Herbal Medicine for Autoimmune Diseases

The immune system is a defense mechanism against infections and illnesses caused by various agents, including bacteria, viruses, and other causative factors. Any disruption in the functioning of the immune system, which is highly organized and precisely regulated, can result in the emergence of immune deficiencies, hypersensitivity reactions, or autoimmune diseases (AIDs). Under certain circumstances, the immune system generates autoantibodies that target their cells, giving rise to AIDs, including multiple sclerosis, type I diabetes, rheumatoid arthritis, inflammatory bowel disease, hashimoto thyroiditis, systemic lupus erythematosus, psoriasis, etc. In such cases, the immune system cannot differentiate between foreign substances and the body's own cells. Different factors, such as genetic, epigenetic, and environmental factors, trigger autoimmunity. Currently, autoimmune diseases of various origins are managed using glucocorticoids, non-steroidal anti-inflammatory drugs, immunosuppressive agents, and biological treatments. Nevertheless, a comprehensive cure for these conditions continues to remain beyond our reach. Numerous herbal natural products have been investigated as potential alternative approaches for the management of autoimmune disorders. In this introductory chapter, we summarized the essential concepts of the immune system, the formation, stages, and types of autoimmune diseases, and the role of herbal medicines in the management of AIDs.

The well-known inflammatory and autoimmune condition known as systemic lupus erythematosus (SLE) causes symptoms in the kidneys, the skin, the brain, and the heart. It can also cause complications that affect several organs. The diversity in organ involvement and heterogeneous conditions of patients led to the complicated management of SLE. Increasingly, there is evidence highlighting the importance of phytochemicals in both dietary and non-dietary contexts in the management of SLE without side effects.

Herein, we discuss the role of different plant extracts with their metabolites and their modes of action against SLE updated to 2023, in addition to the incorporation of herbal formulas in the management of the SLE. The present work is an overview of different plant extracts and their secondary metabolites with significant anti-inflammatory, antioxidant, and immunomodulation in SLE. The current chapter focuses on the various targets, mechanisms, and pathways of natural products that manage SLE. Based on the current work, it can be inferred that natural products show potential as effective agents in the medical care of SLE.

The global incidence of type 1 diabetes mellitus (T1DM) is rising substantially and T1DM remains a marked economic burden despite advances in the diagnosis, prevention, and treatment of complications. T1DM, often associated with autoimmune disease, is characterized by insulin deficiency and insufficiency due to beta cell destruction. The primary treatment for T1DM is insulin therapy, limited by the risk of hypoglycemia and weight gain. Other treatments for T1DM are teplizumab and donislecel, which have recently received FDA approval. Beyond these treatment options, T1DM patients are interested in non-pharmacological interventions and are willing to use herbal products. Therefore, we reviewed the effects of herbal medicines used for T1DM, including fenugreek, ficus extracts, cinnamon, berberine, silymarin, silibinin, curcumin, resveratrol, catechins, ginseng, olive leaf, allicin, thymoquinone, and mangiferin to understand their level of evidence and associated effects, and their potential for use as antidiabetic agents in the clinic. As a result of our research, the majority of the studies were conducted on diabetic animal models. There are limited clinical studies investigating herbal medicines in T1DM. Studies show that the abovementioned herbal medicines are beneficial in T1DM by lowering glucose levels, increasing insulin levels, and exerting anti-oxidant, anti-inflammatory, and pancreas islet β-cell protective mechanisms. However, these studies are insufficient to recommend the use of existing herbs in treating T1DM on a clinical level.

Phyto-nanotechnology presents a promising avenue for revolutionizing rheumatoid arthritis (RA) treatment. By integrating plant-derived compounds with nanotechnology, this approach addresses the limitations of conventional RA therapies. Nanoformulations of phytochemicals, such as curcumin, resveratrol, and quercetin, enable targeted drug delivery to inflamed joints, optimizing therapeutic efficacy while minimizing systemic side effects. Enhanced bioavailability, attributed to the encapsulation of phytochemicals within nanoparticles, facilitates improved pharmacokinetics and delivery across biological barriers. The immunomodulatory and anti-inflammatory properties of phytochemicals are harnessed more effectively through nanoparticle-mediated sustained release, offering the potential to suppress inflammatory processes and mitigate joint damage. Furthermore, the cartilageprotective and regenerative capabilities of certain plant-derived compounds can be optimized with nanotechnology, promoting joint health. The versatility of phytonanotechnology allows for combination therapies, synergizing the benefits of multiple compounds and conventional drugs within nanoparticles. While these advancements hold substantial promise, further research is imperative to refine nanoparticle formulations, assess safety, and validate efficacy through preclinical and clinical studies, ultimately paving the way for transformative RA treatments in clinical practice. In this chapter, phyto-nano drug delivery systems that can increase the effectiveness of medicinal plants in RA treatment are focused on.

Inflammatory bowel disease (IBD) that affects a large population worldwide, is a gastrointestinal disorder that includes Crohn’s disease and ulcerative colitis. The genetic factors, immunological, and microbial factors play critical roles in the pathogenesis of IBD. However, there is still no pharmacological therapy providing the definitive treatment of the disease. Gastrointestinal symptoms of IBD significantly reduce the patient's quality of life and IBD patients often tend to use herbal medicines as an alternative and complementary therapy for improving the symptoms. Among herbal medicines used for IBS, Andrographis paniculata, Boswellia serrata, and Aloe vera are prominent plant species, and catechins and curcumin are the commonly investigated phytochemicals. Here, we summarized the main factors in the pathogenesis of IBD, the current treatment strategies, and commonly used natural compounds and herbs with evidence-based data. The findings pointed out that further clinical trials having a higher sample size are required prior to the recommended use of these herbal medicines in therapy.

Multiple sclerosis (MS) is an autoimmune disease that causes myelination defects and axonal impairment in the central nervous (CNS) system, causing inhibition of electrical transmission. The disease's typical symptoms include stiffness, persistent discomfort, exhaustion, motor and mobility problems, and cognitive deficits. Although immunosuppressive and immune-modulating medications have been the fundamental basis of MS treatment, there is currently no known treatment for the disease. Herbaloriginated therapies are now being considered a possible therapeutic option for MS by using medicinal plant extracts or phytochemicals. Numerous research works have emphasized the medicinal herbs' anti-inflammatory and antioxidant properties, which make them a natural treatment for MS. According to the literature, several plants, such as hemp, turmeric, ginkgo, St. John's wort, black cumin, ginseng, and ginger have been reported to have various therapeutic effects in MS patients. Otherwise, the most promising substances that have been suggested to treat MS symptoms include curcumin, resveratrol, cannabinoids, apigenin, omega 3, and vitamin D. In this chapter, we compiled medicinal plants, and phytochemicals that have potential effects on MS. It is suggested that clinical trials were conducted on MS patients with medicinal plants, which were prominent in vivo findings. We also advise further research in this field to identify the precise active ingredients present in these extracts for the best composition necessary for the intended therapeutic effect.

Celiac disease (CD) manifests as a targeted autoimmune response that adversely affects the small intestine, primarily affecting individuals with a particular genetic predisposition. Diagnosis centers on identifying this gluten-sensitive enteropathy, which can be ameliorated through the implementation of a gluten-free diet (GFD), correlating with mucosal healing and symptom alleviation. The human microbiota, a vast symbiotic community within the gastrointestinal tract, profoundly impacts human health. Advances in genome sequencing have elucidated the intricate relationship between gut microbiota and autoimmune diseases, including CD, emphasizing the significant role of dietary patterns in shaping the gut microbiota. The influence of GFD on microbiota composition, the only clinically validated treatment for CD, leads to a nutritional shift and potential macronutrient imbalance. Emerging research also highlights the therapeutic potential of various herbs with antioxidant, anti-inflammatory, antimicrobial, gastroprotective, and immunomodulatory properties as complementary approaches to manage CD. This chapter synthesizes the complex interactions between genetics, diet, gut microbiota, and potential herbal interventions in CD, paving the way for more comprehensive understanding and management strategies.

The prevalence of autoimmune diseases in developed societies suggests the use of natural products for prevention and treatment. At the beginning of preventive approaches, the idea of regularly consuming herbal products that can have positive effects on autoimmune diseases and making them a part of the diet is common. Beneficial phytochemicals can be reached by consuming these herbal products directly and/or the products obtained from them. In addition, numerous studies have demonstrated that berries offer the potential to protect against autoimmune diseases if they are consumed regularly with their phytochemicals, especially phenols, anthocyanins, vitamins, and specific minor components. There are also studies on the effects of these phytochemicals on autoimmune diseases. It is stated that the regular consumption of berry fruits increases the quality of life, and the protective effect it provides is much easier and less costly than the treatment of autoimmune diseases. This chapter is aimed at revealing the potential of berry fruits to protect from autoimmune diseases, reduce the negative effects of the disease, and/or support treatment. Although studies on the beneficial effects of berries have increased in recent years, they are still behind other fruits.

Currently, Hashimoto's thyroiditis (HT) and Graves' disease (GD) are the foremost conditions that people think of when discussing autoimmune thyroid disorders. While radioactive iodine (RAI) treatment, anti-thyroid drugs, and surgical resection are currently at the forefront for GD; thyroid replacement therapy is used for HT. Many studies are being performed to develop new treatment methods for Graves and Hashimoto thyroiditis patients who do not respond to traditional treatments. While herbal treatments are being tried for GD, studies are being carried out on changing nutritional habits or additional food supplements for HT. While there are currently many studies on traditional Chinese medicine in the literature for GD, nutrients for HT are considered complementary treatments using their anti-inflammatory and antioxidant properties. In patients with HT, the need for levothyroxine increases, especially due to possible interactions of gliadin with thyroid antigens, the presence of lactose components in levothyroxine preparations, and damage to the intestinal villi in those with lactose intolerance. Therefore, the course of the disease may be better in HT patients with additional dietary recommendations.