Nephroprotective Role of Boerhavia diffusa in Renal Disorders: A Review

 

Santhosh S1, Pazhani GP2, Arathi MS3, Manickam S4*

1Scholar, Department of Anatomy, Chettinad Hospital and Research Institute,

Chettinad Academy of Research and Education, Kelambakkam – 603103, Tamil Nadu, India.

2Associate Professor, SRM College of Pharmacy, SRM Institute of Science and Technology,

Kattankulattur – 603203, Tamil Nadu, India.

3Associate Professor, Department of Anatomy, Chettinad Hospital and Research Institute,

Chettinad Academy of Research and Education, Kelambakkam – 603103, Tamil Nadu, India.

4 Associate Professor, Department of Anatomy, Chettinad Hospital and Research Institute,

Chettinad Academy of Research and Education, Kelambakkam – 603103, Tamil Nadu, India.

*Corresponding Author E-mail: gandhiayu@hotmail.com

 

ABSTRACT:

The herb Boerhavia diffusa (BD) is well-known in the Indian medicinal system. Punarnava is its vernacular name. BD is one of the chief ingredients in ayurvedic formulations used for urinary diseases. In the realm of phytochemistry, the plant has risen to prominence due to its diverse biological activities. Here, we reviewed the scientific literature available on administration of BD for acute kidney injury, chronic kidney disease, polycystic kidney disease, renal calculi, urinary tract infection, and COVID-19 related kidney disease and we also explored its antioxidant and anti-inflammatory properties. The nephroprotective effect of BD has been clearly demonstrated in in vitro, in vivo, and in clinical studies. The in vivo studies have yielded a plethora of data. The most commonly employed extracts were aqueous, hydroalcoholic, ethanolic, and methanolic extracts. Clinical studies have employed polyherbal combinations containing BD extract. Irrespective of the type of BD extract, all studies showed reduction in the key markers of kidney diseases, namely urea, creatinine, BUN, and proteins. It has antifibrotic property reducing the formation of extracelluar collagen deposition in the renal tubules, which is not much explored. The review highlights the importance of further research required in establishing the molecular mechanisms underlying the action of BD. With in-depth molecular research and clinical trials, BD could be developed into a novel therapeutic agent for the successful treatment of renal disorders especially the chronic kidney disease.

 

KEYWORDS: Boerhavia diffusa, Punarnava, nephroprotective, acute kidney disease, chronic kidney disease, urolithiasis.

 

 


INTRODUCTION: 

Boerhavia diffusa (BD) Linn., commonly known as punarnava, is an herbal plant widely used in Indian medical system. It belongs to genus Boerhavia, which consists of around 40 tropical and subtropical species. Among those, six species are found in India. It is found in abundance during the rainy seasons in India, Srilanka, Malay Peninsula, China, Australia, Africa, America, and the Islands of the Pacific1.

 

Major active ingredient of the plant is Punarnavine, which is an alkaloid present in the root of the plant2. In addition, amino acids, vitamins C, B2, and B3, saturated fatty acids, arachidic acids, palmitate acetate and behenic acid are found in it. Further, methanolic extract of BD is found to have minerals like manganese, calcium, sodium, copper, and zinc3. It also contains secondary metabolites such as rotenoids, ecdysteroids, alkaloids, and phenolic and lignan glycosides, among others. The chemical marker for BD is boeravinone B, which belongs to the rotenoid family4,5.

 

Because of its varied pharmacological and biological activities, the plant has achieved prominence in the field of phytochemistry. BD is reported to have immunomodulatory effects, immunosuppressive activity, antioxidant activity, antidiabetic activity, anti-inflammatory activity, nitric oxide scavenging activity, hepatoprotective activity, antibacterial activity, anti-viral activity, and  antifibrinolytic activity4,6.

 

Urinary system consists of organs such as kidney, ureter, urinary bladder and urethra. Numerous diseases having varied etiology, namely acute kidney injury, chronic kidney disease (CKD), polycystic kidney disease, renal calculi, and urinary tract infection afflict it. BD is one among numerous traditional plants, used in ayurvedic formulations for treatment of urinary disorders7. The present study tries to summarize the available scientific literatures on the nephroprotective effect of BD on various urinary diseases. Special attention will be given to the antioxidant and anti-inflammatory properties of BD.

 

METHODS:

Databases PubMed and Science Direct were searched for the following search terms kidney disease [Title/Abstract] AND Boerhavia diffusa [Title/Abstract] and the articles retrieved were utilized in this review. We included all the relevant articles that employed whole plant or plant parts or extract of BD irrespective of the part used or type of extract. Reduction in albuminuria or proteinuria, improvement in renal histopathology, improvement in kidney function (lower levels of urea or creatinine) or reduction in crystal formation or reduction in the rate of infection was considered renoprotective.

 

Our search fetched three In vitro, twenty-two In vivo and eight clinical studies. Studies employed various types of extracts namely: aqueous extract, hydroalcoholic, ethanolic, and methanolic extracts. In clinical studies, most studies have employed polyherbal combinations with BD or BD extract as one of the ingredients. The animal model used, experimental disease model employed and the outcome of the studies were tabulated (Table 1, 2 and 3). Later the renoprotective role of BD on different kidney disorders was analyzed and the mode of action assessed or proposed is concisely reported.


 

 

Table 1: In vitro studies employing BD extract

S. No.

Type of extract, used and Dose

Cell lines and disease model employed

Outcome of the study

Reference

1.

Ethyl acetate fraction/25 and 50 µg/ml

Cyclosporine A induced nephrotoxicity  in MDCK cells

↓Apoptosis, ↓Cell cycle arrest at G0 /G1 and sub G0/G1, ↓ caspase 3, LPO, and nitric oxide release,

↓ Accumulation of collagen, and ↑the survivability of cells

Kalaivani, Arockiasamy8

2.

Ethanolic extract/200mg

Urinary tract infection (UTI) cell-culture

↓ Infection (bacterial count)

Vineeth, Deepak9

3.

Polyherbal combination containing BD/2.4mg/ml in 0.5% dimethyl sulfoxide

Cisplatin induced Acute kidney injury (AKI) in NRK-52E and HK-2 cell lines

↑SOD,↑CAT,↓ cleaved caspase-3,↓ MAPK

Dachuri, Song10

↓: Decreased; ↑: Increased; CAT: Catalase; LPO: Lipid peroxidation; MAPK: Mitogen-activated protein kinase; MDCK: Madin–Darby Canine Kidney

 

Table 2: In vivo studies employing BD extracts

S. No

Type of extract, Plant parts used, Route of administration, and Dose

Animal model

Disease model

Outcome of the study

Reference

1.

Polyherbal combination /Oral/100, 200 and 400mg/kg

Wistar albino rats

Normal rats

↑Na+, K+, Cl- excretion, ↑Diuretic, Saluretic and Natriuretic indices

Bhusan, Kumar11

2.

Alcoholic extract/Leaves/Oral /150 and 300mg/kg

Male Wistar albino rats

Normal rats

Urine volume↑ and ↑excretion of Na+

Venkatesh, Dinakar12

3.

Aqueous extract/Whole plant/ Oral/200  and  400mg/kg/10 days

 Male Wistar rats

Gentamicin induced CKD model

↓BUN, ↓sr.creat, ↓MDA, ↑PAH,↑ GSH, and histology of kidney indicates restored renal tubules

Sawardekar and Patel13

4.

Hydroalcoholic extract /Root/Oral/ 500mg/kg/ 90days

Dogs

CKD

↓Systolic and diastolic pressure, ↑ Hb became normal, but no changes TEC, ↓sr. creat, ↓SUN, total protein, and albumin in urine,↓ urine ALT, GGT, and ↓urine potassium and phosphorus

Oburai, Rao14

5

Aqueous extract /Root/Oral/300mg/kg/28days

 Male Wistar rats

Adenine induced CKD

↑Hb, TEC, and granulocytes and ↓ total protein, ↓AST, ↓ALT, ↓SUN ↓uric acid, ↓creat, ↑phosphorus in urine

Raval, Patel15

6.

Aqueous extract/Root/Oral/200 and 400mg/kg/14 days

Wistar male albino rats

Acetaminophen-induced nephrotoxicity

↓ Sr. creat, BUN, ↓MDA, ↑SOD, ↓ GST, ↑CAT, ↑GPx and ↓ protein and ↑microscopic study showed restored normal renal architecture

Pareta, Harwansh16

7.

Hydroalcholic extract / Root / oral / 50,100 and 200mg/kg / 10 days

Albino Wistar rats

 

Cisplatin induced nephrotoxicity

↓Sr.creat, BUN, ↓MDA ↑ SOD, ↑GSH, ↓TNF-α ↓active caspase-3, expression in kidneys, ↓IL-1ß, IL-6

Renal tubules appeared normal in histopathological study and ultra-structure of renal cells were normal

Karwasra, Kalra17

8.

Methanolic extract / Leaves /Oral / 50,100 and 200mg/kg / l28 days

Male Albino rats

Nephrotoxicity induced by D-galactosamine

 ↓ Lipid profiles in the kidney

Arivu and Muthulingam18

9.

Methanolic extract / leaves / Oral / 150mg/kg / 21 days

Male Albino rats

Nephrotoxicity induced by lead acetate

↓ Urea, uric acid, creat, ↑protein levels in blood, ↓TBARS, ↑SOD, ↑CAT, ↑GPx

Vaidegi and Anuradha19

10.

Aqueous extract / Leaves / Oral / 200mg/Kg / 5 days

Wistar male rats

Mercuric chloride induced nephrotoxicity

↓ ACP, ALP, AST, and ALT, Urea, LPO, and ↑ GSH, GST Vitamin C, and CAT

Indhumathi, Shilpa20

11.

Polyherbal combination containing BD (Neeri) / Oral /1640 and 3280mg/kg / 42 days

Albino Wistar rats

Nephrotoxicity induced by lead acetate

↓ Sr. creat, urea, urinary protein, urinary glucose; and ↑ levels of S.albumin, s.total proteins, and also the structural changes  in kidney tissue

Barwal, Kumari21

12.

Polyherbal combination containing BD / Oral/ 150 and 300mg/kg / 8 days

Male and female Wistar rats

Nephrotoxicity induced by methotrexate

↓ Urea, uric acid, creat, and ↑ protein levels in blood, ↓TBARS, ↑SOD, ↑CAT, ↑GPx, ↓ALT, ↓AST, ↓total protein, ↓TNF-α 

Sharma, Baboota22

13.

Polyherbal combination containing BD / Oral / 25, 50 and 100mg/kg/ 28 days

Male Wistar rats

Renal impairment induced by CCl4

↓ AST, ALP, AST, cholesterol, urea, BUN, and creat, ↓MDA, ↑SOD, ↑GPx normal renal architecture in kidney tissue

Ahmad, Abuzinadah23

14.

The polyherbal combination containing BD (Cystone) / Oral/750 mg/kg / 28 days

Male and female Wistar albino rats

Coax-renal injury induced by hyperoxaluria

↑ Urine volume, ↓urinary pH, along with ↑ urinary excretion of oxalate, calcium, and phosphate, ↓ LPO and ↑SOD, CAT, and GPx in the kidney

Bodakhe, Namdeo24

15.

Aqueous extract / Root / Oral / 100 and 200mg/kg / 28 days

 

Wistar male albino rats

Ethylene glycol induced renal injury

↑ Urine output, ↓protein, glutathione in urine, microscopic observation showed the ↓crystals, and normal renal architecture, ↓MDA, ↑CAT, ↑SOD, ↓GST, ↑GPx

Pareta, Patra25

16.

Polyherbal combination containing BD (Cystone) / Oral / 5Mg/Kg / 7 days

Wistar male rats

Acute renal injury induced by glycerol intoxication

 ↓ Urea, creat, BUN and ↑SOD,↑CAT, ↓LPO

Yadav, Sharma26

17.

Polyherbal combination containing BD (CATCAB-50) / Oral / 50 mg/kg/ 10 days

Male and female Wistar rats

Glomerulo-nephritis induced by CCl4

↓ Urea, uric acid, creat, and total protein and ↓AST, ↓ALT, ↓total protein

Maurya and Kumar27

18.

Ethanolic extract / Whole plant / Oral / 200mg/kg / 14 days

Wistar male rats

Nephrotoxicity induced by gentamicin

↓ Urea, uric acid, creat, Na+ and K+

Shanmugapriya, Anuradha28

19.

Ethanolic extract / Whole plant / Oral / 200 and 400mg/kg / 10 days

Wistar rats

Nephrotoxicity induced by cisplatin

↓ Urea, sr. creat, BUN,ALP↓, MDA↑,GSH, and ↑CAT and ↑SOD and ↑GPx ↓tubular necrosis in histopathology of renal tissue

Nalini, Chidambaranathan29

20.

Ethanolic extract / Leaves / Oral / 500mg/kg / 28days

Female albino Wistar rats

Alloxan induced Diabetic model

↓ Na+-K+ Pase↑, GPx, ↑CAT, ↑SOD, and ↑GSH ↓sr.creat, urea

Singh, Baxi30

21.

Aqueous extract / Root / Oral /100-200mg/kg / 28 days

Wistar male rats

Urolithiasis induced by ethylene glycol

↓CaOx nucleation, aggregation of CaOx, and formation of crystals

Histopathology: Prevention of CaOx crystals deposition in renal tubules

Pareta, Patra31

22

Polyherbal combination containing BD extract / Oral / 28 days

Male and female rats

Ethylene glycol induced urolithiasis

↑urine volume, ↓uric acid, ↓Sr. creat, uric acid, potassium, chloride, phosphorus, oxalate, calcium, chloride,

Vaishnav, Patel32

↓: Decreased; ↑: Increased; ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase /transaminase; BUN: Blood Urea Nitrogen; CaOx: Calcium oxalate; CAT: Catalase; GGT: gamma glutamyl transferase; GPx: Glutathione peroxidase; GSH: Reduced glutathione; GST: Glutathione S-transferase; Hb: Hemoglobin; IL: Interleukin; LPO: Lipid peroxidation;  MDA: Malondialdehyde; PAH: p‑Amino hippuric acid; ROS: Reactive oxygen species; s: Serum level of; s. creat: Serum creatinine; SOD: Superoxide dismutase; SUN: Serum urea nitrogen; TBARS: thiobarbituric acid reactive substances; TEC: Total erythrocyte count; TNF-α: tumor necrosis factor alpha

 

Table3: Clinical trials employing BD extract

S.No.

Type of extract, Route of administration and Dose

Sample population selected for study

Outcome of the study

Reference

1.

Aqueous extract/Oral/0.5ml

Patients with polycystic kidney disease

↓LPO, ↑GSH, ↑(GPx), and ↓GST

Sathyapriya, Vijayachandrika33

2.

BD syrup/Oral/20ml for15 days

CKD patients

↑Hb, TLC and Na+, K+, Cl-, Sr. Creat, Cal, urea, phosphate came to normal range

Dwivedi, Mishra34

3.

Compounds from BD (Punarnava)/Oral/20ml/day for 8 days

Renal disease patients

↓sr. creat, urea and ↑Na+ and K+ kidneys were normal bilaterally (USG)

Misar35

4.

Punarnavadi Kwatha (Decoction)/Oral/40ml for 30 days

Patient with chronic renal failure (CRF)

↓Sr. creat, urea and ↑Hb

Patel, Patel36

5.

BD extract Capsule (250mg)/ Oral/2 capsules for 30 days

Hypertensive patients

↓Sr. creat, total cholesterol,↑Na+, K+, excretion and maintained the normal blood pressure

Nayak, Nayak37

6.

Neeri  syrup (containing BD)/ 15ml/Oral/7 days

Patients with Glomerulonephritis

↓ Fever, ↓abdominal pain, and the micturition was normal

Hagone and Kuchewar38

7.

BD extract capsule (250mg)/ Oral/2 capsules for 60 days

Hyperkalemic patients

K+ levels came to normal range

Sekhar and Anindya39

8.

Unex capsule (containing BD)/ Oral/ 2capsules for 15 days

Urolithiasis patients

USG abdomen, showed no evidence of calculus

Deshpande, Malekar40

↓: Decreased; ↑: Increased; Cl-: Chloride; GPx: Glutathione peroxidase; GSH: Reduced glutathione; GST: Glutathione S-transferase; Hb; Hemoglobin; USG:Ultrasonography; K+: Potassium; LPO: Lipid peroxidation Na+: Sodium;  s: Serum level of; s. creat: Serum level of creatinine

 


BD and Chronic Kidney Disease (CKD):

In vitro studies:

Kalaivani, Arockiasamy8 investigated the effect of ethyl acetate fraction (EF) of BD on cyclosporine A induced tubular cell damage in Madin-Darby canine kidney (MDCK) cell lines and found that BD protected the damaged kidney tubular cells from apoptosis and cell cycle arrest (Table 1). In addition, antioxidant property of BD was attributed to reduction of collagen accumulation and increased viability of MDCK cells.

 

In vivo studies:

In CKD-induced rats, BD extract lowered serum creatinine, BUN, urea, lipid profiles, and blood glucose levels, as well as increased antioxidant enzyme (SOD, CAT, GSH, GPx) levels and lowered MDA and LPO generation. These results showed BD was beneficial in improving the kidney function of CKD rats (Table 2) 16, 19, 22, 23, 29, 38.

 

Oburai, Rao14 administered root extract of BD along with conservative anti-hypertensive drug enalapril to canines with chronic renal failure (CRF). The study results showed significantly reduced systolic and diastolic blood pressure, serum creatinine, urea, nitrogen, phosphorus, urinary protein, ALP, and GGT levels. The mechanism attributed to the better results were the anti oxidant property of BD which reduced the LPO and increase the anti oxidant enzymes resulting in clinical improvement in CRF canines. Raval, Patel15 reported similar changes in the blood parameters in adenine induced CKD rats with administration of BD root extract.  Maurya and Kumar27 reported that the polyherbal formulation of BD (CATCAB-50) decreased the blood urea, uric acid, creatinine, and protein, and serum biomarkers ALT, AST and bilirubin in CCl4 induced glomerulonephritic rats. Indhumathi, Shilpa20 had shown that treatment of BD extract to mercuric chloride induced nephrotoxicity rats resulted in reduced ALT, AST and LPO and increased the levels of reduced glutathione, catalase, and Vitamin C.

 

Karwasra, Kalra17 documented the anti-inflammatory properties of BD. It reduced the TNF-α and active caspase-3 expressions in kidneys of cisplatin-induced nephrotoxic rats. Cisplatin is degraded into a highly reactive form in proximal tubular cells and depletes endogenous antioxidants, resulting in the accumulation of ROS and oxidative stress within the cells. The administration of BD was shown to prevent the drop in antioxidant enzymes (SOD, GSH) and inhibit lipid peroxidation. Enhanced inflammatory reactions and oxidative stress in the kidney's proximal tubule cells results in tubular cell death and necrosis. It was shown that BD suppresses elevated levels of pro-inflammatory cytokines TNF-α, IL-1, and IL-6, in addition to its anti-inflammatory capabilities.

 

Clinical trials:

Usage of BD in CKD, renal failure, and glomerulonephritis patients showed improvement in blood and urinary parameters as depicted in the table 3. Further Polyherbal combination containing BD resulted in reduced albuminuria, RBC, and blood glucose38.

 

Oxidative stress and inflammation play an important role in the development of CKD and its complications41. BD ameliorates both these phenomena contributing to the nephroprotective effects reported in these studies.

 

BD And Acute Kidney Injury (AKI):

AKI is defined as an abrupt loss of kidney function leading to the retention of nitrogenous and other waste products that would ordinarily be excreted by the kidneys. In acute kidney damage-induced rats, BD successfully lowered urea, uric acid, creatinine, BUN, Na+ and k+ excretion levels21,28,30.

 

In vitro studies:

Dachuri, Song10 investigated the nephroprotective properties of a polyherbal combination containing BD in cisplatin-induced cell injury model. The protective action of BD included antioxidant effects such as reduced ROS and increased SOD and CAT activity, decreased annexin V- positive apoptotic cells and cleaved caspase-3 expression, as well as inhibited the expression of mitogen-activated protein kinase-related proteins (Table 1).

 

In vivo studies:

Sawardekar and Patel13 showed that aqueous extract of BD root acted against gentamicin-induced nephrotoxicity. The extract reduced the levels of BUN, serum creatinine, GSH and MDA and reduced necrosis of renal tubules and restored the normal renal architecture. Gentamicin disrupts the mitochondrial respiratory chain leading to formation of reactive oxygen species. BD treatment enhanced the antioxidant enzymes and prevented the kidney injury. Rafiq, Viswanatha42 displayed improvement in renal function with a single dose of polyherbal combination containing BD (Cystone syrup). Further, the combination reduced the serum urea, creatinine, and BUN and increased the body weight. Yadav, Sharma26 demonstrated that in cisplatin-induced AKI, polyherbal combination containing BD reduced the increased serum levels of SOD, CAT, blood urea, creatinine, and LPO (Table 2).

 

Clinical trials:

Nayak, Nayak37 documented the use of BD capsules by hypertensive patients markedly reduced their blood pressure, serum urea, creatinine and total cholesterol (Table 3).

 

BD and Urolithiasis:

Urolithiasis is the formation of stones in the kidney, ureter, or bladder in humans. Increased levels of serum calcium, potassium, chloride and pH of urine would reduce the urine volume and induce the crystal aggregation and crystal-cell interaction within the renal tubules leading to the formation of renal calculus. Zalavadiya, Shah43, Suman44, and Dhole, Dhole45 reviewed traditional plants used in the treatment of urolithiasis.

 

BD treatment protected the kidney from crystal induced renal cell injury and other damage initiated by the calcium oxalate (CaOx) crystal deposition in kidneys of rats25,31. Further, BD extract maintained the urine volume through increase in the excretion of the Na+ and K+12. In various studies, the diuretic effect of BD reduced serum creatinine, uric acid, potassium, chloride, phosphorus, calcium, oxalate and increased the urine volume24,28,32.

 

Pareta, Patra25 showed BD extract to decrease the malondialdehyde (MDA), increased the antioxidant enzymes (SOD, CAT, GST, GPx) and reduced the crystal formation in the hyperoxaluria induced nephrotoxicity in rats.  In addition, BD decreased CaOx nucleation, aggregation, and formation of crystals in synthetic urine due to its diuretic property31. Further, BD also demonstrates potent analgesic activity, which could be beneficial in colic related to urolithiasis46.

 

BD and Urinary Tract Infection (UTI):

Vineeth, Deepak9 Deepak5revealed the bactericidal activity of BD leaves and an alcoholic preparation called Punarnavasavam (containing BD) on five urinary tracts infection causing pathogens namely Escherichia coli, Enterococcus, Klebsiella, Proteus, and Pseudomonas species.

 

BD and Kidney Disease in Corona Virus Disease (COVID-19):

SARS-CoV-2 infection not only affects the lungs but also reaches kidney causing collapsing glomerular disease and tubular necrosis by targeting angiotensin-converting enzyme II (ACE2) receptors resulting in AKI. Further, it complicates the treatment of existing kidney diseases and increases the mortality. One probable mechanism proposed for kidney damage in COVID-19 is the cytokine storm produced by the release of inflammatory mediators. It is postulated that drugs that can inhibit the inflammatory factors like IL-6, TNF-α could be helpful in the treatment of kidney disease in COVID-19 patients47.

 

Recent in-silico study revealed that phytochemicals Biorobin, Bioquercetin and Boerhavisterol present in BD docked to Main protease, a target protein of SARS-CoV-2. Among these phytochemicals, Biorobin had lowest binding energy and Boerhavisterol displayed druglikeness by obeying Lipinski’s rule48. Therefore, BD can probably exert protective action against COVID-19 induced kidney disease.

 

Antioxidant Property:

Existing literature substantiates the increased reactive oxygen species (ROS) circulation in kidney diseases. Increasing level of ROS leads to cellular damage and cell death by various mechanism. Plants BD and Trianthema portulacastrum L. are considered as punarnava. However, BD has been experimentally proved to have better antioxidant potential than Trianthema portulacastrum49. The studies cited in tables 1-3 show beyond doubt that BD has a significant antioxidant property, which reduces the ALT, AST, GGT, MDA, and GSH levels and increase the endogenous antioxidant (SOD, CAT, GPx, and GSH) levels13,14. Most of the available literature cites antioxidant property of BD as the central mechanism for amelioration of various pathologies involved in kidney diseases16,25,29,30

 

Anti-Inflammatory Property:

Inflammation is one of the main etiologies of kidney diseases and is ameliorated by diminishing expression of pro-inflammatory cytokines (IL-1b and IL-6) and apoptotic markers (cytochrome C and caspase 3).  BD extract has been shown to reduce the expression of pro-inflammatory markers and apoptotic markers in the nephrotoxicity induced rats8,17. Increased TNF-α expression reported in nephrotoxicity and renal tubular inflammation is also shown to be counteracted by the administration of BD22.

 

Antifibrotic Property:

BD extract has been shown to reduce the renal fibrosis through inhibition of extracellular collagen synthesis in the renal tubules8.

 

These studies reveal that BD is a promising plant that can be useful in both acute and chronic kidney diseases. It can be tested in end stage renal disease patients, who are depending on dialysis or renal transplantation. Very few studies have investigated the mechanisms other than antioxidant and anti-inflammatory namely antifibrotic, anti-apoptosis and inhibition of cell cycle arrest. In-depth molecular research is essential to establish the molecular targets modulated by BD while ameliorating the renal diseases. Further, it should be tested with randomized clinical trials to establish its activity in real clinical situations.

 

CONCLUSION:

Scientific research has provided valid basis for the BD and established the protective role of BD in various kidney disorders. It is very well evident from the in vitro and in vivo studies that BD has a beneficial role in challenging diseases like acute kidney disease and chronic kidney disease. While trying to establish the nephroprotective effect of BD, majority of the studies focus on its antioxidant and anti-inflammatory properties.  Further research is required to identify the important phytochemical substances in BD responsible for these biological and therapeutic effects. In addition, various mechanisms by which BD modulates the molecular pathology of various renal diseases are to be explored with their upstream and downstream targets. These efforts can help in the development of BD as a novel therapeutic agent for the successful management of renal disorders in the near future.

 

ACKNOWLEDGEMENTS:

The authors would like to thank Chettinad Academy of Research and Education for the financial support.

 

CONFLICT OF INTEREST:

There is no potential conflict of interest to declare.

 

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Received on 20.11.2021          Modified on 10.01.2022

Accepted on 24.02.2022        © RJPT All right reserved

Research J. Pharm. and Tech 2023; 16(2):962-968.

DOI: 10.52711/0974-360X.2023.00161