# Inhibition of Inflammatory Regulators for Chronic Obstructive Pulmonary Disease (COPD) Treatment from Indonesian Medicinal Plants: A Systematic Review

## TL;DR

This review explores how five Indonesian medicinal plants may help treat COPD by reducing inflammation through various scientific methods.

## Contribution

The study systematically identifies Indonesian plants with anti-inflammatory potential for COPD treatment.

## Key findings

- Five Indonesian plants were found to inhibit inflammatory regulators in COPD.
- In vitro and in vivo studies confirmed the anti-inflammatory effects of these plants.
- In silico analysis identified bioactive compounds with strong binding to inflammatory receptors.

## Abstract

A characteristic of Chronic Obstructive Pulmonary Disease (COPD) is the inflammation of the respiratory pathway. Inflammatory regulators affected in COPD include cyclooxygenase-2 (COX-2), tumor necrosis factor-alpha (TNF-α), interleukin (IL-1β), and interleukin-6 (IL-6). Therefore, this systematic review aimed to investigate the biological activity of Indonesian medicinal plants as anti-inflammation through in vitro, in silico, and in vivo studies. A digital search was conducted using Scopus, Google Scholar, and PubMed online databases to find relevant articles by applying specific keywords related to the subject of interest. The results showed 18 studies that reported five Indonesian medicinal plants proven to inhibit inflammation regulation. The five plants were sambiloto (Andrographis paniculata), legetan warak (Adenostemma lavenia), kersen (Muntingia calabura), babadotan (Ageratum conyzoides), and sembung rambat (Mikania micrantha Kunth). In vitro studies, A. paniculata, A. lavenia, and M. calabura can suppress the levels of pro-inflammatory cytokines, such as TNF-α, IL-1β, and IL-6, in LPS-stimulated RAW 264.7 cells. In silico studies, compounds that have strong binding to bind inflammatory receptors are andrographiside contained in A. paniculata; ent-11α-hydroxy-15-oxo-kaur-16-en-19-oic acid contained in A. lavenia; 7-Hydroxyflavone contained in M. calabura; and 22,23-Dihydrospinasterol contained in A. conyzoides. In vivo studies, extracts of A. paniculata, M. calabura, A. conyzoides, and M. calabura can reduce inflammation in lung tissue in animal models (hamsters, mice, and rats). This systematic review might help to develop COPD treatment and build scientifically natural products from Indonesian medicinal plants for future investigations.