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REVIEW ARTICLES
CURRENT SCIENCE, VOL. 81, NO. 9, 10 NOVEMBER 2001 1179
Imbalance in antioxidant defence and human
diseases: Multiple approach of natural
antioxidants therapy
Ashok K. Tiwari
Pharmacology Division, Indian Institute of Chemical Technology, Hyderabad 500 007, India
The origin of diseases of multifactorial nature is being
understood now due to vitiation in the basic homeo-
static balance phenomenon in the body. A majority of
disease conditions like atherosclerosis, hypertension,
ischaemic diseases, Alzheimer’s disease, Parkinsonism,
cancer and inflammatory conditions are being consi-
dered caused primarily due to the imbalance between
pro-oxidant and antioxidant homeostasis. Antioxidant
principles from natural resources possess multiface-
tedness in their multitude and magnitude of activities
and provide enormous scope in correcting the
imbalance. Therefore, much attention is being directed
to harness and harvest the antioxidant principles from
natural resources. In the light of present under-
standing about the role of free radicals in pathogenesis
of multiple diseases, this article provides an account of
multifaceted activities of antioxidants and discusses
the multiple approach due to which these phyto-
chemicals deserve proper position in therapeutic
armamentarium.
THERE is an explosion of global awareness concerning
increasing imbalances in natural ecosystem. Therefore,
various measures are being taken up to correct the root
cause of the imbalance. Human beings constantly struggle
against the changing environmental conditions to maintain
optimum health and vigour throughout their life, during
all the seasons. The human body depends on the conti-
nuous holistic interaction between internal and external
factors. When this interaction is in a state of equilibrium,
man enjoys health and when it fails, either due to internal
deficiency or hostile environmental factors, the balance is
disturbed and leads to disharmony and disease.
Recently, Hellstrom1 has proposed the altered homeo-
static theory which asserts that multiple acquired and
genetic factors move the basic homeostatic balance of
the body in such a direction that it inappropriately activates
defence mechanisms and favours multiple diseases.
Therefore, it is important to understand the homeostatic
process and find out the causes, which create inappro-
priate imbalance. These causes may be the real factor,
lack of which may be important in ensuing the disease
process. The ideal curative approach would then be the
restoration of these factors, which will improve the
imbalance and shift the physiological process in the
direction of homeostatic balance. The altered homeostatic
theory is regarded as a holistic approach to the disorders
of multifactorial nature, because bodily homeostasis
epitomizes the idea of a functioning whole.
As one of the aspects of the body’s natural ecosystem,
it is increasingly being realized now that a majority of the
diseases/disorders are mainly due to the imbalance
between pro-oxidant and anti-oxidant homeostatic pheno-
menon in the body. Pro-oxidant conditions dominate
either due to increased generation of free radicals and/or
their poor quenching/scavenging into the body2–4.
Free radicals are fundamental to any biochemical
process and represent an essential part of aerobic life and
our metabolism. They are continuously produced by the
body’s normal use of oxygen such as respiration and some
cell-mediated immune functions. They are also found or
generated through environmental pollutants, cigarette
smoke, automobile exhaust fumes, radiation, air-
pollutants, pesticides, etc.5–8. Naturally, there is a dynamic
balance between the amount of free-radicals generated in
the body and antioxidants to quench and/or scavenge them
and protect the body against their deleterious effects9,10.
However, the amount of these protective antioxidant
principles present under the normal physiological condi-
tions, are sufficient only to cope with the physiological
rate of free-radical generation. It is obvious, therefore,
that any additional burden of free-radicals either from
environment or produced within the body, can tip
the free-radical (pro-oxidant) and anti-free-radical (anti-
oxidant) balance leading to oxidative stress, which may
result in tissue injury and subsequent diseases4,11–14
(Figure 1). Thus the antioxidants status in human reflects
the dynamic balance between the antioxidant defence and
pro-oxidant conditions and has been suggested as a useful
tool in estimating the risk of oxidative damage9,15,16.
In this context, research in the recent past has
accumulated growing body of evidences to show that
enrichment of body systems with natural antioxidant
principles may correct the vitiated homeostasis2,17–21. e-mail: astiwari@yahoo.com
REVIEW ARTICLES
REVIEW ARTICLES
CURRENT SCIENCE, VOL. 81, NO. 9, 10 NOVEMBER 2001 1180
Further, these efforts can prevent the onset as well as treat
the disease caused/or fostered due to free-radicals and
related oxidative stress. These evidences accelerated the
search for antioxidant principles, which led to the
identification of natural resources and isolation of active
antioxidant molecules. Collectively, these molecules are
called polyphenolics, and flavonoids have contributed
enough to the understanding in this area.
Based on recent understanding of the multifarious,
multifaceted aspects of natural antioxidants, success and
failures of antioxidant therapy in clinical studies, this
article aims to review the present knowledge, limitations
and future prospects of this high-yielding therapeutic
avenue. Since flavonoids have been studied in detail as
antioxidants, favourable as well as critical evaluation of
different aspects of these phytochemicals relating to their
antioxidant properties have been analysed in particular.
Nonetheless, descriptions provided herein, may be
applicable to other polyphenolic compounds also.
Flavonoids
Flavonoids present a great variety of structural speci-
ficities. As potent antioxidants, flavonoids are especially
important for protection against human disease. The
multiple properties of these phytochemicals have made
them more attractive, as they can modulate various
aspects of disease like lipid peroxidation involved in
atherogenesis, thrombosis, carcinogenesis, hepatotoxicity
and a variety of disease conditions. The basic structure of
a flavonoid contains a flavon nucleus (2-phenyl-benzo-ϒ-
pyran) consisting of benzene rings (A) and (B) combined
by an oxygen-containing pyran ring (C). The differences
in substitution on ring (C) distinguish the different classes
of flavonoids (Figure 2).
Antioxidant properties are related to structural
features
It is the free-radical entity, which is primarily responsible
to initiate damage to the biological targets leading to
different disorders. However, as the understanding is
progressing, it is being realized that merely radical
scavenging activity of a compound is not directly related
to the protection in biological system rather, structure
matters much and the in vivo radical-generating
conditions22. According to the mode of action, anti-
oxidants may be classified as free-radical scavenger/
terminator, chelater of metal ions, capable of catalysing
lipid peroxidation or as oxygen scavengers that react with
superoxides and so on23–27. Similarly, according to the
environment they are exposed to and the situation they
find, polyphenolic antioxidants act either by trapping the
initiating radical, propagating lipid peroxyl radicals,
Figure 1.
Balance of reactive oxygen species (ROS) generation and antioxidant defence. Under
normal physiological conditions the body copes with the flux of ROS. Oxidative s
tress describes a
condition in which antioxidant defence is insufficient to keep the level of ROS below a toxic
threshold. This may be due to either the excessive generation of ROS or loss of antioxidant defence
or both.
Figure 2.
Skeletal structure of flavonoid and related structures.
REVIEW ARTICLES
CURRENT SCIENCE, VOL. 81, NO. 9, 10 NOVEMBER 2001 1181
recycling α-tocopherol and or deactivating the excited
photosensitizer, etc.28.
Structural determinants for radical scavenging
property and antioxidant potential
With the increasing knowledge about various free-radicals
and free-radical scavengers, several structural determi-
nants have been proposed. Bors et al.23 proposed the
following structural determinants for effective radical
scavenging properties by flavonoids (Figure 3). (1) The
O-dihydroxy (catechol) structure in ring (B), which is the
obvious radical target site for all flavonoids, with a
saturated 2,3-double bond. (2) The 2,3-double bond in
conjugation with a 4-oxo function which is responsible for
electron delocalization from the (B) ring. (3) The
additional presence of both 3 and 5 hydroxyl groups for
maximum radical scavenging potential and strong radical
absorption.
Frankel24 further elaborated the explanation for
these structural criteria and added that flavonoids are
recognized for both their ability to donate electrons and
stop chain reactions. This activity is attributed to the
phenolic hydroxyls, particularly in the 3′,4′-OH of the
(B) ring and the 2,3-double bond in the (C) ring. Activity
increases with the number of –OH groups in rings (A) and
(B). These phytochemicals impart their antioxidant
activity by scavenging diverse groups of radicals like
hydroxyl radicals (.OH), superoxide anion radicals (O2–. ),
singlet oxygen (1O2), alkoxyl radicals (RO.), peroxyl
radicals (ROO.), peroxynitrite (ONOO.) and mechanisms
like complexing proteins (enzymes and their metal-
binding sites), inducing synergistic effects by reducing
oxidized antioxidants (mixture of vitamins E and C).
Jovanovic et al.29 specified that organic ROO. selectively
attacks the (B) ring of any 3′,4′ or 2′,5′-dihydroxyl
flavonoid. Pannala et al.30 suggest that flavonoids sca-
venge ONOO. by two possible mechanisms: (i) prefe-
rential nitration for the monohydroxycinnamates, and
(ii) electron donation for catecholes (Figure 4). The metal
chelating activity of these phytochemicals is due to their
binding metals at two points of their molecules: (i) the
orthodiphenol (3′,4′-di OH) grouping in ring (B) and
(ii) the ketal structure in ring (C) (Figure 5).
Concurrently, Georgi and colleagues31 suggested that
the free-radical scavenging properties of antioxidant
compounds are often associated with their ability to form
stable radicals after their reaction with free-radicals.
Flavonoids that can scavenge radicals effectively usually
give rise to semiquinone free-radical in alkaline solution.
This special feature may also give rise to their active sites.
The semiquinone free-radical or aroxyl radical may
react with a second radical, acquiring a stable quinone
structure18 (Figure 4). However, aroxyl radical can also
interact with oxygen, generating quinones and O2–. which
may be responsible for the undesired pro-oxidant effects
of flavonoids. Therefore the possible side reactions with
aroxyl radical also play an important role. The structural
criteria discussed above and below meet the requirement
in scavenging highly reactive .OH as well as O2–.
radicals18,31. As illustrated in Figure 4, it is proposed that
O-dihydroxyl structure in ring (A) makes better anti-
oxidant than others31.
Therefore, the activities of antioxidants are related to
the stability of the free-radicals formed after they react
with active radicals. Flavonoids with O-tri or O-
dihydroxyls in the (B) ring and/or in the ring (A) form
stable free-radicals. This is an important feature with
flavonoid compounds, due to which many are better
antioxidants than antioxidant nutrient vitamins C and E
Figure 3.
Structural determinants of radical scavenging property.
Figure 4.
Scavenging of ROS (R
.) by flavonoids and formation of
stable structure.
Figure 5.
Binding sites in flavonoids for transition metals.
REVIEW ARTICLES
CURRENT SCIENCE, VOL. 81, NO. 9, 10 NOVEMBER 2001 1182
and β-carotene, on a mole-for-mole basis. These anti-
oxidant nutrients do not form stable radicals and are
dependent for their scavenging/transport on other
systems2,32,33.
Apart from the above criteria, other features also play
an important role in considering antioxidant properties:
(i) Rate constant with different types of radicals. The
lower the reactivity of a free-radical to be scavenged,
more important are the structural requirements as
described for a flavonoid to act as effective as an
scavenger. However, de Groot12 argues that rate constant
for the reaction of a flavonoid with a free-radical or any
other reactive oxygen species (ROS), is just one factor
which determines its potency to act as an antioxidant.
(ii) Stoichiometry of the radical scavenging process.
(iii) Effective concentration to be reached at the site
where the reactive species is being formed. (iv) Stability
and decay kinetics of the resulting product such as
flavonoid aroxyl radical, is also an important aspect.
Structural determinants for scavenging
superoxides (O2–. ) and their sources
O2–. radical has been of intense interest owing to its
increased dominance in vivo in different disease
conditions. In a majority of the cases, this radical is
generated enzymatically. Xanthin oxidase (XOD)-mediated
generation of O2–. is extensively studied. Oxidation of
hypoxanthin to uric acid with simultaneous generation of
O2–. and H2O2 has been observed to play a crucial role
during myocardial ischaemia, reperfusion injury, gout,
rheumatoid arthritis and many other inflammatory
conditions. Molecular oxygen, which is easily available in
vivo, acts as an electron acceptor during reoxidation of
XOD and generates O2–. and H2O2 (refs 34 and 35).
Xanthin oxidase
Hypoxanthin
uric acid + O2–. + H2O2
O2
XOD is considered an important biological source of
O2–. radical. These and other ROS contribute to oxidative
stress in an organism and are involved in many patho-
logical conditions such as inflammation, atherosclerosis,
cancer, ageing, etc. Decades ago, Robac and Gryglewski36
had reported that antioxidative property of several
flavonoids was a result of scavenging of O2–. .
Detailed study by Cos and colleagues37 provides
very important insight to categorize flavonoids into
different classes based on their structure and biological
activity related to XOD inhibition and/or O2–. scavenging:
(i) Flavonoids which can scavenge only O2–. without
inhibitory activity on XOD such as (+) taxifolin,
(–) epicatechin, (–) epigallocatechin; (ii) Flavonoids which
can effectively inhibit XOD activity, but cannot scavenge
O2–. radicals, such as kaempferol, morin, isorhamntin;
(iii) Compounds which possess both the O2–. scavenging
activity as well as XOD inhibitory capacity such as
quercetin, 7-neohespiridosylluteolin,4′,7-dimethylquercetin,
3-rutinosylkaempferol; (iv) Compounds which possess
XOD inhibitory activity, but may become pro-oxidant and
increase the generation of O2–. such as luteolin, galangin,
apigenin; (v) Compounds with marginal effect on XOD
inhibition along with pro-oxidant properties such as
7-hydroxyflavone; (vi) Flavonoids with neither XOD
inhibitory nor O2–. scavenging capacity such as 4′-hydroxy-
flavanone, 3-hydroxylflavone, cirsimarin, 6-glucosyl-8-
xylosylapigenin.
Based on the above categorization, at least two
structural criteria for a flavonoid have been proposed:
(a) to possess strong XOD inhibitory activity, flavonoids
should have hydroxyl groups at C-5 and C-7 with a
double bond between C-2 and C-3, and (b) to scavenge
O2–. effectively, on the other hand, a hydroxyl group at
C-3′ in ring (B) and at C-3 position is essential.
This study acknowledges that the knowledge of struc-
tural criteria provides a better tool to identify compounds
with desired biological activity and also an insight into
looking for better therapeutic agents. For example,
allopurinol, an anti-rheumatic, anti-gout drug, possesses
only XOD inhibitory activity and has no check on the
O2–. produced already at the target site. It becomes obvious,
therefore, that compounds bearing both the O2–. scavenging
as well as XOD inhibitory activity may offer better
therapeutic potential than allopurinol. Flavonoids with
both these properties possess in common OH-groups,
either at C-5, C-3 or C-3′ and C-4′. However, for a single
compound to meet every criterion is not encouraging as
the presence of –OH group at C-3 slightly decreases XOD
inhibitory activity, which suggests that a planar flavonoid
structure is a necessary requirement for this particular
activity. Although these observations and interpretations
provide important understanding in structure–activity
relationships, it is important to note that in vitro
observations may have limitations while interpreting
in vivo effects, as in the case of luteolin. According to
Cos et al.37, luteolin apart from possessing XOD
inhibitory activity may accelerate generation of O2–. .
However, recent in vivo studies report its important
therapeutic contribution in inflammatory, chronic obstructive
pulmonary disease, and bronchitis, as antitusive expecto-
rant without any adverse effect on cardiovascular
damage38,39. It is also important to note that flavonoids
can be oxidized and may exert pro-oxidant effects in vitro
under some assay conditions; however, most reported
studies have emphasized their antioxidant effects as they
may not meet similar conditions in vivo.
It seems important, therefore that a combination of
antioxidant molecules is better suited to satisfy diverse bio-
logical activity, where compounds impart their biological
activity working synergistically for better therapeutic value.
REVIEW ARTICLES
CURRENT SCIENCE, VOL. 81, NO. 9, 10 NOVEMBER 2001 1183
Transition metals, lipid peroxidation and
antioxidant
Metals play an important role in biological processes.
There are several important biochemical and physio-
logical mechanisms where involvement of metals plays a
crucial role. Although they are trapped and transported
into the body via highly sequestered and controlled
processes, there are several circumstances where any
deviation from their controlled mechanism leads to their
leakage into the surrounding environment, where they
contribute to overt generation of free-radicals and con-
sequently, lipid peroxidation, tissue injury and oxidative
stress40–44.
Most of the biological studies of lipid peroxidation
involve transition metal ions, added to or contaminating
reaction mixtures. Copper ions, Cu2+, are classically used
to stimulate low-density lipoprotein (LDL) peroxidation
in vitro and Fe2+ for lipid peroxidation models45,46. The
presence of Cu2+/Fe2+ has been frequently observed in
atherosclerotic lesions. When Fe2+, Cu2+ or certain
chelates of these ions (Fe2+ + ADP) are added to lipo-
somes, lipoproteins or isolated biological membranes,
peroxidation of lipids ensues41,47,48. Oxidized forms of
these transition metals can also accelerate peroxidation, if
a reducing agent is added to or present (FeCl2/ascorbate)
in the experimental set-up.
Brown et al.49 studied LDL oxidation mediated by Cu2+
and observed structural requirements for flavonoids. They
noticed that the ortho 3′,4′-dihydroxy substitution in the
ring (B) is shown to be important for Cu2+-chelate
formation, thereby influencing antioxidant activity (Figures
4 and 5). Presence of a 3-hydroxy group in a flavonoid
structure enhances the oxidation of quercetin and
kaempferol, whereas luteolin and rutin, each lacking the
3-hydroxyl group, do not oxidize readily in the presence
of Cu2+ ions. They demonstrated that the reactivities of
flavonoids in protecting LDL against Cu2+ ion-induced
oxidation are dependent on their structural properties in
terms of the response of a particular flavonoid to Cu2+
ions. Whether chelation or oxidation, their partitioning
abilities between the aqueous compartment and the
lipophilic environment within LDL particles and their
hydrogen-donating antioxidant properties are important
aspects. A number of flavonoids effectively chelate trace
metals, which play an important role in oxygen meta-
bolism. Free iron and copper are potential enhancers
of ROS formation, as exemplified by the reduction of
H2O2 with the generation of highly aggressive hydrogen
radicals,
H2O2 + Fe2+ (Cu+) → .OH + OH– + Fe3+ (Cu2+)
Or, by copper-mediated LDL (LH) oxidation,
LH + L. →→ LOO..
Pietta18 proposed that binding sites for trace metals
to flavonoids are the catechol moiety in the (B) ring, the
3-hydroxyl, 4-oxo groups in the heterocyclic ring, and the
4-oxo, 5-hydroxyl groups between the heterocyclic ring
and the ring (A) (Figure 5).
Generation of hydrogen peroxide and antioxidant
activities of flavonoids
Miura et al.50 suggest that flavonoids which possess
pyrogallol (adjacent trihydroxyl) and/or catechol (adjacent
dihydroxyl) moieties in their structure show strong H2O2
generating activity via an O2–. anion radical and also
possess inhibitory activities in rat liver microsomal lipid
peroxidation. Flavonoids which generate H2O2 can
scavenge free-radicals. Flavonoids act as antioxidants not
only by free-radical scavenging, but also by the metal
chelation and by inhibition of enzymes like NADPH
oxidase in human neutrophils, mitochondrial succinoxi-
dase and NADH oxidase and inhibit microsomal
cytochrome P-450 (Fe2+)-dependent enzymatic reactions
by their metal-chelating activity50–52.
The electron and H+ donating capacity of flavonoids
seem to contribute to the termination of lipid peroxidation
chain reaction based on their reducing power29,53. Due to
their reducing power these phytochemicals act as both
antioxidant as well as pro-oxidant depending upon the
environment they are exposed to. They act as pro-oxidant
in the absence of radicals. The classical antioxidants, α-
tocopherol and vitamin C, are also reported to behave in a
similar fashion.
Flavonoids generate H2O2 by donating a hydrogen atom
from their pyrogallol or chatechol structure to oxygen,
through a superoxide anion radical50 (Figure 6). The
pyrogallol-type flavonoids generate more H2O2 than
catechol. More the H2O2 generation, more potent is the
radical trapping.
The increased generation of H2O2 by flavonoids has
been a matter of considerable debate, where most of the
studies come from in vitro cell culture. H2O2 has many
cellular effects depending on the cell types examined and
H2O2 concentration. The response of cells to H2O2 varies
according to the cell studied, its level of enzymatic
Figure 6.
Scheme representing H2O2 generation by flavonoids.
REVIEW ARTICLES
CURRENT SCIENCE, VOL. 81, NO. 9, 10 NOVEMBER 2001 1184
antioxidants like catalase and other H2O2 removing
enzymes. H2O2 has been reported to raise intracellular
Ca2+, activate transcription factors, repress expression of
certain genes, promote or inhibit cell proliferation, be
cytotoxic, activate or suppress certain signal transduction
pathways, promote or suppress apoptosis. However, the
observations that flavonoids increase the generation of
H2O2 appears ambiguous. Long et al.54 very recently
cautioned that increased generation of H2O2 by flavonoids
may be due to artifacts in the cell-culture media and
therefore, it must be precautiously interpreted as such
relating in vivo effects. It appears important that most of
the reported effects of polyphenolic compounds on cells
may be due to their oxidation in the culture media,
leading to H2O2 generation and again it may not be the
real situation in vivo. Therefore, more studies are required
to differentiate direct cellular effects of phenolic
compounds from effects caused by H2O2 generation in the
culture media and factual conditions in vivo.
Anticytotoxicity properties and structural
requirement for antioxidants
A variety of synthetic and dietary polyphenols protect
mammalian and bacterial cells from cytotoxicity induced
by hydroperoxides, especially H2O2. The polyphenols
bearing O-dihydroxyl or its equivalent structures in
flavonoids are essential for protection against H2O2
mediated cytotoxicity22. It seems difficult for polyphenols
possessing free carboxyl groups to be incorporated into
the cells or the cell membranes, because of electrostatic
repulsion occurring between the negative charge of the
carboxyl group and the membrane phospholipids. This
may be the reason that neither α-tocopheral nor ascorbate
offers cytoprotection due to H2O2-mediated cytotoxicity.
Several hindered alkyl phenols such as BHT (2,6-
ditertbutyl-4-methyl phenol) are widely used as anti-
oxidants and free-radical scavengers55. Apart from their
beneficial antioxidant effects, these alkyl phenols also
produce detrimental effects in animals. Liver microsomes
and hepatocytes from rats metabolize BHT extensively
through two main routes: (i) hydroxylation of alkyl
substituents and (ii) oxidation of the pi-electron system.
The latter pathway generates initially a phenoxyl radical
that partitions between two reactive products: combina-
tion with molecular oxygen and followed by reduction
yields hydroperoxides (BHT-OOH) and one electron
oxidation yields the quinone methide (BHT-QM). Both
these metabolic products are more toxic than the parent
compound. These observations further suggest the
importance of structural requirement in order to achieve
desired beneficial properties.
It is important to note that cases with flavonoids are
also not fair throughout in this context. Griffiths56
observed that flavonoids are metabolized in vivo as
phenolic acids. Limasset et al.57 analysed several phenolic
acids which are attributed to be the metabolites of
flavonoids and are known to present antioxidant
properties through their ability to reduce H2O2 produced
by stimulated polymorphonuclear cells (PMNCs). They
propose the following structural features based on
biological activities: (i) Monophenolic compounds have a
little, if any, inhibitory effect; (ii) Ortho-diphenolic acids
have strong inhibitory effect with a little difference
depending on acidic chain; (iii) metaorthomethylation of
diphenolic compounds has a little effect on the inhibitory
action. On the other hand, O-methylation on parahydroxyl
reduces the inhibitory effect; (iv) Methylation, both in
para and meta, suppresses completely the inhibitory
effect; (v) unsaturation in α and β position of propionic
chain leads to the most effective inhibitory compounds.
In a recent study in this regard, Silva et al.58 observed
structure–activity relationship of caffeic acid and deri-
vatives. They note that esterification of the carboxyl
group of dihydrocaffeic acid dramatically enhanced the
radical scavenging potency of the compound. However,
similar effects were not observed with caffeic acid. The
authors suggest that the n-alkyl esters of both phenolic
series had similar potencies, and their antiradical
activities are independent of the alkyl chain length.
Knowledge of the driving forces related with anti-
radical and/or antioxidant behaviour of these compounds
is worthy research therefore, because it could be a very
important basis to explain some of their biological
properties, especially those related with deleterious
oxidative processes59.
Present status and future prospects
The molecular components of free-radical biology and
biological inter-relationships of these components in
mediating various disease processes are beautifully being
unravelled for better understanding and exploitation in
biomedical/clinical sciences52,60,61. Parallel identification
and isolation of anti-free-radical/antioxidant principles
from natural resources are simultaneously presenting
enormous scope for their better therapeutic application.
Sustained interest in the use of antioxidants for treatment
of human disease62–66 and the role of dietary antioxidant
in prevention of disease development offer better
understanding for the development of newer and better
therapeutic entities42,67–69. These developments in both the
therapeutic and nutritional fields have not only been
punctuated by some successes, but by some spectacular
failures as well70–73. In this concern, major contribution
relates to the trials with antioxidant compounds, vitamins
E and C and β-carotene, either in combination or alone.
Several authors have reviewed the positive and negative
aspects associated with these widely studied mole-
cules2,32,74. Halliwell75 has explained the antioxidant
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CURRENT SCIENCE, VOL. 81, NO. 9, 10 NOVEMBER 2001 1185
paradox. The protective effect of diet may not be
equivalent to the protective effect of antioxidant in the
diet, rather a combination in association with antioxidant
principles may be responsible for beneficial effects. For
example, β-carotene in the diet may protect against cancer
development, but β-carotene may not be the only true
protective agent. Similarly, it is important to note that
most of these studies emerge from in-vitro observations
and their in vivo interpretation has got certain limitations.
This may be the reason that individual isolated
compounds number in thousands; however, in vivo
observations of only a few are reported. Pietta18 also
supports this view and suggests that the basis of
epidemiological observations are fruits, vegetables,
medicinal plants and beverages. Preventive role of these
materials is due to a variety of constituents, including
vitamins, minerals, fibre and numerous phytochemicals,
including flavonoids. Thus, it is possible that flavonoids
also contribute to the protective effect. A possible
protective role against coronary heart disease (CHD) of
flavonoid intake has been reported in four out of six
epidemiological studies76. Therefore, foundation studies
based on epidemiologic observations that antioxidants
impart beneficial effects are presenting a strong basis for
the exploitation of their therapeutic potential.
Very recently, Polidori et al.16 have reviewed the
human plasma profiles of antioxidant molecules in
different disease conditions. The authors observed the
imbalance/deficiencies of different antioxidants in diffe-
rent disease states. This study suggests that there is an
urgent need to have fingerprints of antioxidant profiles in
different disease conditions. This information can pave
the way for selecting a particular type of preparation with
desired permutations for the treatment of a particular
disease. Though population studies are emerging to show
the reduced antioxidant status in CHD, cancer and
neurological disorders16,77–82, global impact is yet to be
substantiated.
The holistic therapeutic effects of dietary antioxidants
may be observed, as they can display their first
antioxidant defence in the digestive tract by limiting ROS
formation15,83–85 and scavenging them and may impart
antiulcer activity86. Further, once absorbed, either as
aglycons or glycosides87–89 or to a larger extent, as
phenolic acids, they continue to exert antioxidant effect
along with other systemic activities.
One of the main purposes of antioxidant therapy is to
reduce arterial wall and other target site’s inflammation,
induced by oxidative stress. Increased oxidative stress and
induction of redox-sensitive genes by activating NF-kβ
(ref. 90) is a common final pathway of action of classical
risk factors: hypercholesterolemia, hypertension, smoking
and diabetes. Abundance of NF-kβ is the marker of
imbalance between pro-oxidant and antioxidant. Pharma-
cological manipulation by antioxidants ameliorates the
abundance of NF-kβ (ref. 91).
The use of a combination of antioxidants with varied
modes of action has better effects and resembles much
more an antioxidant-rich diet supplementation, on which
the positive data from epidemiological studies are based.
The arguments proposed by Fryer92 are very pertinent in
this respect. He argues that although a diet rich in β-
carotene protects against cancer development, β-carotene
may not be the only protective agent. When we are
looking for natural products, the approach should also be
natural. Analysis of plant material always reveals the
presence of six carotenoids, of which β-carotene is
usually the most abundant. The remaining five are present
at much lower concentrations. However, they are by no
means less important. Two of these dietary components
(zeaxanthin and lutein) are thought to be essential for well-
being of the retina93. A diet rich in high β-carotene will
also contain much lower concentrations of these rare
carotenoids and mere supplementation of pure β-carotene
alone cannot be expected to produce the same effects as a
balanced intake provided by a diet rich in fruit and
vegetables. Also, isolation and administration of β-
carotene from carotinoids may lead to the loss of certain
biological activities and synergistic actions observed with
holistic approach.
Similarly, van Acker et al.94 have suggested that
vitamin E is a generic term used to collectively describe a
range of tocopherol and tocotrienol molecules. In vivo,
α-tocopherol is most abundant and therefore, the most
important vitaminer. It terminates the chain reaction of
lipid peroxidation by scavenging lipid peroxyl radicals. In
this reaction, α-tocopherol itself becomes a radical.
Glutathion seems to be able to regenerate α-tocopherol
via a so-called free-radical reductase. The authors
observed that introduction of antioxidant flavonoids such
as 7-monohydroxyethyl rutoside, fisetin or naringenin
restored GSH-dependent protection in case of α-tocopherol
deficiency. This suggests that flavonoids can take over the
role of α-tocopherol as an antioxidant. Concurrently,
Jiang and colleagues95 reported that in contrast to α-
tocopherol, it is the γ-tocopherol and its metabolites
which possess anti-inflammatory activities (particularly
COX-2 inhibition), predominantly in macrophages and
epithelial cells. This activity is independent of their
antioxidant property. Apart from free-radicals, local
expression of COX-2 and mediated inflammatory activity
deteriorate pathological conditions in atherosclerotic
plaques and cancer. Therefore, apart from antioxidant
activity of tocopherol, its other aspects are also important.
The finding that flavonoids can take over the role of
tocopherols appears hence, an important development.
Antioxidants are ubiquitous in natural products. The
putative therapeutic impression of many traditional
medicines appears to be attributed to the presence of
antioxidant principles. The great variation in their
magnitude as well as multitude of activities may even
become more important for protective effects in situations
REVIEW ARTICLES
CURRENT SCIENCE, VOL. 81, NO. 9, 10 NOVEMBER 2001 1186
where free-radical species are not directly involved in the
disease process but may participate and/or foster the
secondary events2,69,96. Better understanding, therefore, of
the structure–activity relationship of these phytochemi-
cals, synergistic mode of action and their relative
importance in different mechanisms may provide deeper
insights in finding out better and safer therapeutics.
The concept of synergy is central to the holistic
approach. The trend of the modern concept to isolate pure
compounds may not achieve the desired results, as
observed in the natural version. Once an active principle
is isolated from the natural product without its synergical
colleagues to support and/or balance its action, it may
lose its character as present in its natural form. The
isolation and study of a problem from its environment is
the beauty of modern science. However, the natural/
holistic approach attempts to solve problems by taking
these in their entirety, with all their interlinkages and their
complexity. This may be the reason why Ayurvedic
preparations have different permutations according to the
disease conditions.
It has been observed by our own experience that a
majority of Ayurvedic preparations prescribed in disease
conditions now being explained to be mediated through
oxidative stress, possess strong antiradical properties97.
Kumar98 observed that Ayurveda, the science of longevity
is not just a collection of therapeutic recipes, but a
framework which defines the conditions of sickness and
connotes them with healing practices. As rightly and
timely perceived by Kochhar99 that it is in the framework
of cultural Copernicanism, where concerted efforts are
being made in the world of medicine to identify
traditional knowledge systems and accord them the
recognition. It is high time for us therefore, to explore
the possibility of identifying our traditional therapeutic
knowledge and interpret it according to the recent
advancements, in order to give it a deserving place.
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ACKNOWLEDGEMENTS. This work is supported by CSIR Co-
ordinated Programme on Development and Commercialization of
Bioactive Substances from Plant Sources, New Delhi. I gratefully
acknowledge Dr K. V. Raghavan, Director, Indian Institute of Chemical
Technology (IICT), Prof. R. Kumar, Chairman of the programme, Dr
O. P. Agrawal, Joint Advisor, CSIR, for their constant encouragement
and Dr J. S. Yadav, Dy. Director and Head, Natural Product
Laboratory, IICT for his invaluable suggestions and discussion during
preparation of the manuscript. Thanks are also due to Mr P. V. Srinivas
for excellent technical support and Mr Hafeez for typing the
manuscript.
Received 16 April 2001; revised accepted 23 July 2001
