Indonesia International (Bio)Medical Students’ Congress 2018

LITERATURE REVIEW: MORINGA OLEIFERA FOR REDUCE

CATARACTOGENESIS MECHANISM
Rina Elsa Rizkiana1, Kistia Rita Santi2
1
2016 Nursing Academy of Kesdam IV/Diponegoro (+6287832931221, Merbau Raya RT
05/RW 06 Padangsari, Banyumanik, Semarang, Central Java, Indonesia 50267,
xxx.elsa1357@gmail.com)
2
2017 Nursing Academy of Kesdam IV/Diponegoro

ABSTRACT

Background: Several studies have shown that oxidative stress plays an important role in the
mechanism of cataract known as cataractogenesis. Oxidative stress occurs when free radicals
exceeds the ability of lens cells to eliminate. Hyperglycemia in diabetic patients increases the
amount of oxidative stress that accelerates the process of cataractogenesis. Moringa Oleifera
has become a popular herb in the community in management of numerous diseases yet there is
insufficient scientific evidence to explain the mechanism of action and validate its apparent
uses and efficacy. Objective: improve knowledge about the function of Moringa Oleifera to
reduce the mechanisms cataractogenesis in DM patients based on evidence based. Methods:
The source journal or article is used obtained from a search through Google Scholar from 2008
to 2018. Then the authors make an assessment of the journal or article up to the stage of making
literature review. Results: This review illustrates that Moringa oleifera possesses some or the
other nutritional and medinical property. It is a reservoir of dietary supplements and act as
cardiac and circulatory stimulant with antioxidant, anti-inflammatory, antipyretic,
antiepileptic, antitumor, anticancer, diuretic, antihypertensive, antispasmodic,
hypocholestemic, antidiabetic, antibacterial, antifungal, antiulcer and hepatoprotective
properties. Moringa Oleifera can help to maintenance the process cataractogenesis in diabetes
mellitus occurs through three ways. Conclusion: Moringa oleifera can be herbal therapy for
reduce the process cataractogenesis in diabetes mellitus.

Keywords: Moringa Oleifera, Cataract, Cataractogenesis, Diabetus mellitus

INTRODUCTION
Herbal medicine is the oldest form of
healthcare known to mankind and most
cultures have long folk medicine histories
that include the use of plants. The WHO
recognizes herbal medicines as a valuable
and readily available resource for Primary
Health Care and has endorsed their safe and
effective use1. In recent decades, cataract is
the leading cause of blindness in Indonesia
and in the world2. Cataract is an eye disease
where the lens becomes cloudy so blurred
vision. Estimates of the incidence of
cataracts was 0.1% / year or every year
among 1,000 people there is a new cataract
patients. The figure puts Indonesia as the
country with the highest blindness in
Southeast Asia3. Indonesia's population
also has a tendency to suffer from cataracts
15 years sooner than people in the
subtropics.
Based on age, the Indonesian Association
of Ophthalmologists (Perdami) in 2013
noted, the prevalence of blindness due to
cataract higher in older age groups. In the
age group 45-59 years, the prevalence of
blindness due to cataract 20 cases per 1,000
people. As for the age group over 60 years,
50 cases per 1,000 people4. Research shows
that 31.4% of cataract patients also suffer
from diabetes5. The process of cataract
formation, known as cataractogenesis in
diabetic patients more quickly than non-
DM, it means that the lens in people
suffering from diabetes faster cloudy.
Since the inception of human civilization
man has been searching for food which can
keep him healthy and active6. In this
modern era of research and technology this
futile search still continues to discover
novel herbal drugs and alternate source of
nutritional supplements7. One such
promising tree which has successfully
cleared all the tests of nutritional benefits,
medicinal properties, environmental and
consumption safety is the perennial,
multipurpose, softwood-tree ‘Moringa
oleifera’ of the monogeneric family
Moringaceae8. Every part of this tree is
edible and the leaves, roots, seeds, root-
bark, stem-bark and pods have medicinal
properties9. Moringa is actually a versatile
tree and a nature’s medicine cabinet10. It
contains various glycosides of
thiocarbamate and isothiocyanate class.
Moringyne, pterygospermin, niaziridin, 4-
(α-L-rhamnopyranosyloxy) benzyl
isothiocyanate, 4-(α-L-
rhamnopyranosyloxy) benzyl
glucosinolate, etc are some of the
therapeutically proven compounds,
10
reported in Moringa . Many diseases and
chronic symptoms can be overcome10.
Literature review will discuss more about
the function of moringa oleifera for reduce
the process of formation of cataract
(cataractogenesis) in diabetic patients.
MATERIAL AND METHOD
The preparation of this literature review
begins with the selection of the topic,
followed by a search through Google
Scholar journal by using keywords. This
search is limited to journals and articles
from 2008 to 2018. The key words are
"moringa oleifera, cataract, visual acuity,
oxidative stress, reactive oxygen species".
Fulltext articles and abstracts were
reviewed in accordance with the inclusion
criteria. Criteria for inclusion in the
literature review are: moringa oleifera for
cataracts and mechanism of cataract
formation.
RESULT AND DISCUSSION
A common environmental factor in most
age-related cataracts is believed to be
oxidative stress. Cataract formation occurs
when the rate of reactive oxygen species
(ROS) production exceeds the rate of their
removal11. During environmental stress
(e.g. UV or heat exposure), ROS levels can
increase dramatically. In vitro and in vivo
studies suggest that light penetration into
the eye is a significant contributory factor
in the cataractogenesis, with the major
effect being through photochemical
generation of ROS and consequent
oxidative stress to the tissue12. This may
result in significant damage to cell
structures such as damage of DNA, RNA,
and proteins. Low levels of antioxidants,
such as glutathione and vitamin C or
inhibition of the antioxidant enzymes, such
as catalase (CAT), superoxide dismutase
(SOD) and various peroxidases, cause
oxidative stress and may damage or kill
cells13.
Cataracts in diabetic patients or often
known as diabetic cataract is the main cause
of visual impairment in patients with
diabetes mellitus. Pathophysiology of
diabetic cataract associated with the
accumulation of sorbitol in the lens and the
lens protein denaturation. Another theory
says that there are three mechanisms of a
cataract caused by hyperglycemia, is14:
1) The mechanism of glucose
autooxidation, or reactive oxygen
compounds that contain oxygen free
radicals in diabetic patients will
induce lipid peroxidation resulting in
the modification of cellular
macromolecules such as lipids, DNA
and proteins in various tissues
including the eye lens. Modification
of cellular macromolecules in various
tissues have led to a complex
syndrome in people with diabetes
including cataracts.
2) Glycation of protein nonenzimatik,
elevated levels of glucose in the
aqueous humor can induce protein
glycation in the lens, a process that
produces superoxide radical (O2-)
and the formation of advanced
glycation endproducts or AGE also
trigger the formation of free radicals.
3) Activity polyol metabolic pathway
that further accelerate the formation
of reactive oxygen compounds are
free radicals containing oxygen,
turbidity in the lens can occur due to
hydration (fluid replenishment) lens,
or as a result of denaturation of lens
proteins. In diabetes mellitus, the
accumulation of sorbitol in the lens
that will increase osmotic pressure
and cause fluid to build up in the lens.
While the protein denaturation occurs
due to oxidative stress by Reactive
Oxygen Species (ROS), which
oxidize proteins lens (crystalline).
The formation of excessive reactive oxygen
compounds resulting in an imbalance
between protective antioxidants and free
radicals in patients with DM resulting in
oxidative damage known as oxidative
stress. Oxidative damage in diabetic
patients is characterized by increased levels
of MDA in diabetic patients is higher than
the non DM15.
According that, the numerous uses of
Moringa Oleifera was compiled for
scientific recording and appropriate
application to avoid of cataractogenesis.
Moringa oleifera is actually a versatile tree
and a nature’s medicine cabinet10. It
contains various glycosides of
thiocarbamate and isothiocyanate class.
Moringyne, pterygospermin, niaziridin, 4-
(α-L-rhamnopyranosyloxy) benzyl
isothiocyanate, 4-(α-L-
rhamnopyranosyloxy) benzyl
glucosinolate, etc are some of the
therapeutically proven compounds,
reported in Moringa. Many diseases and
chronic symptoms can be overcome by the
virtue of its antihypertensive, antiasthmatic,
diuretic, anticancer, antibiotic, antiulcer,
analgesic, central nervous system (CNS)-
depressant, antiepileptic, antiinflammatory,
antihelminthic and antiurolithiatic
properties16.
Antidiabetic activity
An extract from the moringa leaf has been
shown to be effective in lowering blood
sugar levels within 3hrs ingestion, though
less effectively than the standard
hypoglycemic drug, glibenclamide.
Wound healing properties18
Three wound models viz excision wound,
incision wound and dead space wound were
selected for assessing wound healing
activity of ethanolic and ethyl acetate
extracts of leaves. Ethyl acetate extracts
(10% extract in the form of ointment)
showed significant wound healing activity
that is comparable with the standard vicco
turmeric cream. Phytosterols and phenolic
compounds present in these extracts
promote the wound healing activity.
Antipyretic activity and analgesic
activity18
The antipyretic activity of ethanolic,
petroleum ether, solvent ether and ethyl
acetate extracts of seeds was screened using
yeast induced hyperpyrexia method.
Paracetamol I.P (200mg/ kg) was used as
standard for comparison. The ethanolic and
ethyl acetate extracts of seeds showed
significant antipyretic activity. The
experimental studies have shown that
alcoholic extract of leaves and seeds of
Moringa oleifera possess marked analgesic
activity. It is equipotent to standard drug
(Aspirin 25mg/ kg.).
Anti-Inflammatory activity and anti
asthmatic activity18
Poultice of leaves is beneficial in glandular
swellings.
In blindness and eye infections18
Though there are many causes of blindness
Vitamin A deficiency causes impaired dark
adaptation and night blindness. Eating
Moringa leaves, pods and leaf powder
which contain high proportion of Vitamin
A can help to prevent night blindness and
eye problems in children. Ingesting
drumstick leaves (Beta- carotene and
leutin) with oil helps in improving Vitamin
A nutrition and perhaps delays the onset of
cataract. Also the juice can be instilled into
eyes in cases of conjunctivitis.
CONCLUSION
The Moringa oleifera tree is remarkable
because all parts of the tree are edible and
reliable alternatives to provide good
nutrition, and a number of promising
applications from a biotechnology point of
view. It provides a rich, rare and perfect
combination of nutrients, amino acids,
antidiabetic, antioxidants, anti-aging and
antiinflammatory
properties used for nutrition and healing.
There have been several studies conducted
so far about their immediate effects on
humans. Given the enormous benefits to
humanity, research that is medically
controlled with human subjects is
importantly, to document the bio
availability and effectiveness of Moringa
leaf nutrients. Moringa oleifera also a
promising source of herbal therapy in an
effort to maintain eye health controlling
consumption excessive glucose from
exposure against the risk of diabetes that
resulted in cataracts thus reducing the
mechanism of cataractogenesis in people
with diabetes mellitus. Using moringa
oleifera as an herbal therapy will support
the enhancement of Healthy Eye
socialization Vision 2020 and perform
strategically programs for the community in
particular prevention and treatment of
cataracts disease as the number one cause
blindness in Indonesia and the world.
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