Hypercholesterolemia Treatment using Basella Alba

by Wasiah Olundegun

Hypercholesterolemia is a major risk factor for liver damage, primarily due to the accumulation of excess lipids, which leads to oxidative stress and inflammation. This condition disrupts normal liver function, as indicated by elevated liver function indices such as Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST) and Alkaline Phosphatase (ALP). Hypercholesterolemia is characterized by increased serum concentrations of low-density lipoprotein (LDL) and triglycerides (TG). Hypercholesterolemia is closely associated with atherosclerosis, which is the main cause of mortality in world population. Accumulated deposits of oxidized LDL results to atherosclerotic plaque formation which contributes to stroke, myocardial infarction, and cardiovascular diseases (CVDs). 

It is well known that the hypercholesterolemic drugs are effective in lowering LDL but the long term consumption causes adverse effects such as liver and muscle injuries, rhabdomyolysis, myopathy, and acute renal failure. Also, drugs like Atorvastatin are used to lower cholesterol levels, but they might cause an increase in the concentration of liver enzymes, indicating stress to the liver. Therefore the need for an alternative therapy offering a better understanding of how treatments can mitigate these risks, and investigation and usage of natural products from plant origin in treating various diseases including CVDs have gained much attention. 

Hypercholesterolemia, a condition characterized by elevated levels of cholesterol in the blood, has been a significant public health concern worldwide. When treated with statins, it is often accompanied by elevated levels of liver function indices, which are indicators of organ damage. Alanine Aminotransferase (ALT), is an enzyme primarily found in the liver. Elevated levels of ALT in the body indicate liver damage, this could be due to intake of excessive alcohol, exposure to toxins or other factors. ALT levels might be a little bit more of an accurate indicator of liver health, since it is more specific to the liver. Aspartate Aminotransferase (AST) is an enzyme found in various tissues, including liver, heart and muscles. Elevated AST in the muscles may indicate liver impairment but they can also be linked to disorder of other organs. It is used in conjunction with ALT to assess liver health. The enzyme Alanine Phosphatase (ALP) is an enzyme present in the bile ducts, liver and bones. ALP levels are particularly useful in diagnosing conditions relating to bile flow and liver diseases.

Basella alba is rich in bioactive compounds such as flavonoids, saponins, carotenoids and polyphenols which have been shown to exhibit antioxidant, anti-inflammatory and lipid-lowering properties. The plant’s high content of antioxidants helps to neutralize free radicals, reducing oxidative stress, a major contributor to liver damage in hypercholesterolemic conditions. The experiment aimed to investigate the efficacy of Basella alba leaf extract in protecting the liver by evaluating its impact on enzymatic liver function indices in hypercholesterolemic rats.

Theaflavin (TF) and its derivatives, known collectively as theaflavins, are antioxidant polyphenols.

Basella alba is known as Indian spinach and Amunututu locally and belongs to the family of Basellaceae. It is a perennial vine which grows rapidly and extremely heat tolerant. It is also popularly known as Malabar spinach, Ceylon spinach, vine spinach, climbing spinach, Chinese spinach and cyclone spinach. It is a wild leafy vegetable, which is rare in its natural habitat, but in recent times, it is an important leafy vegetable grown for its nutritive value throughout the temperate regions as an annual and the tropics as a perennial crop. Basella alba is now wildly cultivated and is a vegetable that has been used from ancient time due to its various pharmacological activities such as antifungal, antiulcer, anticonvulsant, antihypertensive, and many more activities. In Asian countries, the stem and leaf of Basella alba have been employed as traditional medicine to treat dysentery, skin diseases, hemorrhages, anemia, constipation, gonorrhea, and cancer.  

In a study carried out recently, hypercholesterolemia was induced in male Wistar rats using Triton-X, a nonionic surfactant that disrupts lipid metabolism, leading to elevated cholesterol levels and treated with Basella alba. Four groups of rats were used: Group 1, the positive control group that was not induced or treated; Group 2, the negative control group that was induced with hypercholesterolemia using Triton-X and untreated; Group 3, induced with hypercholesterolemia using Triton-X and treated with the reference drug, Atorvastatin; and Group 4, induced with hypercholesterolemia using Triton-X and treated with 400 mg/kg body weight of Basella alba. Treatment was carried out for seven days after induction of hypercholesterolemia was confirmed.

Basella alba demonstrated lipid-lowering effect. The extract significantly reduced the total cholesterol and low-density lipoprotein (LDL) levels in the hypercholesterolemic rats, comparable to atorvastatin. Elevated LDL levels are markers of hyperlipidemia and a primary cause of atherosclerosis. By lowering LDL and maintaining high-density lipoprotein (HDL) and triglyceride levels within normal ranges. Basella alba shows potential as a natural lipid lowering agent.

The extract also shows a significant reduction in the concentration of the liver enzymes, compared to the negative control and the group treated by the reference drug. Unlike atorvastatin, which increased the ALT, AST and ALP levels in the serum, Basella alba maintained the enzymes within normal ranges and lowered them, indicating its hepatoprotective effect.

The study highlighted that while atorvastatin  effectively reduced lipid levels, it caused an increase in AST levels, indicating potential liver stress. In contrast, Basella alba lowered the lipid levels and also protected the liver from damage. This dual action of Basella alba demonstrates its potential as a safer alternative to conventional lipid lowering drugs.

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