exploration of tandem MS/MS data obtained by ultra-high performance liquid chromatography/electrospray ionization quadrupole time-of-flight mass spectrometry (UHPLC-ESI-QTOF-HRMS) allowed the identification of 17 additional  cis -clerodane-type furanoditerpenoid lactones, analogues of  1 . These results support the hypothesis that the mechanisms underlying hepatotoxicity of  Tinospora crispa  are the same as those encountered with furanoditerpenoids-containing plants such as  Teucrium chamaedrys  or  Dioscorea bulbifera . In the context of type 2 diabetes treatment, we recommend that  Tinospora crispa  intake should be more closely monitored for signs of hepatotoxicity.

Clerodane furanoditerpenoids as the probable cause of toxic hepatitis induced by Tinospora crispa