Synergic Treatment of Plant-Based Antioxidants with Iron Chelators for Iron Overload in Transfusion-Dependent-Thalassemia Patients: A Systematic Review

Abstract

The combined use of plant-based antioxidants and iron chelators presents a synergistic treatment approach that effectively tackles both iron overload and the accompanying oxidative stress in individuals with transfusion-dependent Thalassemia (TDT). Plant-based antioxidants counteract reactive oxygen species (ROS) and oxidative damage, whereas iron chelators effectively bind excess iron, reducing the body's iron concentration. This combined therapy can be beneficial in improving TDT patients with iron overload. We systematically reviewed the literature exploring the plant-based antioxidants with iron chelators for iron overload in transfusion-dependent Thalassemia Patients. All fourteen included studies were randomized clinical trials, employing various randomization methods including simple randomization, double-blinded, triple-blinded, and crossover designs. The included studies enrolled participants across different age groups, including both young and adult patients. Despite the variability in plant-based antioxidants with iron-chelating properties, the key findings were as follows: Nine studies reported a significant reduction in iron overload, eight studies observed a marked decrease in oxidative stress markers, and five studies demonstrated reduced liver enzyme levels, suggesting potential hepatoprotective effects. All included studies reported significant effects of various supplements on key biomarkers, including total iron (Fe), ferritin, total iron-binding capacity (TIBC), total antioxidant capacity (TAC), malondialdehyde (MDA), and liver enzymes (AST, ALT). Silymarin, green tea, and grape seed extract (GSE) supplementation demonstrated notable reductions in total Fe, Ferritin, ASL, and ALT levels. Additionally, these supplements increased TIBC levels, suggesting improved iron metabolism. In contrast, quercetin and curcumin supplementation did not show a statistically significant difference compared to control groups in these outcomes.