Doxorubicin is a widely used and promising anticancer drug; however, a severe dose-dependent cardiotoxicity hampers its therapeutic value. Doxorubicin may cause acute and chronic issues, depending on the duration of toxicity. In clinical practice, the accumulative toxic dose is up to 400 mg/m² and increasing the dose will increase the probability of cardiac toxicity. Several molecular mechanisms underlying the pathogenesis of doxorubicin cardiotoxicity have been proposed, including oxidative stress, topoisomerase beta II inhibition, mitochondrial dysfunction, Ca²⁺ homeostasis dysregulation, intracellular iron accumulation, ensuing cell death (apoptosis and necrosis), autophagy, and myofibrillar disarray and loss. Natural products including flavonoids have been widely studied both in cell, animal, and human models which proves that flavonoids alleviate cardiac toxicity caused by doxorubicin. This review comprehensively summarizes cardioprotective activity flavonoids including quercetin, luteolin, rutin, apigenin, naringenin, and hesperidin against doxorubicin, both in in vitro and in vivo models.

Doxorubicin (DOX) has been extensively utilized in cancer treatment. However, DOX administration has adverse effects, such as cardiac injury. This study intends to analyze the expression of TGF, cytochrome c, and apoptosis on the cardiac histology of rats induced with doxorubicin, since the prevalence of cardiotoxicity remains an unpreventable problem due to a lack of understanding of the mechanism underlying the cardiotoxicity result. Vernonia amygdalina ethanol extract (VAEE) was produced by soaking dried Vernonia amygdalina leaves in ethanol. Rats were randomly divided into seven groups: K- (only given doxorubicin 15 mg/kgbw), KN (water saline), P100, P200, P400, P4600, and P800 (DOX 15 mg/kgbw + 100, 200, 400, 600, and 800 mg/kgbw extract); at the end of the study, rats were scarified, and blood was taken directly from the heart; the heart was then removed. TGF, cytochrome c, and apoptosis were stained using immunohistochemistry, whereas SOD, MDA, and GR concentration were evaluated using an ELISA kit. In conclusion, ethanol extract might protect the cardiotoxicity produced by doxorubicin by significantly reducing the expression of TGF, cytochrome c, and apoptosis in P600 and P800 compared to untreated control K- (p < 0.001). These findings suggest that Vernonia amygdalina may protect cardiac rats by reducing the apoptosis, TGF, and cytochrome c expression while not producing the doxorubicinol as doxorubicin metabolite. In the future, Vernonia amygdalina could be used as herbal preventive therapy for patient administered doxorubicin to reduce the incidence of cardiotoxicity.

Andaliman (Zanthoxylum acanthopodium DC.) fruit is a spice plant widely used in North Sumatra. The chemical content in the Andaliman plant has a cardioprotective effect, with antioxidant properties that inhibit oxidative stress and free radicals. SOD (superoxide dismutase), BNP (Brain Natriuretic Peptide), and cTnT (troponin T) are measured as markers of heart damage, and histopathology is to see heart damage. Quercetin administration was used as a comparison. The hydroalcoholic extract’s phytochemical content and chemical elements were analyzed using LC-HRMS and GC-MS. The findings showed that the hydroalcohol extract of Andaliman fruits affected the blood levels of SOD, BNP, and cTnT in the blood of doxorubicin-induced rats. SOD levels increased, and BNP decreased; the 300 mg/kg BW group was not significantly different from the 50 mg/kg BW quercetin group. cTnT levels also decreased; the 150 mg/kg BW and 300 mg/kg BW groups were not significantly different, and both were better than the 50 mg/kg BW quercetin group. EAF with 150 mg/kg BW and 300 mg/kg BW can also repair damage to rat heart tissue caused by doxorubicin. Andaliman fruit extract has cardioprotective effects and anti-free radical activity due to its content and potential to be developed.

Multidrug-resistant bacteria have raised global concern about the inability to fight deadly infectious diseases. Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa are the most common resistant bacteria that are causing hospital infections. The present study was undertaken to investigate the synergistic antibacterial effect of the ethyl acetate fraction of Vernonia amygdalina Delile leaves (EAFVA) with tetracycline against the clinical isolates MRSA and P. aeruginosa. Microdilution was used to establish the minimum inhibitory concentration (MIC). A checkerboard assay was conducted for the interaction effect. Bacteriolysis, staphyloxanthin, and a swarming motility assay were also investigated. EAFVA exhibited antibacterial activity against MRSA and P. aeruginosa with a MIC value of 125μg/mL. Tetracycline showed antibacterial activity against MRSA and P. aeruginosa with MIC values of 15.62 and 31.25μg/mL, respectively. The interaction between EAFVA and tetracycline showed a synergistic effect against MRSA and P. aeruginosa with a Fractional Inhibitory Concentration Index (FICI) of 0.375 and 0.31, respectively. The combination of EAFVA and tetracycline induced the alteration of MRSA and P. aeruginosa, leading to cell death. Moreover, EAFVA also inhibited the quorum sensing system in MRSA and P. aeruginosa. The results revealed that EAFVA enhanced the antibacterial activity of tetracycline against MRSA and P. aeruginosa. This extract also regulated the quorum sensing system in the tested bacteria.

Antioxidants are molecules that can inhibit or prevent the oxidation reactions of other molecules that generate free radicals. Antioxidants can be synthesized in the body (endogenous) or obtained from food intake (exogenous). Modern pharmacological investigations show that the extract of Picria fel-terrae Lour. Herbs. Effective as an antioxidant because of the high content of flavonoids and phenols. This study aims to analyze the antioxidant activity, total phenol content and total flavonoid content in ethanol extract (EE). The powder was extracted by Soxhletation, percolation and reflux method with absolute ethanol. Antioxidant activity was analyzed by 1,1-diphenyl-2-picrylhydrazyl (DPPH), FRAP, ABTS and CUPRAC. Total phenol content was measured using the Folin-Ciocalteau method and total flavonoid content was measured using AlCl₃ reagent using colorimetric method. The best antioxidant activity and the highest total phenolic content were indicated by the soxhlet extraction method with IC₅₀ 23.52 ± 0.17 g/mL and 160.77 ± 0.95 mg GAE/g, and the highest total flavonoid content was indicated by the reflux method (1.08 ± 0. 02 mg QE/g). In conclusion, the ethanolic extract of Picria fel-terrae Lour. Herbs Lour with reflux extraction method can be further developed as an antioxidant.

Free radicals also play a role in the pathology of various degenerative diseases such as cancer, rheumatism, coronary heart disease, cataracts, and others. Free radicals can come from within the body (endogenous) and outside the body (exogenous). Litsea cubeba (Lour,) is a Lauraceae family plant which have contents volatile oils which used as antimicrobial, anticancer on breast cancer, pesticide, antideppressants, antiinflammation, antioxidant, and neuro pharmacology. The extract was prepared using water with the soxhletation method. The antioxidant activity was determined with the 1,1-diphenyl-2-picrylhydrazyl (DPPH), 2,2’-Azinobis [3-ethylbenzothiazoline-6)-sulfonic acid] -diammonium salt (ABTS) and Ferric Reducing Antioxidant Power (FRAP) methods. Total flavonoid and total phenolic content were determined with colorimetric methods. Antioxidant activity measured as IC₅₀ was 23.37 ± 0.42 µg/mL; 111.21 ± 0.42 and 109.01 ± 0.28 respectively. The extract was found to contain high levels of total phenolic (282.93 ± 0.33 mg GAE/g) and total flavonoid 7.49 ± 0.51 mg QE/g). The results reveal that ethanol extract of Litsea cubeba Lour. Bark has antioxidant potential. The further analysis is to isolation antioxidant compound.