POTENTIAL OF FLAVONOIDS IN MORINGA OLEIFERA LEAF EXTRACT AS AN ALTERNATIVE THERAPY OF REUMATOID ARTHRITIS BASED ON ANTI-INFLAMMATORY APPROACH
Abstract
ABSTRACT
Introduction: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that causes joints inflammation and the most cases are found in the elderly. However, until now pharmacological therapy for RA treatment is still considered inefficient, expensive, and causes many side effects. Therefore, a new alternative treatment is needed. One of the plants that can be used as an alternative is Moringa oleifera due to its anti-inflammatory properties.
Discussion: Moringa oleifera leaf extract with ethanol maceration contains flavonoids (12.16%), mostly in the form of quercetin (6.3%). The role of flavonoids as anti-inflammatory agents in RA is to reduce neutrophil activity in the production of proinflammatory cytokines through inhibition of Nuclear Factor kappa-light-chain-enhancer from Activated B Cells (NF-?B) signaling, inhibition of Matrix Metalloproteinase (MMP) activity, and inhibition of the peroxidase active sites at cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), and 5-lipoxygenase (5-LOX). Quercetin is effective in treating rheumatoid arthritis by providing anti-inflammatory and analgesic effects. The most effective method to obtained Moringa oleifera leaf extract is by drying method with maceration process in 96% ethanol and packaged in oral capsules. Moringa oleifera extract also has fewer side effects compared to currently available RA treatments. Moringa oleifera extract combined with other drugs as adjuvants, such as methotrexate and indomethacin, can increase the anti-inflammatory curative effect in RA without significant side effects.
Conclusion: Moringa oleifera leaf extract has potential in the treatment of rheumatoid arthritis.
Keywords: Anti-inflammatory, Flavonoids, Moringa oleifera, Rheumatoid Arthritis
Downloads
Download data is not yet available.
References
1. Putri RM, Lutfi A, Alini A. Pengaruh Terapi Back Massage Terhadap Penurunan Nyeri Rheumatoid Arthritis pada Lansia. Jurnal Ners 2020;4(2):40–6.
2. Studi P, Keperawatan S, Pahlawan U, Tambusai T. Efektifitas Kompres Serei Hangat Terhadap Penurunan Skala Nyeri Arthritis Rheumatoid Pada Lansia di Desa Naumbai Wilayah Kerja Puskesmas Kampar. Jurnal Ners 2020;4(1):29–34.
3. Pujastuti NKDM, Mertha IM, Dewi IDAR. Perbedaan Kompres Hangat Jahe dan Back Massage Terhadap Penurunan Skala Nyeri Ekstrimitas Bawah Pada Lansia dengan Rheumatoid Athritis. Fakultas Kedokteran Universitas Udayana 2018;6:67–72.
4. Widayati D, Hayati F. Peningkatan Kenyamanan Lansia dengan Nyeri Rheumatoid Arthritis Melalui Model Comfort Food For The Soul. Jurnal Ilmu Keperawatan 2017;5(1):6–15.
5. Murata S, Doi T, Sawa R, Saito T, Nakamura R, Isa T, et al. Association between joint stiffness and health-related quality of life in community-dwelling older adults. Arch Gerontol Geriatr 2017;73:234–9.
6. Dewi RS. Keperawatan Gerontik. Deepublish; 2014.
7. MacKey RH, Kuller LH, Deane KD, Walitt BT, Chang YF, Holers VM, et al. Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women’s Health Initiative. Arthritis Rheumatol 2015;67(9):2311–22.
8. England BR, Sayles H, Michaud K, Caplan L, Davis LA, Cannon GW, et al. Cause-Specific Mortality in Male US Veterans With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016;68(1):36–45.
9. Verstappen SMM. Rheumatoid arthritis and work: The impact of rheumatoid arthritis on absenteeism and presenteeism. Best Pract Res Clin Rheumatol 2015;29(3):495–511.
10. Bawarodi F, Rottie J, Malara R, Studi P, Keperawatan I, Kedokteran F. Faktor-Faktor yang Berhubungan dengan Kekambuhan Penyakit Rematik di Wilayah Puskesmas Beo Kabupaten Talaud. Jurnal Keperawatan 2017;5(1).
11. Chauhan K, Jandu JS, Goyal A, Al-Dhahir MA. Rheumatoid Arthritis. Rosen and Barkin’s 5-Minute Emergency Medicine Consult: Fifth Edition 2021;
12. Verri WA, Vicentini FTMC, Baracat MM, Georgetti SR, Cardoso RDR, Cunha TM, et al. Flavonoids as Anti-Inflammatory and Analgesic Drugs: Mechanisms of Action and Perspectives in the Development of Pharmaceutical Forms. Studies in Natural Products Chemistry 2012;36:297–330.
13. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis 2018;9(1):143–50.
14. Ghlichloo I, Gerriets V. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). Treatment of Chronic Pain Conditions: A Comprehensive Handbook 2021;77–9.
15. Brand L, Wolmarans DW, Brand SJ. A quick and painless reminder: The pharmacotherapy of rheumatoid arthritis in primary practice. South African Family Practice 2018;60(2):38–42.
16. Ray SJ, Wolf TJ, Mowa CN. Moringa oleifera and inflammation: A mini-review of its effects and mechanisms. Acta Hortic 2017;1158:317–30.
17. Padayachee B, Baijnath H. An overview of the medicinal importance of Moringaceae. Journal of Medicinal Plants Research 2012;6(48):5831–9.
18. Narande JM, Wulur A, Yudistira A. Uji Efek Antiinflamasi Ekstrak Etanol Daun Suji (Dracaena Angustifolia Roxb) Terhadap Edema Kaki Tikus Putih Jantan Galur Wistar. Pharmacon 2013;2(3).
19. Liang L, Wang C, Li S, Chu X, Sun K. Nutritional compositions of Indian Moringa oleifera seed and antioxidant activity of its polypeptides. Food Sci Nutr 2019;7(5):1754.
20. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet 2016;388(10055):2023–38.
21. Brzustewicz E, Henc I, Daca A, Szarecka M, Sochocka-Bykowska M, Witkowski J, et al. Autoantibodies, C-reactive protein, erythrocyte sedimentation rate and serum cytokine profiling in monitoring of early treatment. Cent Eur J Immunol 2017;42(3):259–68.
22. Littlejohn EA, Monrad SU. Early Diagnosis and Treatment of Rheumatoid Arthritis. Prim Care 2018;45(2):237–55.
23. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA 2018;320(13):1360–72.
24. Deane KD, Demoruelle MK, Kelmenson LB, Kuhn KA, Norris JM, Holers VM. Genetic and environmental risk factors for rheumatoid arthritis. Best Pract Res Clin Rheumatol 2017;31(1):3–18.
25. Tan EM, Smolen JS. Historical observations contributing insights on etiopathogenesis of rheumatoid arthritis and role of rheumatoid factor. J Exp Med 2016;213(10):1937–50.
26. Baratawidjaja KG, Rengganis I. Imunologi Dasar Edisi 10. Jakarta: Balai Penerbit Fakultas Kedokteran Universitas Indonesia; 2012.
27. Zhang L, Yuan Y, Xu Q, Jiang Z, Chu CQ. Contribution of neutrophils in the pathogenesis of rheumatoid arthritis. J Biomed Res 2020;34(2):86–93.
28. Yuan K, Zhu Q, Lu Q, Jiang H, Zhu M, Li X, et al. Quercetin alleviates rheumatoid arthritis by inhibiting neutrophil inflammatory activities. J Nutr Biochem 2020;84.
29. Chandrashekara S, Mukhtar Ahmad M, Renuka P, Anupama KR, Renuka K. Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int J Rheum Dis 2017;20(10):1457–67.
30. Leone A, Spada A, Battezzati A, Schiraldi A, Aristil J, Bertoli S. Cultivation, genetic, ethnopharmacology, phytochemistry and pharmacology of Moringa oleifera leaves: An overview. Int J Mol Sci 2015;16(6):12791–835.
31. Wei Y, Xia N, Zhang W, Huang J, Ren Z, Zhu L, et al. Serum retinol-binding protein 4 is associated with insulin resistance in patients with early and untreated rheumatoid arthritis. Joint Bone Spine 2019;86(3):335–41.
32. Zabetian-Targhi F, Mahmoudi MJ, Rezaei N, Mahmoudi M. Retinol Binding Protein 4 in Relation to Diet, Inflammation, Immunity, and Cardiovascular Diseases. Advances in Nutrition 2015;6(6):748–62.
33. Clarke J. Β-Carotene Blocks the Inflammasome. Nat Rev Rheumatol 2020;16(5):248.
34. Carr AC, McCall C. The role of vitamin C in the treatment of pain: New insights. J Transl Med 2017;15(1):1–14.
35. Zaringhalam J, Akbari A, Zali A, Manaheji H, Nazemian V, Shadnoush M, et al. Long-term treatment by vitamin B1 and reduction of serum proinflammatory cytokines, hyperalgesia, and paw edema in adjuvant-induced arthritis. Basic Clin Neurosci 2016;7(4):331–40.
36. Suwannasom N, Kao I, Pruß A, Georgieva R, Bäumler H. Riboflavin: The health benefits of a forgotten natural vitamin. Int J Mol Sci 2020;21(3).
37. Prousky JE. The use of niacinamide and solanaceae (nightshade) elimination in the treatment of osteoarthritis. Journal of Orthomolecular Medicine 2015;30(1):13–21.
38. Sahin K, Kucuk O, Orhan C, Tuzcu M, Durmus AS, Ozercan IH, et al. Niacinamide and undenatured type II collagen modulates the inflammatory response in rats with monoiodoacetate-induced osteoarthritis. Sci Rep 2021;11(1):1–15.
39. Doi K, Ito H, Tomizawa T, Murata K, Hashimoto M, Tanaka M, et al. Oral steroid decreases the progression of joint destruction of large joints in the lower extremities in rheumatoid arthritis. Medicine (United States) 2019;98(47).
40. Xie J, Peng LJ, Yang MR, Jiang WW, Mao JY, Shi CY, et al. Alkaloid Extract of Moringa oleifera Lam. Exerts Antitumor Activity in Human Non-Small-Cell Lung Cancer via Modulation of the JAK2/STAT3 Signaling Pathway. Evidence-based Complementary and Alternative Medicine 2021;2021.
41. Rani NZA, Husain K, Kumolosasi E. Moringa genus: A review of phytochemistry and pharmacology. Front Pharmacol 2018;9(FEB):1–26.
42. Maleki SJ, Crespo JF, Cabanillas B. Anti-inflammatory effects of flavonoids. Food Chem 2019;299(July).
43. Zasada M, Budzisz E. Retinoids: Active molecules influencing skin structure formation in cosmetic and dermatological treatments. Postepy Dermatol Alergol 2019;36(4):392–7.
44. Brzezinski P, Martin L. Usage of unsaturated esters of retinol to defeat Hopf’s acrokeratosis verruciformis in hands and feet of a youg man. Our Dermatology Online 2018;9(3):339–40.
45. Jeyakodi S, Krishnakumar A, Kumar Chellappan D. Beta Carotene-Therapeutic Potential and Strategies to Enhance Its Bioavailability. Nutri Food Sci Int J 2018;7(4):1–7.
46. Kasperczyk S, Dobrakowski M, Kasperczyk J, Ostałowska A, Zalejska-Fiolka J, Birkner E. Beta-carotene reduces oxidative stress, improves glutathione metabolism and modifies antioxidant defense systems in lead-exposed workers. Toxicol Appl Pharmacol 2014;280(1):36–41.
47. Polegato BF, Pereira AG, Azevedo PS, Costa NA, Zornoff LAM, Paiva SAR, et al. Role of Thiamin in Health and Disease. Nutrition in Clinical Practice 2019;34(4):558–64.
48. Manzetti S, Zhang J, Van Der Spoel D. Thiamin function, metabolism, uptake, and transport. Biochemistry 2014;53(5):821–35.
49. Salvador JAR, Carvalho JFS, Neves MAC, Silvestre SM, Leitão AJ, Silva MMC, et al. Anticancer steroids: Linking natural and semi-synthetic compounds. Nat Prod Rep 2013;30(2):324–74.
50. Rasheed A, Qasim M. a Review of Natural Steroids and Their Applications. Int J Pharm Sci Res 2013;4(2):520–31.
51. Junaidi E, Anwar YAS. Aktivitas Antibakteri dan Antioksidan Asam Galat dari Kulit Buah Lokal yang Diproduksi dengan Tanase. ALCHEMY Jurnal Penelitian Kimia 2018;14(1):131.
52. Kahkeshani N, Farzaei F, Fotouhi M, Alavi SS, Bahramsoltani R, Naseri R, et al. Pharmacological effects of gallic acid in health and disease: A mechanistic review. Iran J Basic Med Sci 2019;22(3):225–37.
53. Tajik N, Tajik M, Mack I, Enck P. The potential effects of chlorogenic acid, the main phenolic components in coffee, on health: a comprehensive review of the literature. Eur J Nutr 2017;56(7):2215–44.
54. Huang S, Wang LL, Xue NN, Li C, Guo HH, Ren TK, et al. Chlorogenic acid effectively treats cancers through induction of cancer cell differentiation. Theranostics 2019;9(23):6745–63.
55. Santana-Gálvez J, Villela Castrejón J, Serna-Saldívar SO, Jacobo-Velázquez DA. Anticancer potential of dihydrocaffeic acid: a chlorogenic acid metabolite. http://mc.manuscriptcentral.com/tcyt 2020;18(1):245–8.
56. Tajik N, Tajik M, Mack I, Enck P. The potential effects of chlorogenic acid, the main phenolic components in coffee, on health: a comprehensive review of the literature. European Journal of Nutrition 2017 56:7 2017;56(7):2215–44.
57. Ashoori M, Saedisomeolia A. Riboflavin (vitamin B2) and oxidative stress: A review. British Journal of Nutrition 2014;111(11):1985–91.
58. Saedisomeolia A, Ashoori M. Riboflavin in Human Health: A Review of Current Evidences. 1st ed. Elsevier Inc.; 2018.
59. El-Said KS, Atta A, Mobasher MA, Germoush MO, Mohamed TM, Salem MM. Quercetin mitigates rheumatoid arthritis by inhibiting adenosine deaminase in rats. Molecular Medicine 2022;28(1).
60. Ansari MM, Neha, Khan HA. Quercetin alleviate oxidative stress and inflammation through upregulation of antioxidant machinery and down-regulation of COX2 and NF-κB expression in collagen induced rheumatoid arthritis. International Journal of Drug Development and Research 2014;6(1):215–30.
61. Lesjak M, Beara I, Simin N, Pintać D, Majkić T, Bekvalac K, et al. Antioxidant and anti-inflammatory activities of quercetin and its derivatives. J Funct Foods 2018;40(October 2017):68–75.
62. Xu D, Hu MJ, Wang YQ, Cui YL. Antioxidant activities of quercetin and its complexes for medicinal application. Molecules 2019;24(6).
63. Chen AY, Chen YC. A Review of The Dietary Flavonoid, Kaempferol on Human Health and Cancer Chemoprevention. Food Chem 2013;138(4):2099–107.
64. Ren J, Lu Y, Qian Y, Chen B, Wu T, Ji G. Recent progress regarding kaempferol for the treatment of various diseases (Review). Exp Ther Med 2019;2759–76.
65. Standing CT. Kaempferol as a Dietary Anti-Inflammatory Agent : :1–12.
66. Silva dos Santos J, Gonçalves Cirino JP, de Oliveira Carvalho P, Ortega MM. The Pharmacological Action of Kaempferol in Central Nervous System Diseases: A Review. Front Pharmacol 2021;11(January).
67. Tong Z, He W, Fan X, Guo A. Biological Function of Plant Tannin and Its Application in Animal Health. Front Vet Sci 2022;8(January):1–7.
68. Rizvi S, Raza ST, Ahmed F, Ahmad A, Abbas S, Mahdi F. The role of Vitamin E in human health and some diseases. Sultan Qaboos Univ Med J 2014;14(2):157–65.
69. Wallert M, Ziegler M, Wang X, Maluenda A, Xu X, Yap ML, et al. α-Tocopherol preserves cardiac function by reducing oxidative stress and inflammation in ischemia/reperfusion injury. Redox Biol 2019;26(August):101292.
70. Salinthone S, Kerns AR, Tsang V, Carr DW. α-Tocopherol (vitamin E) stimulates cyclic AMP production in human peripheral mononuclear cells and alters immune function. Mol Immunol 2013;53(3):173–8.
71. Choudhury K, Clark J, Griffiths HR. An almond-enriched diet increases plasma α-tocopherol and improves vascular function but does not affect oxidative stress markers or lipid levels. Free Radic Res 2014;48(5):599–606.
72. Pozzer D, Invernizzi RW, Blaauw B, Cantoni O, Zito E. Ascorbic Acid Route to the Endoplasmic Reticulum: Function and Role in Disease. 2021.
73. Sorice A, Guerriero E, Capone F, Colonna G, Castello G, Costantini S. Ascorbic Acid: Its Role in Immune System and Chronic Inflammation Diseases. Mini-Reviews in Medicinal Chemistry 2014;14(5):444–52.
74. Chambial S, Dwivedi S, Shukla KK, John PJ, Sharma P. Vitamin C in disease prevention and cure: An overview. Indian Journal of Clinical Biochemistry 2013;28(4):314–28.
75. Mittal A, Sharma M, David A, Vishwakarma P, Saini M, Goel M, et al. An experimental study to evaluate the anti-inflammatory effect of moringa oleifera leaves in animal models. Int J Basic Clin Pharmacol 2017;6(2):452.
76. Guazelli CFS, Staurengo-Ferrari L, Zarpelon AC, Pinho-Ribeiro FA, Ruiz-Miyazawa KW, Vicentini FTMC, et al. Quercetin attenuates zymosan-induced arthritis in mice. Biomedicine & Pharmacotherapy 2018;102:175–84.
77. Kolaczkowska E, Kubes P. Neutrophil recruitment and function in health and inflammation. Nat Rev Immunol 2013;13(3):159–75.
78. Mahdi HJ, Khan NAK, Asmawi MZ Bin, Mahmud R, Murugaiyah VA. In vivo anti-arthritic and anti-nociceptive effects of ethanol extract of Moringa oleifera leaves on complete Freund’s adjuvant (CFA)-induced arthritis in rats. Integr Med Res 2018;7(1):85.
79. Saini RK, Sivanesan I, Keum YS. Phytochemicals of Moringa oleifera: a review of their nutritional, therapeutic and industrial significance. 3 Biotech 2016;6(2):1–14.
80. Vongsak B, Sithisarn P, Mangmool S, Thongpraditchote S, Wongkrajang Y, Gritsanapan W. Maximizing total phenolics, total flavonoids contents and antioxidant activity of Moringa oleifera leaf extract by the appropriate extraction method. Ind Crops Prod 2013;44(November 2017):566–71.
81. Fatmawati A, Sucianingsih D, Kurniawati R, Abdurrahman M. Microscopic Identification and Determination of Total Flavonoid Content of Moringa Leaves Extract and Ethyl Acetate Fraction ( Moringa oleifera L .) Identifikasi Mikroskopis dan Penentuan Kandungan Flavonoid Total Ekstrak Daun Kelor dan Fraksi Etil Asetat. 2021;1(1).
82. Iwansyah AC, Manh TD, Andriana Y, Hessan MA Bin, Kormin F, Cuong DX, et al. Effects of various drying methods on selected physical and antioxidant properties of extracts from moringa oliefera leaf waste. Sustainability (Switzerland) 2020;12(20):1–12.
83. Sapra A, Mus S, Dwirandy D, Malluka R, Khairi N. Diffusion Study of Cream Formula of Lyophilized Ethanol Extract of Moringa oleifera L. Leaves. Jurnal Farmasi Galenika (Galenika Journal of Pharmacy) (e-Journal) 2021;7(2):131–42.
84. Alqahtani MS, Kazi M, Alsenaidy MA, Ahmad MZ. Advances in Oral Drug Delivery. Front Pharmacol 2021;12(February).
85. Grgić J, Šelo G, Planinić M, Tišma M, Bucić-Kojić A. Role of the encapsulation in bioavailability of phenolic compounds. Antioxidants 2020;9(10):1–36.
86. Xie F, Ding X, Zhang QY. An update on the role of intestinal cytochrome P450 enzymes in drug disposition. Acta Pharm Sin B 2016;6(5):374–83.
87. KARIMAH M. Pembuatan dan Karakterisasi Kapsul Pati-Alginat dari Ekstraksi Rumput Laut Coklat (Sargassum sp.) Sebagai Material Drug Delivery System. Adln - Perpustakaan Universitas Airlangga Pedoman 2016;
88. Homayun B, Lin X, Choi HJ. Challenges and recent progress in oral drug delivery systems for biopharmaceuticals. Pharmaceutics 2019;11(3).
89. Koyama A, Tanaka A, To H. Daily oral administration of low-dose methotrexate has greater antirheumatic effects in collagen-induced arthritis rats. Journal of Pharmacy and Pharmacology 2017;69(9):1145–54.
90. Abuhelwa AY, Foster DJR, Upton RN. A Quantitative Review and Meta-Models of the Variability and Factors Affecting Oral Drug Absorption—Part I: Gastrointestinal pH. AAPS Journal 2016;18(5):1309–21.
91. Rolle T, Dallorto L, Rossatto S, Curto D, Nuzzi R. Assessing the Performance of Daily Intake of a Homotaurine, Carnosine, Forskolin, Vitamin B2, Vitamin B6, and Magnesium Based Food Supplement for the Maintenance of Visual Function in Patients with Primary Open Angle Glaucoma. J Ophthalmol 2020;2020.
92. Abuhelwa AY, Williams DB, Upton RN, Foster DJR. Food, gastrointestinal pH, and models of oral drug absorption. European Journal of Pharmaceutics and Biopharmaceutics 2017;112:234–48.
93. Chappell M, Payne S. Pharmacokinetics. Biosystems and Biorobotics 2021;24:61–72.
94. Lin M, Zhang J, Chen X. Bioactive flavonoids in Moringa oleifera and their health-promoting properties. J Funct Foods 2018;47:469–79.
95. Mahdi HJ, Khan NAK, Asmawi MZ Bin, Mahmud R, Murugaiyah VA. In vivo anti-arthritic and anti-nociceptive effects of ethanol extract of Moringa oleifera leaves on complete Freund’s adjuvant (CFA)-induced arthritis in rats. Integr Med Res 2018;7(1):85.
96. Fatima N, Fatima SJ. Pharmacological screening for anti-arthritic activity of Moringa oleifera. Asian Journal of Pharmaceutical and Clinical Research 2016;9(3):1–6.
97. Saleem A, Saleem M, Akhtar MF. Antioxidant, anti-inflammatory and antiarthritic potential of Moringa oleifera Lam: An ethnomedicinal plant of Moringaceae family. South African Journal of Botany 2020;128:246–56.
98. Stohs SJ, Hartman MJ. Review of the safety and efficacy of Moringa oleifera. Phytotherapy Research 2015;29(6):796–804.
99. Asiedu-Gyekye IJ, Frimpong-Manso S, Awortwe C, Antwi DA, Nyarko AK. Micro-and Macroelemental Composition and Safety Evaluation of the Nutraceutical Moringa oleifera Leaves. 2014 [cited 2022 Dec 29];Available from: http://dx.doi.org/10.1155/2014/786979
100. Ekhator CN, Osifo UC. Abortifacient Efficacy of Moringa oleifera Leave: An Experimental Study on Adult Female Wistar Rats. Asia Pasific Business Review 2015;3(6):269–72.
101. Sunhre L, Kar A, Panda S. Agnucastoside C, isolated from Moringa oleifera ameliorates thyrotoxicosis and liver abnormalities in female mice. Clinical Phytoscience 2020 6:1 2020;6(1):1–8.
102. Mondal C, Chandra AK. Goitrogenic/antithyroidal potential of moringa leaves (Moringa oleifera) and spinach (Spinacia oleracea) of Indian origin on thyroid status in male albino rats. Brazilian Journal of Pharmaceutical Sciences 2019;55.
103. Showande SJ, Fakeye TO, Kajula M, Hokkanen J, Tolonen A. Potential inhibition of major human cytochrome P450 isoenzymes by selected tropical medicinal herbs—Implication for herb–drug interactions. Food Sci Nutr 2019;7(1):44–55.
104. Fantoukh OI, Albadry MA, Parveen A, Hawwal MF, Majrashi T, Ali Z, et al. Isolation, synthesis, and drug interaction potential of secondary metabolites derived from the leaves of miracle tree (Moringa oleifera) against CYP3A4 and CYP2D6 isozymes. Phytomedicine 2019;60:153010.
105. Ji JJ, Lin Y, Huang SS, Zhang HL, Diao YP, Li K. Quercetin: A Potential Natural Drug for Adjuvant Treatment of Rheumatoid Arthritis. African Journal of Traditional, Complementary, and Alternative Medicines 2013;10(3):418.
106. Kim HR, Kim BM, Won JY, Lee KA, Ko HM, Kang YS, et al. Quercetin, a Plant Polyphenol, Has Potential for the Prevention of Bone Destruction in Rheumatoid Arthritis. J Med Food 2019;22(2):152–61.
107. Haleagrahara N, Hodgson K, Miranda-Hernandez S, Hughes S, Kulur AB, Ketheesan N. Flavonoid quercetin-methotrexate combination inhibits inflammatory mediators and matrix metalloproteinase expression, providing protection to joints in collagen-induced arthritis. Inflammopharmacology 2018;26(5):1219–32.
108. Timur T, Perlakuan D, Media P. Wahana Forestra : Jurnal Kehutanan Vol . 14 No . 1 Januari 2019 Wahana Forestra : Jurnal Kehutanan. 2019;14(1):1–9.
109. Ridwan, Hamim, Suharsono, Hidayati N, Gunawan I. Drumstick (Moringa oleifera) variation in biomass and total flavonoid content in Indonesia. Biodiversitas 2021;22(1):491–8.
110. Javadi F, Ahmadzadeh A, Eghtesadi S, Aryaeian N, Zabihiyeganeh M, Rahimi Foroushani A, et al. The Effect of Quercetin on Inflammatory Factors and Clinical Symptoms in Women with Rheumatoid Arthritis: A Double-Blind, Randomized Controlled Trial. J Am Coll Nutr 2017;36(1):9–15.
2. Studi P, Keperawatan S, Pahlawan U, Tambusai T. Efektifitas Kompres Serei Hangat Terhadap Penurunan Skala Nyeri Arthritis Rheumatoid Pada Lansia di Desa Naumbai Wilayah Kerja Puskesmas Kampar. Jurnal Ners 2020;4(1):29–34.
3. Pujastuti NKDM, Mertha IM, Dewi IDAR. Perbedaan Kompres Hangat Jahe dan Back Massage Terhadap Penurunan Skala Nyeri Ekstrimitas Bawah Pada Lansia dengan Rheumatoid Athritis. Fakultas Kedokteran Universitas Udayana 2018;6:67–72.
4. Widayati D, Hayati F. Peningkatan Kenyamanan Lansia dengan Nyeri Rheumatoid Arthritis Melalui Model Comfort Food For The Soul. Jurnal Ilmu Keperawatan 2017;5(1):6–15.
5. Murata S, Doi T, Sawa R, Saito T, Nakamura R, Isa T, et al. Association between joint stiffness and health-related quality of life in community-dwelling older adults. Arch Gerontol Geriatr 2017;73:234–9.
6. Dewi RS. Keperawatan Gerontik. Deepublish; 2014.
7. MacKey RH, Kuller LH, Deane KD, Walitt BT, Chang YF, Holers VM, et al. Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women’s Health Initiative. Arthritis Rheumatol 2015;67(9):2311–22.
8. England BR, Sayles H, Michaud K, Caplan L, Davis LA, Cannon GW, et al. Cause-Specific Mortality in Male US Veterans With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016;68(1):36–45.
9. Verstappen SMM. Rheumatoid arthritis and work: The impact of rheumatoid arthritis on absenteeism and presenteeism. Best Pract Res Clin Rheumatol 2015;29(3):495–511.
10. Bawarodi F, Rottie J, Malara R, Studi P, Keperawatan I, Kedokteran F. Faktor-Faktor yang Berhubungan dengan Kekambuhan Penyakit Rematik di Wilayah Puskesmas Beo Kabupaten Talaud. Jurnal Keperawatan 2017;5(1).
11. Chauhan K, Jandu JS, Goyal A, Al-Dhahir MA. Rheumatoid Arthritis. Rosen and Barkin’s 5-Minute Emergency Medicine Consult: Fifth Edition 2021;
12. Verri WA, Vicentini FTMC, Baracat MM, Georgetti SR, Cardoso RDR, Cunha TM, et al. Flavonoids as Anti-Inflammatory and Analgesic Drugs: Mechanisms of Action and Perspectives in the Development of Pharmaceutical Forms. Studies in Natural Products Chemistry 2012;36:297–330.
13. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis 2018;9(1):143–50.
14. Ghlichloo I, Gerriets V. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). Treatment of Chronic Pain Conditions: A Comprehensive Handbook 2021;77–9.
15. Brand L, Wolmarans DW, Brand SJ. A quick and painless reminder: The pharmacotherapy of rheumatoid arthritis in primary practice. South African Family Practice 2018;60(2):38–42.
16. Ray SJ, Wolf TJ, Mowa CN. Moringa oleifera and inflammation: A mini-review of its effects and mechanisms. Acta Hortic 2017;1158:317–30.
17. Padayachee B, Baijnath H. An overview of the medicinal importance of Moringaceae. Journal of Medicinal Plants Research 2012;6(48):5831–9.
18. Narande JM, Wulur A, Yudistira A. Uji Efek Antiinflamasi Ekstrak Etanol Daun Suji (Dracaena Angustifolia Roxb) Terhadap Edema Kaki Tikus Putih Jantan Galur Wistar. Pharmacon 2013;2(3).
19. Liang L, Wang C, Li S, Chu X, Sun K. Nutritional compositions of Indian Moringa oleifera seed and antioxidant activity of its polypeptides. Food Sci Nutr 2019;7(5):1754.
20. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet 2016;388(10055):2023–38.
21. Brzustewicz E, Henc I, Daca A, Szarecka M, Sochocka-Bykowska M, Witkowski J, et al. Autoantibodies, C-reactive protein, erythrocyte sedimentation rate and serum cytokine profiling in monitoring of early treatment. Cent Eur J Immunol 2017;42(3):259–68.
22. Littlejohn EA, Monrad SU. Early Diagnosis and Treatment of Rheumatoid Arthritis. Prim Care 2018;45(2):237–55.
23. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA 2018;320(13):1360–72.
24. Deane KD, Demoruelle MK, Kelmenson LB, Kuhn KA, Norris JM, Holers VM. Genetic and environmental risk factors for rheumatoid arthritis. Best Pract Res Clin Rheumatol 2017;31(1):3–18.
25. Tan EM, Smolen JS. Historical observations contributing insights on etiopathogenesis of rheumatoid arthritis and role of rheumatoid factor. J Exp Med 2016;213(10):1937–50.
26. Baratawidjaja KG, Rengganis I. Imunologi Dasar Edisi 10. Jakarta: Balai Penerbit Fakultas Kedokteran Universitas Indonesia; 2012.
27. Zhang L, Yuan Y, Xu Q, Jiang Z, Chu CQ. Contribution of neutrophils in the pathogenesis of rheumatoid arthritis. J Biomed Res 2020;34(2):86–93.
28. Yuan K, Zhu Q, Lu Q, Jiang H, Zhu M, Li X, et al. Quercetin alleviates rheumatoid arthritis by inhibiting neutrophil inflammatory activities. J Nutr Biochem 2020;84.
29. Chandrashekara S, Mukhtar Ahmad M, Renuka P, Anupama KR, Renuka K. Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int J Rheum Dis 2017;20(10):1457–67.
30. Leone A, Spada A, Battezzati A, Schiraldi A, Aristil J, Bertoli S. Cultivation, genetic, ethnopharmacology, phytochemistry and pharmacology of Moringa oleifera leaves: An overview. Int J Mol Sci 2015;16(6):12791–835.
31. Wei Y, Xia N, Zhang W, Huang J, Ren Z, Zhu L, et al. Serum retinol-binding protein 4 is associated with insulin resistance in patients with early and untreated rheumatoid arthritis. Joint Bone Spine 2019;86(3):335–41.
32. Zabetian-Targhi F, Mahmoudi MJ, Rezaei N, Mahmoudi M. Retinol Binding Protein 4 in Relation to Diet, Inflammation, Immunity, and Cardiovascular Diseases. Advances in Nutrition 2015;6(6):748–62.
33. Clarke J. Β-Carotene Blocks the Inflammasome. Nat Rev Rheumatol 2020;16(5):248.
34. Carr AC, McCall C. The role of vitamin C in the treatment of pain: New insights. J Transl Med 2017;15(1):1–14.
35. Zaringhalam J, Akbari A, Zali A, Manaheji H, Nazemian V, Shadnoush M, et al. Long-term treatment by vitamin B1 and reduction of serum proinflammatory cytokines, hyperalgesia, and paw edema in adjuvant-induced arthritis. Basic Clin Neurosci 2016;7(4):331–40.
36. Suwannasom N, Kao I, Pruß A, Georgieva R, Bäumler H. Riboflavin: The health benefits of a forgotten natural vitamin. Int J Mol Sci 2020;21(3).
37. Prousky JE. The use of niacinamide and solanaceae (nightshade) elimination in the treatment of osteoarthritis. Journal of Orthomolecular Medicine 2015;30(1):13–21.
38. Sahin K, Kucuk O, Orhan C, Tuzcu M, Durmus AS, Ozercan IH, et al. Niacinamide and undenatured type II collagen modulates the inflammatory response in rats with monoiodoacetate-induced osteoarthritis. Sci Rep 2021;11(1):1–15.
39. Doi K, Ito H, Tomizawa T, Murata K, Hashimoto M, Tanaka M, et al. Oral steroid decreases the progression of joint destruction of large joints in the lower extremities in rheumatoid arthritis. Medicine (United States) 2019;98(47).
40. Xie J, Peng LJ, Yang MR, Jiang WW, Mao JY, Shi CY, et al. Alkaloid Extract of Moringa oleifera Lam. Exerts Antitumor Activity in Human Non-Small-Cell Lung Cancer via Modulation of the JAK2/STAT3 Signaling Pathway. Evidence-based Complementary and Alternative Medicine 2021;2021.
41. Rani NZA, Husain K, Kumolosasi E. Moringa genus: A review of phytochemistry and pharmacology. Front Pharmacol 2018;9(FEB):1–26.
42. Maleki SJ, Crespo JF, Cabanillas B. Anti-inflammatory effects of flavonoids. Food Chem 2019;299(July).
43. Zasada M, Budzisz E. Retinoids: Active molecules influencing skin structure formation in cosmetic and dermatological treatments. Postepy Dermatol Alergol 2019;36(4):392–7.
44. Brzezinski P, Martin L. Usage of unsaturated esters of retinol to defeat Hopf’s acrokeratosis verruciformis in hands and feet of a youg man. Our Dermatology Online 2018;9(3):339–40.
45. Jeyakodi S, Krishnakumar A, Kumar Chellappan D. Beta Carotene-Therapeutic Potential and Strategies to Enhance Its Bioavailability. Nutri Food Sci Int J 2018;7(4):1–7.
46. Kasperczyk S, Dobrakowski M, Kasperczyk J, Ostałowska A, Zalejska-Fiolka J, Birkner E. Beta-carotene reduces oxidative stress, improves glutathione metabolism and modifies antioxidant defense systems in lead-exposed workers. Toxicol Appl Pharmacol 2014;280(1):36–41.
47. Polegato BF, Pereira AG, Azevedo PS, Costa NA, Zornoff LAM, Paiva SAR, et al. Role of Thiamin in Health and Disease. Nutrition in Clinical Practice 2019;34(4):558–64.
48. Manzetti S, Zhang J, Van Der Spoel D. Thiamin function, metabolism, uptake, and transport. Biochemistry 2014;53(5):821–35.
49. Salvador JAR, Carvalho JFS, Neves MAC, Silvestre SM, Leitão AJ, Silva MMC, et al. Anticancer steroids: Linking natural and semi-synthetic compounds. Nat Prod Rep 2013;30(2):324–74.
50. Rasheed A, Qasim M. a Review of Natural Steroids and Their Applications. Int J Pharm Sci Res 2013;4(2):520–31.
51. Junaidi E, Anwar YAS. Aktivitas Antibakteri dan Antioksidan Asam Galat dari Kulit Buah Lokal yang Diproduksi dengan Tanase. ALCHEMY Jurnal Penelitian Kimia 2018;14(1):131.
52. Kahkeshani N, Farzaei F, Fotouhi M, Alavi SS, Bahramsoltani R, Naseri R, et al. Pharmacological effects of gallic acid in health and disease: A mechanistic review. Iran J Basic Med Sci 2019;22(3):225–37.
53. Tajik N, Tajik M, Mack I, Enck P. The potential effects of chlorogenic acid, the main phenolic components in coffee, on health: a comprehensive review of the literature. Eur J Nutr 2017;56(7):2215–44.
54. Huang S, Wang LL, Xue NN, Li C, Guo HH, Ren TK, et al. Chlorogenic acid effectively treats cancers through induction of cancer cell differentiation. Theranostics 2019;9(23):6745–63.
55. Santana-Gálvez J, Villela Castrejón J, Serna-Saldívar SO, Jacobo-Velázquez DA. Anticancer potential of dihydrocaffeic acid: a chlorogenic acid metabolite. http://mc.manuscriptcentral.com/tcyt 2020;18(1):245–8.
56. Tajik N, Tajik M, Mack I, Enck P. The potential effects of chlorogenic acid, the main phenolic components in coffee, on health: a comprehensive review of the literature. European Journal of Nutrition 2017 56:7 2017;56(7):2215–44.
57. Ashoori M, Saedisomeolia A. Riboflavin (vitamin B2) and oxidative stress: A review. British Journal of Nutrition 2014;111(11):1985–91.
58. Saedisomeolia A, Ashoori M. Riboflavin in Human Health: A Review of Current Evidences. 1st ed. Elsevier Inc.; 2018.
59. El-Said KS, Atta A, Mobasher MA, Germoush MO, Mohamed TM, Salem MM. Quercetin mitigates rheumatoid arthritis by inhibiting adenosine deaminase in rats. Molecular Medicine 2022;28(1).
60. Ansari MM, Neha, Khan HA. Quercetin alleviate oxidative stress and inflammation through upregulation of antioxidant machinery and down-regulation of COX2 and NF-κB expression in collagen induced rheumatoid arthritis. International Journal of Drug Development and Research 2014;6(1):215–30.
61. Lesjak M, Beara I, Simin N, Pintać D, Majkić T, Bekvalac K, et al. Antioxidant and anti-inflammatory activities of quercetin and its derivatives. J Funct Foods 2018;40(October 2017):68–75.
62. Xu D, Hu MJ, Wang YQ, Cui YL. Antioxidant activities of quercetin and its complexes for medicinal application. Molecules 2019;24(6).
63. Chen AY, Chen YC. A Review of The Dietary Flavonoid, Kaempferol on Human Health and Cancer Chemoprevention. Food Chem 2013;138(4):2099–107.
64. Ren J, Lu Y, Qian Y, Chen B, Wu T, Ji G. Recent progress regarding kaempferol for the treatment of various diseases (Review). Exp Ther Med 2019;2759–76.
65. Standing CT. Kaempferol as a Dietary Anti-Inflammatory Agent : :1–12.
66. Silva dos Santos J, Gonçalves Cirino JP, de Oliveira Carvalho P, Ortega MM. The Pharmacological Action of Kaempferol in Central Nervous System Diseases: A Review. Front Pharmacol 2021;11(January).
67. Tong Z, He W, Fan X, Guo A. Biological Function of Plant Tannin and Its Application in Animal Health. Front Vet Sci 2022;8(January):1–7.
68. Rizvi S, Raza ST, Ahmed F, Ahmad A, Abbas S, Mahdi F. The role of Vitamin E in human health and some diseases. Sultan Qaboos Univ Med J 2014;14(2):157–65.
69. Wallert M, Ziegler M, Wang X, Maluenda A, Xu X, Yap ML, et al. α-Tocopherol preserves cardiac function by reducing oxidative stress and inflammation in ischemia/reperfusion injury. Redox Biol 2019;26(August):101292.
70. Salinthone S, Kerns AR, Tsang V, Carr DW. α-Tocopherol (vitamin E) stimulates cyclic AMP production in human peripheral mononuclear cells and alters immune function. Mol Immunol 2013;53(3):173–8.
71. Choudhury K, Clark J, Griffiths HR. An almond-enriched diet increases plasma α-tocopherol and improves vascular function but does not affect oxidative stress markers or lipid levels. Free Radic Res 2014;48(5):599–606.
72. Pozzer D, Invernizzi RW, Blaauw B, Cantoni O, Zito E. Ascorbic Acid Route to the Endoplasmic Reticulum: Function and Role in Disease. 2021.
73. Sorice A, Guerriero E, Capone F, Colonna G, Castello G, Costantini S. Ascorbic Acid: Its Role in Immune System and Chronic Inflammation Diseases. Mini-Reviews in Medicinal Chemistry 2014;14(5):444–52.
74. Chambial S, Dwivedi S, Shukla KK, John PJ, Sharma P. Vitamin C in disease prevention and cure: An overview. Indian Journal of Clinical Biochemistry 2013;28(4):314–28.
75. Mittal A, Sharma M, David A, Vishwakarma P, Saini M, Goel M, et al. An experimental study to evaluate the anti-inflammatory effect of moringa oleifera leaves in animal models. Int J Basic Clin Pharmacol 2017;6(2):452.
76. Guazelli CFS, Staurengo-Ferrari L, Zarpelon AC, Pinho-Ribeiro FA, Ruiz-Miyazawa KW, Vicentini FTMC, et al. Quercetin attenuates zymosan-induced arthritis in mice. Biomedicine & Pharmacotherapy 2018;102:175–84.
77. Kolaczkowska E, Kubes P. Neutrophil recruitment and function in health and inflammation. Nat Rev Immunol 2013;13(3):159–75.
78. Mahdi HJ, Khan NAK, Asmawi MZ Bin, Mahmud R, Murugaiyah VA. In vivo anti-arthritic and anti-nociceptive effects of ethanol extract of Moringa oleifera leaves on complete Freund’s adjuvant (CFA)-induced arthritis in rats. Integr Med Res 2018;7(1):85.
79. Saini RK, Sivanesan I, Keum YS. Phytochemicals of Moringa oleifera: a review of their nutritional, therapeutic and industrial significance. 3 Biotech 2016;6(2):1–14.
80. Vongsak B, Sithisarn P, Mangmool S, Thongpraditchote S, Wongkrajang Y, Gritsanapan W. Maximizing total phenolics, total flavonoids contents and antioxidant activity of Moringa oleifera leaf extract by the appropriate extraction method. Ind Crops Prod 2013;44(November 2017):566–71.
81. Fatmawati A, Sucianingsih D, Kurniawati R, Abdurrahman M. Microscopic Identification and Determination of Total Flavonoid Content of Moringa Leaves Extract and Ethyl Acetate Fraction ( Moringa oleifera L .) Identifikasi Mikroskopis dan Penentuan Kandungan Flavonoid Total Ekstrak Daun Kelor dan Fraksi Etil Asetat. 2021;1(1).
82. Iwansyah AC, Manh TD, Andriana Y, Hessan MA Bin, Kormin F, Cuong DX, et al. Effects of various drying methods on selected physical and antioxidant properties of extracts from moringa oliefera leaf waste. Sustainability (Switzerland) 2020;12(20):1–12.
83. Sapra A, Mus S, Dwirandy D, Malluka R, Khairi N. Diffusion Study of Cream Formula of Lyophilized Ethanol Extract of Moringa oleifera L. Leaves. Jurnal Farmasi Galenika (Galenika Journal of Pharmacy) (e-Journal) 2021;7(2):131–42.
84. Alqahtani MS, Kazi M, Alsenaidy MA, Ahmad MZ. Advances in Oral Drug Delivery. Front Pharmacol 2021;12(February).
85. Grgić J, Šelo G, Planinić M, Tišma M, Bucić-Kojić A. Role of the encapsulation in bioavailability of phenolic compounds. Antioxidants 2020;9(10):1–36.
86. Xie F, Ding X, Zhang QY. An update on the role of intestinal cytochrome P450 enzymes in drug disposition. Acta Pharm Sin B 2016;6(5):374–83.
87. KARIMAH M. Pembuatan dan Karakterisasi Kapsul Pati-Alginat dari Ekstraksi Rumput Laut Coklat (Sargassum sp.) Sebagai Material Drug Delivery System. Adln - Perpustakaan Universitas Airlangga Pedoman 2016;
88. Homayun B, Lin X, Choi HJ. Challenges and recent progress in oral drug delivery systems for biopharmaceuticals. Pharmaceutics 2019;11(3).
89. Koyama A, Tanaka A, To H. Daily oral administration of low-dose methotrexate has greater antirheumatic effects in collagen-induced arthritis rats. Journal of Pharmacy and Pharmacology 2017;69(9):1145–54.
90. Abuhelwa AY, Foster DJR, Upton RN. A Quantitative Review and Meta-Models of the Variability and Factors Affecting Oral Drug Absorption—Part I: Gastrointestinal pH. AAPS Journal 2016;18(5):1309–21.
91. Rolle T, Dallorto L, Rossatto S, Curto D, Nuzzi R. Assessing the Performance of Daily Intake of a Homotaurine, Carnosine, Forskolin, Vitamin B2, Vitamin B6, and Magnesium Based Food Supplement for the Maintenance of Visual Function in Patients with Primary Open Angle Glaucoma. J Ophthalmol 2020;2020.
92. Abuhelwa AY, Williams DB, Upton RN, Foster DJR. Food, gastrointestinal pH, and models of oral drug absorption. European Journal of Pharmaceutics and Biopharmaceutics 2017;112:234–48.
93. Chappell M, Payne S. Pharmacokinetics. Biosystems and Biorobotics 2021;24:61–72.
94. Lin M, Zhang J, Chen X. Bioactive flavonoids in Moringa oleifera and their health-promoting properties. J Funct Foods 2018;47:469–79.
95. Mahdi HJ, Khan NAK, Asmawi MZ Bin, Mahmud R, Murugaiyah VA. In vivo anti-arthritic and anti-nociceptive effects of ethanol extract of Moringa oleifera leaves on complete Freund’s adjuvant (CFA)-induced arthritis in rats. Integr Med Res 2018;7(1):85.
96. Fatima N, Fatima SJ. Pharmacological screening for anti-arthritic activity of Moringa oleifera. Asian Journal of Pharmaceutical and Clinical Research 2016;9(3):1–6.
97. Saleem A, Saleem M, Akhtar MF. Antioxidant, anti-inflammatory and antiarthritic potential of Moringa oleifera Lam: An ethnomedicinal plant of Moringaceae family. South African Journal of Botany 2020;128:246–56.
98. Stohs SJ, Hartman MJ. Review of the safety and efficacy of Moringa oleifera. Phytotherapy Research 2015;29(6):796–804.
99. Asiedu-Gyekye IJ, Frimpong-Manso S, Awortwe C, Antwi DA, Nyarko AK. Micro-and Macroelemental Composition and Safety Evaluation of the Nutraceutical Moringa oleifera Leaves. 2014 [cited 2022 Dec 29];Available from: http://dx.doi.org/10.1155/2014/786979
100. Ekhator CN, Osifo UC. Abortifacient Efficacy of Moringa oleifera Leave: An Experimental Study on Adult Female Wistar Rats. Asia Pasific Business Review 2015;3(6):269–72.
101. Sunhre L, Kar A, Panda S. Agnucastoside C, isolated from Moringa oleifera ameliorates thyrotoxicosis and liver abnormalities in female mice. Clinical Phytoscience 2020 6:1 2020;6(1):1–8.
102. Mondal C, Chandra AK. Goitrogenic/antithyroidal potential of moringa leaves (Moringa oleifera) and spinach (Spinacia oleracea) of Indian origin on thyroid status in male albino rats. Brazilian Journal of Pharmaceutical Sciences 2019;55.
103. Showande SJ, Fakeye TO, Kajula M, Hokkanen J, Tolonen A. Potential inhibition of major human cytochrome P450 isoenzymes by selected tropical medicinal herbs—Implication for herb–drug interactions. Food Sci Nutr 2019;7(1):44–55.
104. Fantoukh OI, Albadry MA, Parveen A, Hawwal MF, Majrashi T, Ali Z, et al. Isolation, synthesis, and drug interaction potential of secondary metabolites derived from the leaves of miracle tree (Moringa oleifera) against CYP3A4 and CYP2D6 isozymes. Phytomedicine 2019;60:153010.
105. Ji JJ, Lin Y, Huang SS, Zhang HL, Diao YP, Li K. Quercetin: A Potential Natural Drug for Adjuvant Treatment of Rheumatoid Arthritis. African Journal of Traditional, Complementary, and Alternative Medicines 2013;10(3):418.
106. Kim HR, Kim BM, Won JY, Lee KA, Ko HM, Kang YS, et al. Quercetin, a Plant Polyphenol, Has Potential for the Prevention of Bone Destruction in Rheumatoid Arthritis. J Med Food 2019;22(2):152–61.
107. Haleagrahara N, Hodgson K, Miranda-Hernandez S, Hughes S, Kulur AB, Ketheesan N. Flavonoid quercetin-methotrexate combination inhibits inflammatory mediators and matrix metalloproteinase expression, providing protection to joints in collagen-induced arthritis. Inflammopharmacology 2018;26(5):1219–32.
108. Timur T, Perlakuan D, Media P. Wahana Forestra : Jurnal Kehutanan Vol . 14 No . 1 Januari 2019 Wahana Forestra : Jurnal Kehutanan. 2019;14(1):1–9.
109. Ridwan, Hamim, Suharsono, Hidayati N, Gunawan I. Drumstick (Moringa oleifera) variation in biomass and total flavonoid content in Indonesia. Biodiversitas 2021;22(1):491–8.
110. Javadi F, Ahmadzadeh A, Eghtesadi S, Aryaeian N, Zabihiyeganeh M, Rahimi Foroushani A, et al. The Effect of Quercetin on Inflammatory Factors and Clinical Symptoms in Women with Rheumatoid Arthritis: A Double-Blind, Randomized Controlled Trial. J Am Coll Nutr 2017;36(1):9–15.
Published
2023-02-22
How to Cite
SUTAMA, Komang Wahyu Widyasanti et al.
POTENTIAL OF FLAVONOIDS IN MORINGA OLEIFERA LEAF EXTRACT AS AN ALTERNATIVE THERAPY OF REUMATOID ARTHRITIS BASED ON ANTI-INFLAMMATORY APPROACH.
Essential: Essence of Scientific Medical Journal, [S.l.], v. 20, n. 2, p. 97-106, feb. 2023.
ISSN 2655-6472.
Available at: <https://ojs.unud.ac.id/index.php/essential/article/view/96159>. Date accessed: 25 apr. 2024.
doi: https://doi.org/10.24843/essential.v20i2.96159.
Section
Artikel Tinjauan Pustaka
ABOUT THE JOURNAL
