The Effect of Jeruju Leaf Brew (Acanthus ilicifolius L) on HOMA-IR and TNF-α in White Rats Induce by STZ-NA
DOI:
https://doi.org/10.31964/mltj.v11i1.648Keywords:
Acanthus Ilicifolius, homeostatic model assessment of insulin resistance (HOMA-IR), jeruju, tumor necrosis factor alpha (TNF-α), type 2 diabetes mellitus (T2DM)Abstract
The International Diabetes Federation (IDF) has reported a consistent global rise in the prevalence of type 2 diabetes mellitus (T2DM). Conventional T2DM treatments such as metformin, sulfonylureas, and insulin therapy are effective. Still, they can lead to side effects, including gastrointestinal disturbances, hypoglycemia, renal impairment, weight gain, and complications associated with injection procedures. The herbal remedies are considered a natural alternative with fewer adverse effects. Acanthus ilicifolius (Jeruju) contains antioxidant compounds such as flavonoids, alkaloids, and saponins and may serve as a complementary therapy. This study investigated the effect of jeruju leaf brew at 6 ml/kg/day and 12 ml/kg/day on tumor necrosis factor alpha (TNF-α) and homeostatic model assessment of insulin resistance (HOMA-IR) levels. Using a true experiment with a randomized post-test only with a control group design, 30 rats were divided into five groups (K0, K−, K+, P1, and P2). After 28 days of intervention, groups P1 and P2 showed significant reductions in TNF-α (7.80 pg/ml and 6.94 pg/ml, respectively) and HOMA-IR (3.75 and 3.28, respectively). These findings indicate that a higher dose of jeruju leaf brew results in greater reductions in TNF-α and HOMA-IR levels in T2DM rats.References
Abdullah, D. (2024). Literatur Review Terapi Herbal pada Penyakit Diabetes Anak L. Journal of Public Health Science (JoPHS), 1(2).
Adhikari, B. (2021). Roles of Alkaloids from Medicinal Plants in the Management of Diabetes Mellitus. In Journal of Chemistry (Vol. 2021). Hindawi Limited. https://doi.org/10.1155/2021/2691525
Álvarez‐Cilleros, D., Martín, M. Á., & Ramos, S. (2018). (‐)‐Epicatechin and the Colonic 2,3‐Dihydroxybenzoic Acid Metabolite Regulate Glucose Uptake, Glucose Production, and Improve Insulin Signaling in Renal NRK‐52E Cells. Molecular Nutrition & Food Research, 62(4). https://doi.org/10.1002/mnfr. 201700470
American Diabetes Association. (2015). 2. Classification and Diagnosis of Diabetes. Diabetes Care, 38(Supplement_1), S8–S16. https://doi.org/ 10.2337/dc15-S005
Anjani, G., Widyastuti, N., Masruroh, Z., Ayu, R., Yuliana, D., Almira, V. G., Fahmy, A., Tsani, A., Nissa, C., & Prawira-Atmaja, I. (2020). Bioactive components and antibacterial activity in Robusta coffee leaves (coffea canephora). International Journal of Pharmaceutical Research, 12(3).
Arnetta Deandra, A., Atfal Prayoga, D., Latifah, E., Kusuma Wardani, A., Septie Dianita, P., Pribadi, P., Setyowati Esti Rahayu, H., Wijayanti, K., & Ilmu Kesehatan, F. (2024). Kandungan Fitokimia dan Aktivitas Farmakologi Tanaman Mangrove Jeruju (Acanthus ilicifolius): Narrative Review. Jurnal Ilmu Farmasi, 15(2).
Ashari, A., & Nurinda, E. (2021). Perbaikan Kadar Insulin Tikus Jantan Galur Wistar Terinduksi Streptozotocin (STZ) Akibat Pemberian Ekstrak Etanol Batang Brotowali. 5(1), 1–8. https://doi.org/10.21927/inpharnmed.v%vi%i. 1253
Azhar, R., Romdhoni, M. F., Karita, D., & Bahar, Y. (2022). Pengaruh Ekstrak Etanol Daun Kersen (Muntingia calabura L.) terhadap Peningkatan Kadar Insulin Tikus Putih Model Diabetes Melitus Tipe 2 setelah Induksi STZ-NA. Muhammadiyah Journal of Geriatric, 3(2), 46. https://doi.org/10.24853/mujg. 3.2.46-53
Balta, I., Stef, L., Butucel, E., Gradisteanu Pircalabioru, G., Venig, A., Ward, P., Deshaies, M., Pet, I., Stef, D., Koyun, O. Y., Callaway, T. R., Gundogdu, O., & Corcionivoschi, N. (2022). The Antioxidant Effect of Natural Antimicrobials in Shrimp Primary Intestinal Cells Infected with Nematopsis messor. Antioxidants, 11(5), 974. https://doi.org/10.3390/antiox11050974
Batubara, R., Aulia, K., Ismanelly Hanum, T., Affandi, O., & Ulfa, M. (2022). Antioxidant activity and microbial contamination of jeruju leaf tea with ginger and lemongrass variant packaging in storage period. IOP Conference Series: Earth and Environmental Science, 1115(1). https://doi.org/10.1088/1755-1315/1115/1/ 012102
Biswas, R., Rahman, S. M. M., Mohammed, K., Islam, D., Billah, M. M., Aunjum, A., Rahman Nurunnabi, T., Kumar Kundu, S., & Islam, M. E. (2019). Antioxidant, Anti-inflammatory, and Anticoagulation Properties of Aegiceras corniculatum and Acanthus ilicifolius. Pharmaceutical and Biomedical Research, 5(3), 35–44. http://pbr.mazums.ac.ir
Blokhina, o. (2003). Antioxidants, Oxidative Damage and Oxygen Deprivation Stress: a Review. Annals of Botany, 91(2), 179–194. https://doi.org/10. 1093/aob/mcf118
Cordero‐Herrera, I., Martín, M. A., Bravo, L., Goya, L., & Ramos, S. (2013). Cocoa flavonoids improve insulin signalling and modulate glucose production via AKT and AMPK in HepG2 cells. Molecular Nutrition & Food Research, 57(6), 974–985. https://doi.org/10.1002/mnfr.201200500
Deutschländer, M. S., Lall, N., Van de Venter, M., & Hussein, A. A. (2011). Hypoglycemic evaluation of a new triterpene and other compounds isolated from Euclea undulata Thunb. var. myrtina (Ebenaceae) root bark. Journal of Ethnopharmacology, 133(3), 1091–1095. https://doi.org/10.1016/j.jep.2010. 11.038
Gayathri, G., & Kavya P. (2023). Vitexin isolated from Acanthus ilicifolius L. leaf enhances GLUT-4 translocation in experimental diabetic rats. Research Square, 1–35.
Ghasemi, A., Khalifi, S., & Jedi, S. (2014). Streptozotocin-nicotinamide-induced rat model of type 2 diabetes (review). Acta Physiologica Hungarica, 101(4), 408–420. https://doi.org/10.1556/APhysiol.101.2014.4.2
Gheibi, S., Kashfi, K., & Ghasemi, A. (2017). A practical guide for induction of type-2 diabetes in rat: Incorporating a high-fat diet and streptozotocin. Biomedicine & Pharmacotherapy, 95, 605–613. https://doi.org/10.1016/ j.biopha.2017.08.098
Islam, Md. S., Islam, Md. T., Washim, M. R., Haque, A. T., Haque, Md. I., Islam, H. R., Rashid, Md. H., & Mahmud, Y. (2024). Antioxidant potentials of Acanthus ilicifolius leaves from Southwest Coastal Region of Bangladesh. Food Chemistry Advances, 5, 100807. https://doi.org/10.1016/j.focha.2024. 100807
Karim, R., Begum, M. M., Alim, M. A., Uddin, M. S., Kabir, M. T., Khan, A. F., Islam, T., Khan, S. I., & Rahman, M. S. (2021). Effects of Alcoholic Extracts of Bangladeshi Mangrove Acanthus ilicifolius Linn. (Acanthaceae) Leaf and Stem on Atherogenic Model of Wistar Albino Rats. Evidence-Based Complementary and Alternative Medicine, 2021. https://doi.org/10.1155/ 2021/7539037
Kaseda, K., Kai, Y., Tajima, M., Suematsu, M., Iwata, S., Miyata, M., Mifude, C. K., Yamashita, N., Seiryu, W. A., Fukada, M., Kobayashi, H., Sotokawauchi, A., Matsui, T., & Yamagishi, S. (2020). Oral administration of spa-derived green alga improves insulin resistance in overweight subjects: Mechanistic insights from fructose-fed rats. Pharmacological Research, 152, 104633. https://doi.org/10. 1016/j.phrs.2020.104633
Kumari, M., & Jain, S. (2012). Tannin: An Antinutrient with Positive Effect to Manage Diabetes. Research Journal of Recent Sciences, 1(12). www.isca.in
Lee, S.-J., Han, J.-M., Lee, J.-S., Son, C.-G., Im, H.-J., Jo, H.-K., Yoo, H.-R., Kim, Y.-S., & Seol, I.-C. (2015). ACE Reduces Metabolic Abnormalities in a High-Fat Diet Mouse Model. Evidence-Based Complementary and Alternative Medicine, 2015, 1–8. https://doi.org/10.1155/2015/352647
Lee, T. T. L., Hui, J. M. H., Lee, Y. H. A., Satti, D. I., Shum, Y. K. L., Kiu, P. T. H., Wai, A. K. C., Liu, T., Wong, W. T., Chan, J. S. K., Cheung, B. M. Y., Wong, I. C. K., Cheng, S. H., & Tse, G. (2022). Sulfonylurea Is Associated With Higher Risks of Ventricular Arrhythmia or Sudden Cardiac Death Compared With Metformin: A Population‐Based Cohort Study. Journal of the American Heart Association, 11(18). https://doi.org/10.1161/JAHA.122.026289
Made Sugi Pradnyasuari, N., & Agung Gede Rai Yadnya Putra, A. (2023). Review Artikel Potensi Tanaman Jeruju (Acanthus ilicifolius L.) sebagai Antiinflamasi. Prosiding Workshop Dan Seminar Nasional Farmasi, 2.
Mahgoub, M. O., Ali, I. I., Adeghate, J. O., Tekes, K., Kalász, H., & Adeghate, E. A. (2023). An Update on the Molecular and Cellular Basis of Pharmacotherapy in Type 2 Diabetes Mellitus. International Journal of Molecular Sciences, 24(11), 9328. https://doi.org/10.3390/ijms24119328
Mani Senthil Kumar, K. T., Gorain, B., Roy, D. K., Zothanpuia, Samanta, S. K., Pal, M., Biswas, P., Roy, A., Adhikari, D., Karmakar, S., & Sen, T. (2008). Anti-inflammatory activity of Acanthus ilicifolius. Journal of Ethnopharmacology, 120(1), 7–12. https://doi.org/10.1016/j.jep.2008.07.024
Margono, D. P. N. H., Suhartono, E., & Arwati, H. (2016). Potensi Ekstrak Kelakai (Stenochlaena palustris (Burm.f) Bedd) Terhadap Kadar Tumor Necrosis Factor Alfa (TNF-α) Pada Mencit BALB/c yang Diinfeksi Plasmodium berghei ANKA. Berkala Kedokteran, 12(1), 77–85.
Martin, M. Á., Goya, L., & Ramos, S. (2016). Antidiabetic actions of cocoa flavanols. Molecular Nutrition & Food Research, 60(8), 1756–1769. https://doi.org/10.1002/ mnfr.201500961
Martín, M. Á., & Ramos, S. (2021). Dietary Flavonoids and Insulin Signaling in Diabetes and Obesity. Cells, 10(6). https://doi.org/10.3390/cells10061474
Meditory, M., & Issn Online, |. (2021). Pengaruh Pemberian Streptozotocin Dosis Tunggal terhadap Kadar Glukosa Darah Tikus Wistar (Rattus norvegicus). Meditory, 9(1), 2338–1159.
Natarajan, S., Rameshbabu, V., Ariharasudhan, S., Hayavadana, J., Rajpurohit, T., & Prakash, C. (2024). Antimicrobial properties of Acanthus ilicifolius and determination of phytochemical composition. Biomass Conversion and Biorefinery, 14(23), 29719–29726. https://doi.org/10.1007/s13399-023-04723-7
Ni Made Sugi Pradnyasuari, & Anak Agung Gede Rai Yadnya Putra. (2023a). Potensi Tanaman Jeruju (Acanthus ilicifolius L.) sebagai Antiinflamasi. Prosiding Workshop Dan Seminar Nasional Farmasi, 2, 218–230. https://doi.org/10.24843/ WSNF.2022.v02.p18
Ni Made Sugi Pradnyasuari, & Anak Agung Gede Rai Yadnya Putra. (2023b). Potensi Tanaman Jeruju (Acanthus ilicifolius L.) sebagai Antiinflamasi. Prosiding Workshop Dan Seminar Nasional Farmasi, 2, 218–230. https://doi.org/10.24843/ wsnf.2022.v02.p18
Nurfitri, W. A., Linirin Widiastuti, E., & Cahyani, N. (2019). Efek Ekstrak Metanol Daun Jeruju (Acanthus ilicifolius L.) serta Buah Jeruju dan Taurin dalam Menurunkan Kadar Glukosa Darah dan Kolesterol serta Fertilitas Mencit Jantan (Mus musculus) yang diinduksi Aloksan. Prosiding Seminar Nasional Tumbuhan Obat Indonesia Ke 55, 1(1), 267–275.
Oktora, S. I., & Butar Butar, D. (2022). Determinants of Diabetes Mellitus Prevalence in Indonesia. Jurnal Kesehatan Masyarakat, 18(2), 266–273. https://doi.org/10.15294/kemas.v18i2.31880
Pan, Q., Xu, Y., Yang, N., Gao, X., Liu, J., Yang, W., & Wang, G. (2016). Comparison of Acarbose and Metformin on Albumin Excretion in Patients With Newly Diagnosed Type 2 Diabetes. Medicine, 95(14), e3247. https://doi.org/10.1097/ MD.0000000000003247
Patel, P. , Patel, H., Bhagiya, H., Kacha, B., & Christian, A. (2022). Type-2 Diabetes Mellitus: A Review of Current Trends. Journal of Pharmaceutical Research, 21(4), 95–104. https://doi.org/10.18579/jopcr/v21i4.22.21
Peng, Y., Ao, M., Dong, B., Jiang, Y., Yu, L., Chen, Z., Hu, C., & Xu, R. (2021). Anti-Inflammatory Effects of Curcumin in the Inflammatory Diseases: Status, Limitations and Countermeasures. Drug Design, Development and Therapy, 15, 4503–4525. https://doi.org/10.2147/DDDT.S327378
PERKENI. (2021). Pedoman Pengelolaan dan Pencegahan Diabetes Mellitus Tipe 2 di Indonesia 2021. https://pbperkeni.or.id/wp-content/uploads/ 2021/11/22-10-21-Website-Pedoman-Pengelolaan-dan-Pencegahan-DMT2-Ebook.pdf. Accessed March 5, 2025
Petersmann, A., Müller-Wieland, D., Müller, U. A., Landgraf, R., Nauck, M., Freckmann, G., Heinemann, L., & Schleicher, E. (2019). Definition, Classification and Diagnosis of Diabetes Mellitus. Experimental and Clinical Endocrinology & Diabetes, 127(S 01), S1–S7. https://doi.org/10.1055/a-1018-9078
Pothiraj, C., Balaji, P., Shanthi, R., Gobinath, M., Suresh Babu, R., Munirah, A. A.-D., Ashraf, A. H., Ramesh Kumar, K., Veeramanikandan, V., & Arumugam, R. (2021). Evaluating antimicrobial activities of Acanthus ilicifolius L. and Heliotropium curassavicum L against bacterial pathogens: an in-vitro study. Journal of Infection and Public Health, 14(12), 1927–1934. https://doi.org/10.1016/j.jiph.2021.10.013
Rahman, Md. A., & Islam, S. (2024). The complications of long time treatment of insulin therapy in type-2 diabetes patients: A Review. Molecular Mechanism Research, 2(1), 6172. https://doi.org/10.59429/mmr.v2i1.6172
Riwu, M., Subarnas, A., & Lestari, K. (2015). The Correlation of Age Factor, Administration, and Metformin Dose Against Risk of Side Effect on Type 2 Diabetes Mellitus. Indonesian Journal of Clinical Pharmacy, 4(3), 151–161. https://doi.org/10.15416/ijcp.2015.4.3.151
Rizeki, E., Safrida, S., & Supriatno. (2020a). Ehanol extract from Achantus Ilicifolius L. leaves as anti-inflammatory ulcers in Mus musculus L. Journal of Physics: Conference Series, 1460(1). https://doi.org/10.1088/1742-6596/ 1460/1/012056
Rizeki, E., Safrida, S., & Supriatno. (2020b). Ehanol extract from Achantus Ilicifolius L. leaves as anti-inflammatory ulcers in Mus musculus L. Journal of Physics: Conference Series, 1460(1), 012056. https://doi.org/10.1088/1742-6596/1460/1/ 012056
Rudianto, A. (2011). The Indonesian Society of Endocrinology’s Summary Article of Diabetes Mellitus National Clinical Practice Guidelines. Journal of the ASEAN Federation of Endocrine Societies, 26(1), 17.
Sadeer, N. B., & Mahomoodally, M. F. (2022). Acanthus ilicifolius L. In Mangroves with Therapeutic Potential for Human Health (pp. 159–171). Elsevier. https://doi.org/ 10.1016/B978-0-323-99332-6.00018-7
Sahoo, J. P., Behera, L., Praveena, J., Sawant, S., Mishra, A., Sharma, S. S., Ghosh, L., Mishra, A. P., Sahoo, A. R., Pradhan, P., Sahu, S., Moharana, A., & Samal, K. C. (2021). The Golden Spice Turmeric (Curcuma longa) and Its Feasible Benefits in Prospering Human Health A Review. American Journal of Plant Sciences, 12(03), 455–475. https://doi.org/10.4236/ajps.2021. 123030
Sharifi-Rad, M., Anil Kumar, N. V., Zucca, P., Varoni, E. M., Dini, L., Panzarini, E., Rajkovic, J., Tsouh Fokou, P. V., Azzini, E., Peluso, I., Prakash Mishra, A., Nigam, M., El Rayess, Y., Beyrouthy, M. El, Polito, L., Iriti, M., Martins, N., Martorell, M., Docea, A. O., … Sharifi-Rad, J. (2020). Lifestyle, Oxidative Stress, and Antioxidants: Back and Forth in the Pathophysiology of Chronic Diseases. Frontiers in Physiology, 11. https://doi.org/10.3389/fphys.2020. 00694
Sravani, D., Machiraju, P. V. S., & Satyaveni, S. (2024). Antioxidant and Antimicrobial Potentials of Acanthus ilicifolius and Excoeceria Agallocha Mangrove Plant Raw Leaf Extracts. Journal of Chemical Health Risks Www.Jchr.Org JCHR, 14(4), 799. www.jchr.org
Sujono, T. A., Nurrochmad, A., Lukitaningsih, E., & Nugroho, A. E. (2021). Immunomodulatory Effect of Methanolic Extract and Ethyl Acetate Fraction of Bengkoang (Pachyrhizus erosus (L.) Urban) Tuber in Mice. Pharmacognosy Journal, 13(1), 59–65. https://doi.org/10.5530/pj.2021.13.9
Udayani, N. N. W., Ratnasari, N. L. A. M., Cahyaningsih, E., & Wardani, I. G. A. A. K. (2021). Evaluasi Efek Samping Penggunaan Kombinasi Insulin pada Pasien Diabetes Melitus Tipe 2 di Salah Satu Rumah Sakit Kabupaten Denpasar. Jurnal Ilmiah Medicamento, 7(2), 112–117. https://doi.org/ 10.36733/medicamento. v7i2.2178
Ulya, N. A., Esti Rahayu, H. S., & Pribadi, P. (2022). The extract of Jeruju plant for anti-inflammatory: A literature review using nursing perspective. Journal of Holistic Nursing Science, 9(2), 96–100. https://doi.org/10.31603/nursing. v9i2.7127
Vani, M., & Manikandan, T. (2018). Phytochemical analysis and antioxidant activity of Acanthus ilicifolius. International Journal Curr Res, 10(12).
Verma, P., Patel, R., Patel, N., Patel, K., Patel, K., & Shah, M. (2020). Acanthus ilicifolius: A True Mangrove with Biomedical Potential. Certified Journal │ 472 Shah et al. World Journal of Pharmacy and Pharmaceutical Sciences, 9(11). https://doi.org/10.20959/wjpps202011-17428
Vira Arunita, A., Setyowati, H., Rahayu, E., & Pribadi, P. (2023). The Effectiveness of Jeruju Plant Extract (Acanthus ilicifolius) as Anticancer: Literature Review. 21(1), 2023.
Wardani, P. K., Gunarti, D. R., & Wulandari, Y. (2023). Peran Flavonoid terhadap TNF Alpha pada Endometriosis . Jurnal Darma Agung, 31(3), 241. https://doi.org/10. 46930/ojsuda.v31i3.3454
Widiastuti, E. L., Ardiansyah, B. K., Nurcahyani, N., & Silvinia, A. (2021). Antidiabetic Potency of Jeruju (Acanthus ilicifolius L.) Ethanol Extract and Taurine on Histopathological Response of Mice Kidney (Mus musculus L.) Induced by Alloxan. Journal of Physics: Conference Series, 1751(1). https://doi.org/ 10.1088/1742-6596/1751/1/012052
Wulansari, N. T., Padmiswari, A. A. I. M., Harditya, K. B., & Sintyadewi, P. R. (2024). Acanthus ilicifolius Leaf Extract Potential as an Alternative Functional Food Beverage. Jurnal Pijar Mipa, 19(2), 331–336. https://doi.org/10.29303/jpm.v19i2. 6590
Za’abi, M. Al, Ali, B. H., Al Suleimani, Y., Adham, S. A., Ali, H., Manoj, P., Ashique, M., & Nemmar, A. (2021). The Effect of Metformin in Diabetic and Non-Diabetic Rats with Experimentally-Induced Chronic Kidney Disease. Biomolecules, 11(6), 814. https://doi.org/10.3390/biom11060814
Zhang, Y., Shen, J., Ma, X., Yao, M., Zhang, Y., & Cao, D. (2022). Anti-infammatory and antioxidant activities of acteoside isolated from Acanthus ilicifolius var. xiamenensis. Applied Biological Chemistry, 65(1), 29. https://doi.org/10.1186/ s13765-022-00695-w
Zhong, R., Miao, L., Zhang, H., Tan, L., Zhao, Y., Tu, Y., Angel Prieto, M., Simal-Gandara, J., Chen, L., He, C., & Cao, H. (2022). Anti-inflammatory activity of flavonols via inhibiting MAPK and NF-κB signaling pathways in RAW264.7 macrophages. Current Research in Food Science, 5, 1176–1184. https://doi.org/ 10.1016/j.crfs.2022.07.007
Zohora, F. T., Hasan, A. H. M. N., Alam, K. M. K., & Wahed, T. B. (2023). Traditional Use, Phytochemistry, Pharmacological and Toxicological Properties of <i>Acanthus ilicifolius</i>: A Review. Journal of Biosciences and Medicines, 11(05), 181–192. https://doi.org/10.4236/jbm. 2023.115013
Zu, G., Sun, K., Li, L., Zu, X., Han, T., & Huang, H. (2021). Mechanism of quercetin therapeutic targets for Alzheimer disease and type 2 diabetes mellitus. Scientific Reports, 11(1), 22959. https://doi.org/10.1038/s41598-021-02248-5.
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