Effect of Piper betle on oxidative stress in patients with Systemic Lupus Erythematosus

Abstract Introduction: Systemic lupus erythematosus (SLE), an inflammatory autoimmune disorder, is associated with an enhanced generation of reactive oxygen species (ROS). Accordingly, this study aimed to monitor the intracellular redox status as a potential biomarker to monitor disease activity (SLEDAI-2K), as also evaluate the antioxidant activity of an ethanolic extract of Piper betle (PB). Materials and Methods: The baseline generation of ROS was measured by flow cytometry in peripheral blood immune cells (PBIC, neutrophils, lymphocytes, and monocytes) sourced from patients with SLE and healthy controls (HC), using 2 ′ , 7 ′ - dichlorodihydrofluorescein diacetate (H 2 DCFDA), and quantified in terms of geometric mean fluorescence channel (GMFC). Subsequently, the effect of PB (250-1000 μg/ml) on generation of ROS was measured. Results: The baseline generation of ROS in neutrophils and lymphocytes of patients with SLE was significantly raised as compared to HC and was reduced by PB in a dose-dependent manner. This reduction in the generation of ROS by PB was achieved through its free radical scavenging activity, as it prevented the enhanced generation of ROS following pre-treatment with Phorbol 12-myristate 13-acetate. Conclusion: In PBIC of patients with SLE, the enhanced oxidative stress was effectively attenuated by an antioxidant PB, through scavenging of free radicals, suggesting that inclusion of antioxidants may be considered as an add-on therapeutic approach in SLE.