Anti-inflammatory and antioxidant capacity of plant extracts of Varronia curassavica: a systematic review of preclinical evidence
Cordia verbenacea; plant derivative; anti-inflammatory.
Varronia curassavica Jacq. This is a native, non-endemic species of Brazil found throughout the country. It is traditionally used to treat inflammatory conditions. This species is included in official Brazilian documents such as the National Phytotherapeutic Formulary of the Brazilian Pharmacopoeia (FFFB) and the List of Medicinal Plants of Interest to the Unified Health System (RENISUS). It is also the basis of a phytotherapeutic medicine registered with the National Health Surveillance Agency (ANVISA), which uses essential oil as an active ingredient. However, no registered products currently contain plant derivatives (extracts) obtained with organic solvents as active ingredients. Although essential oils and organic extracts are plant derivatives, their chemical composition is very different. Consequently, the anti-inflammatory pharmacological effects of essential oil obtained from the leaves cannot be extrapolated to other plant derivatives, such as those obtained with water or ethanol. In this context, a systematic review of the species is warranted to determine whether there is preclinical evidence to support the efficacy, safety and quality of plant derivatives obtained with organic solvents. This study aimed to conduct a systematic review of Varronia curassavica (ervabaleeira) to address questions regarding its antioxidant and anti-inflammatory capacity in preclinical models. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used to guide the selection, screening and eligibility of studies. The guiding question for this review was: "What are the antioxidant and anti-inflammatory capacities of Varronia curassavica (erva-baleeira) in preclinical models?" The search strategy used both MeSH and non-MeSH terms and searches were conducted in PubMed-Medline, Scopus, Web of Science and Embase. Data extraction was performed for the selected studies and the risk of bias was assessed using the risk of bias (RoB) tool of the Systematic Review Center for Laboratory Animal Experimentation (SYRCLE).The systematic review showed that the leaves were the most commonly used part of the plant in the studies. These were typically macerated in organic solvents, most commonly ethanol or 70% ethanol. Most of the studies on the extracts identified four main compounds: rosmarinic acid, artemetin, brickellin and cordialin A. Preclinical animal studies showed that oral administration of the extract significantly reduced the expression of pro-inflammatory cytokines such as TNF-α, IL-6 and IL-1β, reduced oedema and increased the activity of key antioxidant enzymes such as catalase and GSH. In contrast, oral administration of the essential oil also reduced oedema and TNF-α, but did not alter IL-1β or PGE2 levels.The methodological quality of the studies included in this systematic review was predominantly low risk, as most criteria for assessing bias were adequately reported.In conclusion, the evidence supporting the antioxidant and antiinflammatory capacities of organic extracts of V. curassavica is based on robust preclinical models. Ethanolic and hydroethanolic extracts obtained by maceration of erva-baleeira leaves were effective in combating inflammation in vivo, with oral administration serving as the primary route.