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Silybum marianum ethanolic extract: in vitro effects on protoscolices of Echinococcus granulosus G1 strain with emphasis on other Iranian medicinal plants

Abstract

Background

Cystic echinococcosis (CE), is a parasitic zoonosis caused by Echinococcus granulosus (E. granulosus) larvae in liver and lungs of both humans and animals. Surgical intervention is the mainstay for CE treatment, using scolicidal agents that inactivate live protoscolices. This study evaluated the scolicidal effects of Silybum marianum ethanolic extract and its combination with albendazole in vitro for the first time. Moreover, in a literature review, we investigated the effects of a wide range of Iranian medicinal plants on protoscolices of E. granulosus.

Methods

S. marianum ethanolic extract was prepared and high-performance liquid chromatography (HPLC) analysis was used to establish the proportions of its component compounds in the extract. Cytotoxicity was evaluated in mouse macrophage cells (J774A.1 cell line) using MTT method. Next, the scolicidal activity of the extract alone and combined with albendazole was tested as triplicate at various concentrations incubated for 5, 10, 20, 30, and 60 min. Finally, protoscolex viability was determined using 0.1% eosin as a vital stain. PCR–RFLP and DNA sequencing techniques were used to characterize the genotype of E. granulosus.

Results

HPLC analysis showed that S. marianum ethanolic extract contained mostly silydianin (14.41%), isosilybin A (10.50%), and silychristin (10.46%). The greatest scolicidal effects were obtained with the combination of S. marianum with albendazole (79%), S. marianum ethanolic extract alone (77%) and albendazole (69%), at a concentration of 500 μg/ml for 60 min, respectively (P < 0.05). Molecular analysis showed that all the cysts used were G1 genotype.

Conclusion

The data suggest that S. marianum ethanolic extract is a potential scolicide in vitro; however, further investigations are required to determine its efficacy in vivo.

Introduction

The zoonotic tapeworm, Echinococcus granulosus (E. granulosus), is a genetically diverse metazoan parasite causing cystic echinococcosis (CE) or hydatid disease [1, 2]. Human CE infection has a global distribution with a resultant 1–3.6 million disability-adjusted life years (DALYs) worldwide; most of these cases occur in low- and middle-income countries [3, 4]. The predator–prey life cycle of E. granulosus consists of canids (definitive hosts) and herbivores/omnivores species (intermediate hosts) [5, 6], and human infection occurs accidentally by ingestion of E. granulosus eggs from soil, water and vegetables contaminated with infected canid feces [7, 8]. In humans, fluid-filled hydatid cysts are mainly found in the liver and lungs and, to a lesser extent, in the abdominal cavity, muscle, heart, bone and nervous system [9, 10]; as a result, it can cause a wide range of different symptoms and signs.

Currently, there are three treatment approaches for CE, surgical removal, PAIR (puncture, aspiration, injection, and re-aspiration), and chemotherapy using benzimidazole compounds [11,12,13,14]. Globally, surgery remains the most common treatment with chemotherapy as an adjuvant [15, 16], although this is not appropriate for all cyst stages [17]. Cyst rupture and spillage of cysts containing protoscolex-rich fluid during surgery is a significant cause of recurrence [18, 19]. Hence, the selection of a suitable drug to reduce recurrence is crucial [20].

Medicinal plants are considered as huge treasuries for a wide spectrum of valuable therapeutic compounds [21, 22]. Silybum marianum (Asteraceae), is a medically important plant species native to North and South America, Africa, Australia and the Middle East [23, 24]. The seeds of S. marianum contain a powerful substance called silymarin, which has long been used to support liver health [21]. Historically, therapists have used the seeds for their anti-carcinogenic and hepatoprotective effects [21, 25]. Therapeutic effects of S. marianum have also been demonstrated against prostate, skin and breast tumors, cirrhosis and kidney disease [26, 27]. Additionally, several studies have emphasized the anti-helminthic, anti-bacterial, anti-aflatoxin and immunomodulatory features of silymarin in S. marianum seeds [28,29,30,31].

Experimental studies of the scolicidal activity of ethanolic extract of S. marianum seeds are lacking; hence, the current in vitro investigation was designed to evaluate the scolicidal efficacy of S. marianum ethanolic extract alone or combined with albendazole. Also, in a literature review, we investigated the effects of a wide range of Iranian medicinal plants on protoscolices (PSCs) of E. granulosus.

Materials and methods

PSCs preparation and viability test

Livers and lungs of sheep infected with hydatid cysts were collected from the industrial slaughterhouse, Urmia, Northwestern Iran, and transferred, on ice, to the Parasitology Department, Faculty of Medical Sciences, Tarbiat Modares University at Tehran. Hydatid cyst fluid and PSCs were collected in sterile 50-mL tubes, then centrifuged at 2000 rpm for 5 min, as described by Smyth and Barret [32]. The supernatant was discarded and PSCs were washed four times in phosphate-buffered saline (PBS, pH: 7.2), supplemented with 0.5 mg/mL of amphotericin B, 200 mg/mL of streptomycin, 200 U/mL of penicillin and 10% glucose, in order to eliminate the rest of hydatid membranes and fluids [33]. Subsequently, 0.1% pepsin in Hank’s solution (pH: 2.0) was added to PSCs and incubated for 30–45 min to remove the remaining germinal layer and dead PSCs. Pepsin was removed by washing four times with Hank’s solution. To assess the viability of PSCs under light microscope, flame cell motility was examined using 0.1% eosin stain solution (1 g eosin powder dissolved in 1000 mL distilled water); PSCs, unstained after 5 min exposure, were considered as being viable [34]. PSCs with 99% viability were harvested and maintained at 4 °C for future experiments. PSC samples were also stored in 70% ethanol for molecular analysis.

DNA extraction and polymerase chain reaction (PCR)

The genomic DNA of 50 μl of viable PSCs was extracted using a commercial DNA extraction kit, (Roche, Mannheim, Germany) according to the manufacturer’s instructions. Purified DNA samples were kept at -20 °C until further use. In the next step, PCR assay was set up to amplify a 462-bp segment of the ribosomal DNA internal transcribed spacer 1 (ITS1) gene and restriction fragment length polymorphism (RFLP) method was used for parasite genotyping [35]. Finally, PCR products were sequenced using Applied Biosystems 3730/3730xl DNA Analyzers (Bioneer, South Korea) and the results were compared using BLAST software against the GenBank database.

Plant collection and extraction procedure

In the present investigation, S. marianum plants were collected from Tehran suburbs, followed by species authentication (herbarium number 514) by the Botany Division of the Iranian Biological Resource Center, Karaj, Iran. Plant seeds were ground to 0.4 mm diameter using a blender [36]. Next, 10 g of seed powder was extracted in a Soxhlet apparatus (Sigma- Aldrich), initially with 370 mL petroleum ether for 4 h, and then with 350 mL ethanol for 8 h. The ethanol was evaporated from the solution at 40 °C and an ethanolic extract of seeds (1.08 g) was obtained as a soft yellow powder (silymarin), which then dissolved in ethanol as stock solution. Experimental dilutions (500, 250, 125, 62.5, 31.25, 15.62, 7.81, 3.90, and 1.95 μg/ml) were finally prepared in Dulbecco’s modified Eagle medium (DMEM).

High-performance liquid chromatography (HPLC) for silymarin content

HPLC is normally used to identify compounds present in plant extracts and compare their components. For this purpose, we used an Agilent 1290 Infinity LC System (USA). Extracts re-dissolved in ethanol and applied to a standard 250 mm × 4.6 mm HPLC column at a flow rate of 1 mL/min with the detector set at 288 nm for analysis of the chromatogram.

Reference drug (albendazole) preparation and its combination with ethanolic extract of S. marianum

Albendazole (Sigma–Aldrich, St. Louis, USA) was dissolved in DMSO and used as a reference drug at concentrations of 500, 250, 125, 62.5, 31.25, 15.62, 7.81, 3.90, and 1.95 μg/ml, respectively. Combined concentrations for albendazole and ethanolic extract of S. marianum in equal proportions were 500, 250, 125, 62.5, 31.25, 15.62, 7.81, 3.90, and 1.95 μg/ml.

Cytotoxicity assay by MTT

Mouse macrophage cell line (J774A.1), bought from Pasteur Institute of Iran, was cultured in cell culture flasks containing DMEM supplemented with 10% FBS at 37 °C, in a 5% carbon dioxide atmosphere [37]. 105 macrophages were seeded into each well of 96-well culture plates and incubated for 24 h. Then, S. marianum concentrations were added to macrophages in different concentrations and the plates were incubated for 1 day at 37 °C. After addition of 20 μl of MTT solution (5 mg/ml), the plates were incubated at 37 °C for an additional 3–5 h, and the supernatant portion was discarded from each well. Finally, 100 μl DMSO was added to the wells, and 15 min later, optical absorption was read using an ELISA reader (Model 680, BIORAD Co.) at 570 nm. The cell survival was measured as follows:

Survival rate = (AT-AB)/(AC-AB) × 100; where AB is the optical absorption of the blank well, AC is the optical absorption of the control well, and AT is the optical absorption of the treated well.

Analysis of scolicidal effects

For this purpose, 100/mL PSCs were added to DMEM containing 200 U/mL of penicillin, 200 mg/mL of streptomycin, and 0.5 mg/mL of amphotericin B in 96-well culture plates [38]. Subsequently, 0.5 mL of different concentrations of S. marianum extract and its combination with albendazole, were added to the respective wells, mixed gently and incubated for 5, 10, 20, 30, and 60 min at 37 °C. All experiments were done in triplicate. Occasionally, the number and viability of PSCs were determined using 0.1% eosin during incubation periods. The control for the study was non-treated parasites in DMEM. The PSCs fatality rate (PFR) was estimated using the following formula [39]:

$${\text{PFR}} = \frac{{\text{Number dead}}}{{{\text{Number live }}\left( {{\text{control}}} \right)}} \times 100$$

Statistical analysis

ANOVA and t tests were used to determine the differences between tests and control groups; statistical analysis was performed using SPSS v. 17 (SPSS Inc., Chicago, IL, USA). A P-value of less than 0.05 was considered significant.

Search strategy for literature review

For the literature review, national and international databases were searched using the following keywords: “Scolicidal agents”, “Medicinal plants AND E. granulosus”, “Herbal medicine AND E. granulosus”, “In vitro activity of plants AND Echinococcosis”, “Natural products AND Scolicidal”, and “Natural scolicidal”. Articles without full-text accessibility and those with confusing/unclear data and irrelevant papers were excluded.

Results

Genotype characterization

The amplified ITS-1 fragment showed a 462-bp band, as illustrated in Fig. 1. Subsequent PCR–RFLP analysis using Bsh1236I restriction enzyme demonstrated that isolated E. granulosus cysts were of G1 genotype (Fig. 2). A 99% homology was shown between the nucleotide sequences of the G1 isolate in current study and G1 registered in the GenBank database, under accession number MZ312242 and MZ312243.

Fig. 1
figure1

Electrophoresis of PCR amplification (462 bp) provided from liver of sheep sample (lane C− negative control, C +  positive control, lane 1 and 2 positive samples, L ladder 100 bp)

Fig. 2
figure2

Agarose gel electrophoresis of ITS1-PCR products of E. granulosus isolates from sheep after digestion with the restriction enzyme Bsh1236I. (lane C− negative control, C +  positive control, lane 1 and 2 positive samples, L ladder 50 bp)

HPLC analysis

As shown in Table 1 and Fig. 3, HPLC analysis of silymarin constituents of the S. marianum ethanolic extract revealed the presence of silydianin (14.41%), isosilybin A (10.50%), and silychristin (10.46%) at high level, while isosilybin B (3.04%) had the lowest relative concentration. All silymarin compounds are members of the flavonoid family.

Table 1 Percentage of compounds in ethanolic extract of S. marianum seeds obtained with HPLC analysis
Fig. 3
figure3

HPLC of silymarin constituents of the Silybum marianum ethanolic extract

Cytotoxicity assay

Over the range of concentrations tested, the greatest reduction (12%) in macrophage viability was seen at the highest dose (500 ug/ml S. marianum extract) (Table 2). Therefore, even at this concentration, the direct cellular toxicity of S. marianum extract was very low.

Table 2 Toxicity of ethanolic extract of S. marianum using MTT assay

Effect of S. marianum extract on PSCs

The results clearly showed that maximum effect was nearly 77%% with 500 μg/mL of ethanolic extract of S. marianum after 60 min (Fig. 4). Moreover, the scolicidal effects of S. marianum extract concentrations were significant in comparison to the controls in all exposure times (p < 0.05). It is noteworthy that most of the effect on PSCs was seen within in the first 5 min and showed a linear dose relationship. Beyond that time, there was approximately 30% additional effect over the subsequent 55 min for all concentrations.

Fig. 4
figure4

Scolicidal effects of ethanolic extract of S. marianum after exposure at different concentrations for 60 min. Each point represents the mean percentage of fatality rate

Effect of reference drug (albendazole) on PSCs

The highest PFR was 69% at a concentration of 500 μg/ml after 60 min. The scolicidal effects of albendazole concentrations were significant in comparison with the controls at different exposure times (p < 0.05) (Fig. 5). The pattern of effects seen with the silymarin extract was also seen with albendazole.

Fig. 5
figure5

Scolicidal effects of albendazole after exposure at different concentrations for 60 min. Each point represents the mean percentage of fatality rate

Effect of albendazole with S. marianum extract on PSCs

The combination of albendazole and S. marianum extract was statistically significant at different concentrations, when compared with controls in 60 min (P < 0.05) (Fig. 6). The highest PFR with 79% was seen at a concentration of 500 μg/ml after 60 min. Again a similar pattern of effect, with the greatest impact within the first 5 min was seen with the combination. However, there is a suggestion that, at least at the highest doses the initial impact is greater than with the individual compounds.

Fig. 6
figure6

Scolicidal effects of ethanolic extract of S. marianum with albendazole after exposure at different concentrations for 60 min. Each point represents the mean percentage of fatality rate

Discussion

Globally, surgery is considered to be the optimum approach for CE treatment [15] since the cysts are eliminated. However, anaphylaxis, disease relapse, recurrence or secondary dissemination due to the hydatid cyst fluid leakage may occur during surgery, presenting potentially lethal outcomes [40]. Surgery is also not an appropriate approach for certain cyst stages, very small cysts, multiple cysts and for locations other than the liver [17]. To overcome this problem, adjunctive chemotherapy can prevent or reduce recurrence (before surgery, after surgery, or both). In late 1970s, the first pharmacological compounds, the benzimidazole carbamates (mebendazole and albendazole) were introduced for human hydatid cyst treatment [41]. Numerous studies have shown that albendazole is significantly more effective than mebendazole in limiting and reducing the size of hydatid liver cysts [41, 42]. Today, it is the drug of choice for echinococcosis treatment being used before and after surgery or PAIR and for non-surgical intervention [42]. However, albendazole treatment, whether as an adjunct to surgery or as specific chemotherapy for situations where surgery is not appropriate, is not universally effective and is not always well tolerated [42].

In another in vitro study [43], the effect of albendazole (at lower concentration and for a shorter time) on scolicidal activity was greater than in the present study. There are some possible reasons for the difference in the effect of albendazole on PSCs, including drug resistance [44], type of albendazole synthesis [45, 46] and genetic structure and microRNA profile of helminth [47,48,49]. Some studies have suggested drug resistance of PSCs to albendazole [42, 44]. In this regard, one study showed that PSCs isolated from albendazole-treated gerbils became resistant to albendazole re-treatment after in vitro culture [44]. Therefore, it is possible that hydatid cysts isolated from infected sheep in the present study had a history of albendazole exposure and were thereby drug resistant. In future studies, it is suggested that a history of albendazole treatment be considered as an exclusion. On the other hand, some studies have shown that the scolicidal effects of the albendazole metabolite, albendazole sulfoxide, are better than albendazole [46, 50,51,52]. In the present study, we have used albendazole. More recently, some studies have suggested the presence of microRNAs of parasites as a factor in the resistance of various parasitic worms such as E. granulosus to anthelmintics [47, 53]. One study has shown that a high drug concentration or long-term exposure of the PSCs to albendazole resulted in high expression of miR-61 of E. granulosus compared to the control group [47]. The role of miR-61 in the growth, development and metabolism of different stages of E. granulosus is well defined [49, 54]. Therefore, further studies on microRNAs could be useful in understanding resistance mechanisms.

In this study, we defined the E. granulosus genotype since the effect of the compounds might vary depending on which of the 10 genetic genotypes (G1-G10) [55, 56]. Our results showed that all PSCs were G1 strain, which is the most common genotype found globally [55]. Although E. granulosus G1 strain is a major genotype in sheep, there have been reports of other genotypes such as G3, G6, and G7, in sheep [56]. To date, no studies have investigated the effect of different chemotherapeutic agents on the different E. granulosus genotypes. Therefore, it is suggested that PSCs of different genotypes (G1 to G10) be studied to gain a better understanding of the resistance or susceptibility of these genotypes.

In general, finding a suitable alternative drug has become an important challenge. Over the past 4 decades, various herbal extracts and chemical compounds have been investigated in vitro and in vivo as potential treatments [39, 57,58,59,60]. In the current study, an ethanolic extract of S. marianum and its combination with albendazole produced similar scolicidal activity compared to albendazole alone. Plants may induce or inhibit the activity of known anthelmintic agents due to their chemical content [61]. Increased albendazole anthelmintic activity may be due to the presence of secondary metabolites in the extract that facilitate drug uptake into the helminth tegument, thereby making drugs more available to the binding sites and ultimately enhancing the activity of the anthelmintic albendazole [61, 62]. Therefore, the compounds in the ethanolic extract of S. marianum may be a co-factor to enhance albendazole anthelmintic activity. Traditionally, S. marianum is an effective herbal product for a wide range of infectious and non-infectious diseases, with silymarin seen as the highly beneficial substance in its seeds [63, 64]. This compound contains silybin A, silybin B, isosilybin A, isosilybin B, silychristin, isosilychristin, silydianin as a mixture of polyphenolic substances as well as taxifolin as a flavonoid [65,66,67]. As shown in Table 1, silydianin had the highest concentration among the eight substances isolated. The proportions of the different compounds depend on the botanical origin of S. marianum in each country; silychristin (isolated from fruit), silybin A (isolated from stems), and silybin B (isolated from seeds) have the highest concentrations in Russia [68], Iraq [69], and Hungary [70], respectively. Several pharmacological outcomes might be expected with such a potent mixture of organic compounds, especially in fatty-liver disorders and non-alcoholic steatohepatitis [71, 72]. There is good evidence that silibinin is a supportive compound in recovery of Child–Pugh grade 'A' and alcoholic liver cirrhosis [73, 74]. Based on previous studies, S. marianum extract has also shown significant antimicrobial effects against fungi (i.e., dermatophytes and saprophytes) [75] and pathogenic bacteria (Staphylococcus saprophyticus, Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae) [76].

Iran has a great diversity in terms of medicinal plants. In our literature review, 25 studies were eligible for inclusion. As shown in Table 3, in addition to the current study 26 plant species from 23 genera and belonging to 12 families have been reported in the literature to have ethnomedicinal/ pharmacological properties as well as scolicidal activity against PSCs of E. granulosus. Although it seems that the in vitro studies of Iranian medicinal plants on PSCs are extensive, it is possible that useful data were missed within the ‘grey’ literature. Leaves were the most frequently plant part used (31% of studies). The scolicidal effects of medicinal plants range from 17.4% to 100% and the S. marianum extract used in the present study is comparable in activity to other Iranian medicinal plants investigated.

Table 3 Literature review of in vitro scolicidal effectiveness of various Iranian medicinal plants and their characteristics used against protoscoleces of E. granulosus

Conclusion

In summary, an ethanolic extract of S. marianum is a potential alternative scolicide during PAIR treatment of cysts, and to reduce the risk from hydatid cyst fluid PSCs leakage during surgery and the subsequent complications. In the future, more research is needed to evaluate the in vivo effects of this group of compounds in a clinical setting in animal models and ultimately in humans.

Availability of data and materials

All data that support the findings of this study are available in manuscript text, Tables and Figures.

Abbreviations

CE:

Cystic echinococcosis

HPLC:

High-performance liquid chromatography

PSCs:

Protoscolices

DMEM:

Dulbecco’s modified Eagle medium

ITS1:

Internal transcribed spacer 1

RFLP:

Restriction fragment length polymorphism

PAIR:

Puncture, aspiration, injection, and re-aspiration

PFR:

Protoscolices fatality rate

DALYs:

Disability-adjusted life years

References

  1. 1.

    Sarkar S, Roy H, Saha P, Sengupta M, Sarder K, Sengupta M. Cystic echinococcosis: a neglected disease at usual and unusual locations. Trop Parasitol. 2017;7(1):51.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Higuita N, Brunetti E, McCloskey C. Cystic echinococcosis. J Clin Microbiol. 2016;54(3):518–23.

    Article  CAS  Google Scholar 

  3. 3.

    Budke CM, Deplazes P, Torgerson PR. Global socioeconomic impact of cystic echinococcosis. Emerg Infect Dis. 2006;12(2):296.

    PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    Torgerson PR, Devleesschauwer B, Praet N, Speybroeck N, Willingham AL, Kasuga F, et al. World Health Organization estimates of the global and regional disease burden of 11 foodborne parasitic diseases, 2010: a data synthesis. PLoS Med. 2015;12(12):e1001920.

    PubMed  PubMed Central  Article  Google Scholar 

  5. 5.

    Torgerson P, Heath D. Transmission dynamics and control options for Echinococcus granulosus. Parasitology. 2003;127(S1):S143.

    PubMed  Article  PubMed Central  Google Scholar 

  6. 6.

    Gemmell M, Lawson J, Roberts M. Population dynamics in echinococcosis and cysticercosis: biological parameters of Echinococcus granulosus in dogs and sheep. Parasitology. 1986;92(3):599–620.

    PubMed  Article  PubMed Central  Google Scholar 

  7. 7.

    Yang YR, Clements AC, Gray DJ, Atkinson JAM, Williams GM, Barnes TS, et al. Impact of anthropogenic and natural environmental changes on Echinococcus transmission in Ningxia Hui Autonomous Region, the People’s Republic of China. Parasit Vectors. 2012;5(1):1–9.

    CAS  Article  Google Scholar 

  8. 8.

    Oudni-M’rad M, Chaâbane-Banaoues R, M’rad S, Trifa F, Mezhoud H, Babba H. Gastrointestinal parasites of canids, a latent risk to human health in Tunisia. Parasit Vectors. 2017;10(1):1–8.

    Article  Google Scholar 

  9. 9.

    Alam S, Umer US, Gul S, Ghaus S, Farooq B, Gul F. Uncommon sites of a common disease—hydatid cyst. J Postgrad Med Inst (Peshawar). 2014;28(3):270–6.

    Google Scholar 

  10. 10.

    Arinc S, Kosif A, Ertugrul M, Arpag H, Alpay L, Ünal Ö, et al. Evaluation of pulmonary hydatid cyst cases. Int J Surg. 2009;7(3):192–5.

    PubMed  Article  PubMed Central  Google Scholar 

  11. 11.

    Nasseri-Moghaddam S, Abrishami A, Taefi A, Malekzadeh R. Percutaneous needle aspiration, injection, and re-aspiration with or without benzimidazole coverage for uncomplicated hepatic hydatid cysts. Cochrane Database Syst Rev. 2011. https://doi.org/10.1002/14651858.CD003623.pub3.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Minaev SV, Gerasimenko IN, Kirgizov IV, Shamsiev AM, Bykov NI, Shamsiev JA, et al. Laparoscopic treatment in children with hydatid cyst of the liver. World J Surg. 2017;41(12):3218–23.

    PubMed  Article  PubMed Central  Google Scholar 

  13. 13.

    Stojkovic M, Zwahlen M, Teggi A, Vutova K, Cretu CM, Virdone R, et al. Treatment response of cystic echinococcosis to benzimidazoles: a systematic review. PLoS Negl Trop Dis. 2009;3(9):e524.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  14. 14.

    Sokouti M, Sadeghi R, Pashazadeh S, Abadi SEH, Sokouti M, Ghojazadeh M, et al. A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures. Arch Med Sci. 2019;15(2):284.

    PubMed  Article  PubMed Central  Google Scholar 

  15. 15.

    Da Silva AM. Hydatid cyst of the liver—criteria for the selection of appropriate treatment. Acta Trop. 2003;85(2):237–42.

    Article  Google Scholar 

  16. 16.

    Bayrak M, Altıntas Y. Current approaches in the surgical treatment of liver hydatid disease: single center experience. BMC Surg. 2019;19(1):1–10.

    Article  Google Scholar 

  17. 17.

    Junghanss T, Da Silva AM, Horton J, Chiodini PL, Brunetti E. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg. 2008;79(3):301–11.

    PubMed  Article  PubMed Central  Google Scholar 

  18. 18.

    Kilicoglu B, Kismet K, Kilicoglu SS, Erel S, Gencay O, Sorkun K, et al. Effects of honey as a scolicidal agent on the hepatobiliary system. World J Gastroenterol. 2008;14(13):2085.

    PubMed  PubMed Central  Article  Google Scholar 

  19. 19.

    Moazeni M, Larki S. In vitro effectiveness of acidic and alkaline solutions on scolices of hydatid cyst. Parasitol Res. 2010;106(4):853–6.

    PubMed  Article  PubMed Central  Google Scholar 

  20. 20.

    Yones DA, Taher GA, Ibraheim ZZ. In vitro effects of some herbs used in Egyptian traditional medicine on viability of protoscolices of hydatid cysts. Korean J Parasitol. 2011;49(3):255.

    PubMed  PubMed Central  Article  Google Scholar 

  21. 21.

    Bahmani M, Shirzad H, Rafieian S, Rafieian-Kopaei M. Silybum marianum: beyond hepatoprotection. J Evid Based Complementary Altern Med. 2015;20(4):292–301.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  22. 22.

    Petrovska BB. Historical review of medicinal plants’ usage. Pharmacogn Rev. 2012;6(11):1.

    PubMed  PubMed Central  Article  Google Scholar 

  23. 23.

    Qavami N, Naghdi Badi H, Labbafi M, Mehrafarin A. A review on pharmacological, cultivation and biotechnology aspects of milk thistle (Silybum marianum (L.) Gaertn). J Medicinal Plant. 2013;12(47):38–47.

    Google Scholar 

  24. 24.

    Sabir S, Arsshad M, Asif S, Chaudhari SK. An insight into medicinal and therapeutic potential of Silybum marianum (L.) Gaertn. Int J Biosci. 2014;4(11):104–15.

    Google Scholar 

  25. 25.

    Leung AY. Encyclopedia of common natural ingredients used in food, drugs, and cosmetics. Hoboken: Wiley; 1980.

    Google Scholar 

  26. 26.

    Karimi G, Vahabzadeh M, Lari P, Rashedinia M, Moshiri M. “Silymarin”, a promising pharmacological agent for treatment of diseases. Iran J Basic Med Sci. 2011;14(4):308.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Camini FC, Costa DC. Silymarin: not just another antioxidant. J Basic Clin Physiol Pharmacol. 2020. https://doi.org/10.1515/jbcpp-2019-0206.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Alhidary I, Rehman Z, Khan R, Tahir M. Anti-aflatoxin activities of milk thistle (Silybum marianum) in broiler. Worlds Poult Sci J. 2017;73(3):559–66.

    Article  Google Scholar 

  29. 29.

    Bajwa A, Tariq S, Yuchi A, Hafeez R, Arshad A, Zaman M, et al. Evaluation of anti-bacterial activity of Silybum marianum against pathogenic and resistant bacteria. European J Med Plants. 2016;13(4):1–7.

    Article  Google Scholar 

  30. 30.

    Ahmadi K, Banaee M, Vosoghei AR, Mirvaghefei AR, Ataeimehr B. Evaluation of the immunomodulatory effects of silymarin extract (Silybum marianum) on some immune parameters of rainbow trout, Oncorhynchus mykiss (Actinopterygii: Salmoniformes: Salmonidae). Acta Ichthyol Piscat. 2012;42(2):113–20.

    Article  Google Scholar 

  31. 31.

    Siddhartha S, Archana M, Jinu J, Pradeep M. Anthelmintic potential of Andrographis paniculata, Cajanus cajan and Silybum marianum. Pharmacogn J. 2009;1:243.

    Google Scholar 

  32. 32.

    Smyth J, Barrett N. Procedures for testing the viability of human hydatid cysts following surgical removal, especially after chemotherapy. Trans Roy Soc Trop Med Hyg. 1980;74(5):649–52.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  33. 33.

    Walker M, Rossignol JF, Torgerson P, Hemphill A. In vitro effects of nitazoxanide on Echinococcus granulosus protoscoleces and metacestodes. J Antimicrob Chemother. 2004;54(3):609–16.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  34. 34.

    Abdel-Baki AAS, Almalki E, Mansour L, Al-Quarishy S. In vitro scolicidal effects of Salvadora persica root extract against protoscolices of Echinococcus granulosus. Korean J Parasitol. 2016;54(1):61.

    PubMed  PubMed Central  Article  Google Scholar 

  35. 35.

    Moghaddas E, Borji H, Naghibi A, Shayan P, Razmi GR. Molecular genotyping of Echinococcus granulosus from dromedaries (Camelus dromedarius) in eastern Iran. J Helminthol. 2015;89(1):100–4.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  36. 36.

    Barreto JFA, Wallace SN, Carrier DJ, Clausen EC. Extraction of nutraceuticals from milk thistle. Appl Biochem Biotechnol. 2003;108(1):881–9.

    Article  Google Scholar 

  37. 37.

    Lam J, Herant M, Dembo M, Heinrich V. Baseline mechanical characterization of J774 macrophages. Biophysical J. 2009;96(1):248–54.

    CAS  Article  Google Scholar 

  38. 38.

    Naguleswaran A, Spicher M, Vonlaufen N, Ortega-Mora LM, Torgerson P, Gottstein B, et al. In vitro metacestodicidal activities of genistein and other isoflavones against Echinococcus multilocularis and Echinococcus granulosus. Antimicrobial Agents Chemother. 2006;50(11):3770–8.

    CAS  Article  Google Scholar 

  39. 39.

    Napooni S, Arbabi M, Delavari M, Hooshyar H, Rasti S. Lethal effects of gold nanoparticles on protoscolices of hydatid cyst: in vitro study. Comp Clin Path. 2019;28(1):143–50.

    CAS  Article  Google Scholar 

  40. 40.

    Velasco-Tirado V, Romero-Alegría Á, Belhassen-García M, Alonso-Sardón M, Esteban-Velasco C, López-Bernús A, et al. Recurrence of cystic echinococcosis in an endemic area: a retrospective study. BMC Infect Dis. 2017;17(1):1–8.

    Article  Google Scholar 

  41. 41.

    Teggi A, Lastilla MG, De Rosa F. Therapy of human hydatid disease with mebendazole and albendazole. Antimicrob Agents Chemother. 1993;37(8):1679–84.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  42. 42.

    Dehkordi AB, Sanei B, Yousefi M, Sharafi SM, Safarnezhad F, Jafari R, et al. Albendazole and treatment of hydatid cyst: review of the literature. Infect Disord Drug Targets. 2019;19(2):101–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Salih TA, Hassan KT, Majeed SR, Ibraheem IJ, Hassan OM, Obaid A. In vitro scolicidal activity of synthesised silver nanoparticles from aqueous plant extract against Echinococcus granulosus. Biotechnol Rep (Amst). 2020;28:e00545.

    PubMed Central  Article  Google Scholar 

  44. 44.

    Morris D, Taylor D. Echinococcus granulosus: development of resistance to albendazole in an animal model. J Helminthol. 1990;64(2):171–4.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  45. 45.

    Pérez-Serrano J, Casado N, Rodriguez-Caabeiro F. The effects of albendazole and albendazole sulphoxide combination-therapy on Echinococcus granulosus in vitro. Int J Parasitol. 1994;24(2):219–24.

    PubMed  Article  PubMed Central  Google Scholar 

  46. 46.

    Adas G, Arikan S, Kemik O, Oner A, Sahip N, Karatepe O. Use of albendazole sulfoxide, albendazole sulfone, and combined solutions as scolicidal agents on hydatid cysts (in vitro study). World J Gastroenterol. 2009;15(1):112.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  47. 47.

    Mortezaei S, Afgar A, Mohammadi MA, Mousavi SM, Sadeghi B, Harandi MF. The effect of albendazole sulfoxide on the expression of miR-61 and let-7 in different in vitro developmental stages of Echinococcus granulosus. Acta Trop. 2019;195:97–102.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  48. 48.

    Britton C, Winter AD, Gillan V, Devaney E. microRNAs of parasitic helminths–Identification, characterization and potential as drug targets. Int J Parasitol Drugs Drug Resist. 2014;4(2):85–94.

    PubMed  PubMed Central  Article  Google Scholar 

  49. 49.

    Cucher M, Prada L, Mourglia-Ettlin G, Dematteis S, Camicia F, Asurmendi S, et al. Identification of Echinococcus granulosus microRNAs and their expression in different life cycle stages and parasite genotypes. Int J Parasitol. 2011;41(3–4):439–48.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  50. 50.

    Bloom AK, Ryan ET. Albendazole. In: Ryan ET, Hill DR, Solomon T, Aronson NE, Endy TP, editors. Hunter’s tropical medicine and emerging infectious diseases. 10th ed. London: Elsevier; 2020. p. 1141–3.

    Chapter  Google Scholar 

  51. 51.

    Pearson RD. Antiparasitic therapy. In: Goldman L, Schafer AI, editors. Goldman’s Cecil Medicine. 4th ed. Philadelphia: WB Saunders; 2012. p. 2009–13.

    Chapter  Google Scholar 

  52. 52.

    Ingold K, Bigler P, Thormann W, Cavaliero T, Gottstein B, Hemphill A. Efficacies of albendazole sulfoxide and albendazole sulfone against in vitro-cultivated Echinococcus multilocularis metacestodes. Antimicrob Agents Chemother. 1999;43(5):1052–61.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  53. 53.

    Devaney E, Winter AD, Britton C. microRNAs: a role in drug resistance in parasitic nematodes? Trends Parsitol. 2010;26(9):428–33.

    CAS  Article  Google Scholar 

  54. 54.

    Bai Y, Zhang Z, Jin L, Kang H, Zhu Y, Zhang L, et al. Genome-wide sequencing of small RNAs reveals a tissue-specific loss of conserved microRNA families in Echinococcus granulosus. BMC Genomics. 2014;15(1):1–13.

    Article  CAS  Google Scholar 

  55. 55.

    Kinkar L, Laurimäe T, Acosta-Jamett G, Andresiuk V, Balkaya I, Casulli A, et al. Global phylogeography and genetic diversity of the zoonotic tapeworm Echinococcus granulosus sensu stricto genotype G1. Int J Parsitol. 2018;48(9–10):729–42.

    Article  Google Scholar 

  56. 56.

    Khademvatan S, Majidiani H, Foroutan M, Tappeh KH, Aryamand S, Khalkhali H. Echinococcus granulosus genotypes in Iran: a systematic review. J Helminthol. 2019;93(2):131–8.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  57. 57.

    Gholami S, Rahimi-Esboei B, Ebrahimzadeh M, Pourhajibagher M. In vitro effect of Sambucus ebulus on scolices of Hydatid cysts. Eur Rev Med Pharmacol Sci. 2013;17(13):1760–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Fakhar M, Chabra A, Rahimi-Esboei B, Rezaei F. In vitro protoscolicidal effects of fungal chitosan isolated from Penicillium waksmanii and Penicillium citrinum. J Parasit Dis. 2015;39(2):162–7.

    PubMed  Article  PubMed Central  Google Scholar 

  59. 59.

    Lv H, Jiang Y, Liao M, Sun H, Zhang S, Peng X. In vitro and in vivo treatments of Echinococcus granulosus with Huaier aqueous extract and albendazole liposome. Parasitol Res. 2013;112(1):193–8.

    PubMed  Article  PubMed Central  Google Scholar 

  60. 60.

    Mohammadnejad F, Ghaffarifar F, Dalimi A, Mohammad HZ. In Vitro Effects of Artemether, Artemisinine, Albendazole, and Their Combinations on Echinococcus granolosusProtoscoleces. Jundishapur J Nat Pharm Prod. 2016;11(1):e30565.

    Article  CAS  Google Scholar 

  61. 61.

    Adu F, Agyare C, Sam GH, Boakye YD, Boamah V. Anthelmintic resistance modifying properties of extracts of Cyperus difformis L. (Cyperiaceae). Invest Med Chem Pharmacol. 2018;1(1):1–12.

    Google Scholar 

  62. 62.

    Tagoe M, Boakye YD, Agana TA, Boamah VE, Agyare C. In vitro anthelmintic activity of ethanol stem bark extract of Albizia ferruginea (Guill. & Perr.) Benth. J Parasitol Res. 2021. https://doi.org/10.1155/2021/6690869.

    Article  PubMed  PubMed Central  Google Scholar 

  63. 63.

    Mohammed FS, Pehlivan M, Sevindik M. Antioxidant, antibacterial and antifungal activities of different extracts of Silybum marianum collected from Duhok (Iraq). Int J Second Metab. 2019;6(4):317–22.

    Article  Google Scholar 

  64. 64.

    Singh S, Mehta A, Baweja S, Ahirwal L, Mehta P. Anticancer activity of Andrographis paniculata and Silybum marianum on five human cancer cell lines. J Pahrmacol Toxicol. 2013;8(1):42–8.

    Article  Google Scholar 

  65. 65.

    Polyak SJ, Morishima C, Lohmann V, Pal S, Lee DY, Liu Y, et al. Identification of hepatoprotective flavonolignans from silymarin. Proc Nat Accad Sci. 2010;107(13):5995–9.

    CAS  Article  Google Scholar 

  66. 66.

    Kim N-C, Graf TN, Sparacino CM, Wani MC, Wall ME. Complete isolation and characterization of silybins and isosilybins from milk thistle (Silybum marianum). Org Biomol Chem. 2003;1(10):1684–9.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  67. 67.

    Sobolová L, Škottová N, Večeřa R, Urbánek K. Effect of silymarin and its polyphenolic fraction on cholesterol absorption in rats. Pharmacol Res. 2006;53(2):104–12.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  68. 68.

    Minakhmetov R, Onuchak L, Kurkin V, Avdeeva E, Volotsueva A. Analysis of flavonoids in Silybum marianum fruit by HPLC. Chem Nat Compd. 2001;37(4):318–21.

    CAS  Article  Google Scholar 

  69. 69.

    Ghafor Y, Mohammad NN, Salh DM. Extraction and determination of chemical ingredients from stems of Silybum Marianum. Extraction. 2014;6(4):26–32.

  70. 70.

    Kuki A, Nagy L, Deák G, Nagy M, Zsuga M, Kéki S. Identification of silymarin constituents: an improved HPLC–MS method. Chromatographia. 2012;75(3–4):175–80.

    CAS  Article  Google Scholar 

  71. 71.

    Cacciapuoti F, Scognamiglio A, Palumbo R, Forte R, Cacciapuoti F. Silymarin in non alcoholic fatty liver disease. World J Hepatol. 2013;5(3):109.

    PubMed  PubMed Central  Article  Google Scholar 

  72. 72.

    Navarro VJ, Belle SH, D’Amato M, Adfhal N, Brunt EM, Fried MW, et al. Silymarin in non-cirrhotics with non-alcoholic steatohepatitis: A randomized, double-blind, placebo controlled trial. PLoS ONE. 2019;14(9):e0221683.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  73. 73.

    Abenavoli L, Capasso R, Milic N, Capasso F. Milk thistle in liver diseases: past, present, future. Phytother Res. 2010;24(10):1423–32.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  74. 74.

    Parés A, Planas R, Torres M, Caballería J, Viver JM, Acero D, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol. 1998;28(4):615–21.

    PubMed  Article  PubMed Central  Google Scholar 

  75. 75.

    Salehi M, Hasanloo T, Mehrabian S, Farahmand S. Effects of Silybum marianum (L.) Gaertn seeds extract on dermatophytes and saprophytes fungi in vitro compare to clotrimazole. Pharm Sci. 2010;16(4):203–10.

    Google Scholar 

  76. 76.

    Abed I, Al-Moula R, Abdulhasan G. Antibacterial effect of flavonoids extracted from seeds of Silybum marianum against common pathogenic bacteria. World J Exp Biosc. 2015;3(1):36–9.

    Google Scholar 

  77. 77.

    Faizei F, Maghsood AH, Parandin F, Matini M, Moradkhani S, Fallah M. Antiprotoscolices effect of methanolic extract of Zingiber officinale, Artemisia aucheri and Eucalyptus globulus against Echinococcus granulosus in vitro. Iran J Pharmacol Ther. 2015;14(1):7–11.

    Google Scholar 

  78. 78.

    Vakili Z, Radfar MH, Bakhshaei F, Sakhaee E. In vitro effects of Artemisia sieberi on Echinococcus granulosus protoscolices. Exp Parasitol. 2019;197:65–7.

    PubMed  Article  PubMed Central  Google Scholar 

  79. 79.

    Amiri K, Nasibi S, Mehrabani M, Nematollahi MH, Harandi MF. In vitro evaluation on the scolicidal effect of Myrtus communis L. and Tripleurospermum disciforme L. methanolic extracts. Exp Parasitol. 2019;199:111–5.

    PubMed  Article  PubMed Central  Google Scholar 

  80. 80.

    Sadjjadi SM, Zoharizadeh MR, Panjeshahin MR. In vitro screening of different Allium sativum extracts on hydatid cysts protoscoleces. J Invest Surg. 2008;21(6):318–22.

    PubMed  Article  PubMed Central  Google Scholar 

  81. 81.

    Moazeni M, Nazer A. In vitro effectiveness of garlic (Allium sativum) extract on scolices of hydatid cyst. World J Surg. 2010;34(11):2677–81.

    PubMed  Article  PubMed Central  Google Scholar 

  82. 82.

    Eskandarian AA. Scolicidal effects of squash (Corylus spp) seeds, hazel (Curcurbia spp) nut and garlic (Allium sativum) extracts on hydatid cyst protoscolices. J Res Med Sci (Isfahan). 2012;17(11):1011.

    Google Scholar 

  83. 83.

    Rahimi-Esboei B, Ebrahimzadeh M, Fathi H, Rezaei AF. Scolicidal effect of Allium sativum flowers on hydatid cyst protoscolices. Eur Rev Med Pharmacol Sci. 2016;20(1):129–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  84. 84.

    Haghani A, Roozitalab A, Safi SN. Low scolicidal effect of Ocimum bacilicum and Allium cepa on protoccoleces of hydatid cyst: an in vitro study. Comp Clin Pathol. 2014;23(4):847–53.

    Article  Google Scholar 

  85. 85.

    Mahmoudvand H, Kheirandish F, Ghasemi Kia M, Tavakoli Kareshk A, Yarahmadi M. Chemical composition, protoscolicidal effects and acute toxicity of Pistacia atlantica Desf. fruit extract. Nat Prod Res. 2016;30(10):1208–11.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  86. 86.

    Taran M, Azizi E, Shikhvaisi A, Asadi N. The anthelmintic effect of Pistacia khinjuk against protoscoleces of Echinococcus granulosus. World J Zool. 2009;4(4):291–5.

    Google Scholar 

  87. 87.

    Mahmoudvand H, Kheirandish F, Dezaki ES, Shamsaddini S, Harandi MF. Chemical composition, efficacy and safety of Pistacia vera (var. Fandoghi) to inactivate protoscoleces during hydatid cyst surgery. Biomed Pharmacother. 2016;82:393–8.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  88. 88.

    Moazeni M, Mohseni M. Sumac (Rhus coriaria L.): scolicidal activity on hydatid cyst protoscolices. Surg Sci. 2012;3(9):452.

    Article  Google Scholar 

  89. 89.

    Mahmoudvand H, Tavakoli Oliaei R, Mirbadie SR, Kheirandish F, Tavakoli Kareshk A, Ezatpour B, et al. Efficacy and safety of Bunium persicum (Boiss) to inactivate protoscoleces during hydatid cyst operations. Surg Infect (Larchmt). 2016;17(6):713–9.

    Article  Google Scholar 

  90. 90.

    Kavoosi G, Purfard AM. Scolicidal effectiveness of essential oil from Zataria multiflora and Ferula assafoetida: disparity between phenolic monoterpenes and disulphide compounds. Comp Clin Pathol. 2013;22(5):999–1005.

    CAS  Article  Google Scholar 

  91. 91.

    Tabari MA, Youssefi MR, Nasiri M, Hamidi M, Kiani K, Samakkhah SA, et al. Towards green drugs against cestodes: Effectiveness of Pelargonium roseum and Ferula gummosa essential oils and their main component on Echinococcus granulosus protoscoleces. Vet Parasitol. 2019;266:84–7.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  92. 92.

    Lashkarizadeh MR, Asgaripour K, Dezaki ES, Harandi MF. Comparison of scolicidal effects of amphotricin B, silver nanoparticles, and Foeniculum vulgare Mill on hydatid cysts protoscoleces. Iran J Parasitol. 2015;10(2):206.

    PubMed  PubMed Central  Google Scholar 

  93. 93.

    Moazeni M, Saharkhiz MJ, Hosseini AA. In vitro lethal effect of ajowan (Trachyspermum ammi L.) essential oil on hydatid cyst protoscoleces. Vet Parasitol. 2012; 187(1–2):203–208.

  94. 94.

    Rouhani S, Salehi N, Kamalinejad M, Zayeri F. Efficacy of Berberis vulgaris aqueous extract on viability of Echinococcus granulosus protoscolices. J Invest Surg. 2013;26(6):347–51.

    PubMed  Article  PubMed Central  Google Scholar 

  95. 95.

    Sharifi-Rad J, Hoseini-Alfatemi SM, Sharifi-Rad M, da Silva JAT, Rokni M, Sharifi-Rad M. Evaluation of biological activity and phenolic compounds of Cardaria draba (L.) extracts. J Biol Today’s World. 2015;4(9):180–9.

    Article  Google Scholar 

  96. 96.

    Bahrami S, Razi Jalali M, Ramezani Z, Pourmehdi Boroujeni M, Toeimepour F. In vitro scolicidal effect of Lepidium sativum essential oil. J Ardabil Univ Med Sci. 2016;15(4):395–403.

    Google Scholar 

  97. 97.

    Zibaei M, Sarlak A, Delfan B, Ezatpour B, Azargoon A. Scolicidal effects of Olea europaea and Satureja khuzestanica extracts on protoscolices of hydatid cysts. Korean J Parasitol. 2012;50(1):53.

    PubMed  PubMed Central  Article  Google Scholar 

  98. 98.

    Moazeni M, Saharkhiz MJ, Hoseini AA, Alavi AM. In vitro scolicidal effect of Satureja khuzistanica (Jamzad) essential oil. Asian Pac J Trop Biomed. 2012;2(8):616–20.

    PubMed  PubMed Central  Article  Google Scholar 

  99. 99.

    Jahanbakhsh S, Azadpour M, Kareshk AT, Keyhani A, Mahmoudvand H. Zataria multiflora Bioss: lethal effects of methanolic extract against protoscoleces of Echinococcus granulosus. J Parasit Dis. 2016;40(4):1289–92.

    PubMed  Article  PubMed Central  Google Scholar 

  100. 100.

    Zibaei M, Salehi S, Jafari Z, Bahadory S, Firoozeh F, Shahivand M. In vitro assessment of the protoscolicidal activities of the Ephedra major methanol extracts. Int j enteric pathog. 2017;5(1):5–8.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank all staff of Department of Parasitology of Tarbiat Modares University, Iran. This paper is issued from thesis of Ali Taghipour, Ph.D student of Medical Parasitology.

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This research was funded by the Tarbiat Modares University.

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All authors contributed to study design. AT and FG contributed to all parts of the study. ZS and AD contributed to study implementation. AT and FG collaborated in the analysis and interpretation of data. AT, FG and JH collaborated in the manuscript writing and revision. All the authors commented on the drafts of the manuscript and approved the final version of the article.

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Correspondence to Fatemeh Ghaffarifar.

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Taghipour, A., Ghaffarifar, F., Horton, J. et al. Silybum marianum ethanolic extract: in vitro effects on protoscolices of Echinococcus granulosus G1 strain with emphasis on other Iranian medicinal plants. Trop Med Health 49, 71 (2021). https://doi.org/10.1186/s41182-021-00363-7

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Keywords

  • Cystic echinococcosis
  • In vitro
  • Scolicide
  • Silybum marianum