Available online on 15.11.2023 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright   © 2023 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access  Full Text Article                                                                                                                                                              Review Article

A Review on Medicinal uses of Moringa oleifera

Dhiman Jasmine*

Department of Pharmaceutics, Global College of Pharmacy, Kahanpur Khuhi, Anandpur Sahib, 140117, India.

 

Introduction

 

Moringa oleifera is the most widely cultivated pan-tropical species of a monogeneric family, the Moringaceae, which is native to the sub-Himalayan tracts of India, Pakistan, Bangladesh and Afghanistan. Moringa oleifera is known by such regional names as benzolive, drumstick tree, kelor, marango, mlonge, mulangay, nébéday, saijhan, and sajna.¹. Virtually every part of the tree is beneficial in some way and both rural and urban people depend on it for their livelihood. In developing tropical countries, Moringa trees have been used to combat malnutrition, especially among infants and nursing mothers ^2,3. The leaves of the Moringa tree are an excellent source of Nutrients like Minerals, Protein and Vitamins (A and C) ^{4, 5, 6}, Moringa has approximately 46 antioxidants and is one of the most powerful sources of natural anti-oxidants. Anti-oxidants supply the free atoms needed by the human body and mitigate the effect of free radicals. M. oleifera contains active compounds such as flavonoids, tannins, saponins, alkaloids, phenolics, and triterpenoids which possess antibacterial effects.⁷

Medicinal usus of Moringa oleifera 

Moringa has approximately 46 antioxidants and is one of the most powerful sources of natural anti-oxidants. Anti-oxidants supply the free atoms needed by the human body and mitigate the effect of free radicals. M. oleifera contains active compounds such as flavonoids, tannins, saponins, alkaloids, phenolics, and triterpenoids which possess antibacterial effects hence it can be used as safe and cheap plant antimicrobial agent. The extract from leaves of Moringa oleifera has high mineral and protein content and its historic reputation as a traditional medicine for different diseases has been previously investigated for its potential in treating different oral soft tissue diseases ^16, 17. 

Enamel Tissue Remineralization

Moringa oleifera extract contains the highest values of calcium and phosphate that are required for the remineralization process. Therefore, Moringa oleifera extract is investigated by Younis et al for its ability to treat induced enamel lesion.¹⁸ Scanning electron microscopy revealed that Leaves extract of Moringa oleifera loaded-varnish groups IV & V showed the most re-establishment of normal enamel architecture. Elemental analysis of the treated surfaces of Groups IV and V showed the surfaces treated by Moringa oleifera leaf extract loaded-varnish groups had significantly higher Ca, P, and O deposition than the fluoride varnish group. Leaves extract of Moringa oleifera might be considered as a biomimetic material which having capacity to guiding enamel tissue remineralization.¹⁹

Study by Risnayanti Anas et al, concluded that there is an increase in the amount of calcium in the teeth after the application of Moringa oleifera based paste and Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application. Moringa oleifera based paste and CPP-APP are effective to increasing calcium levels in teeth compared to the pre-test group.²⁰

Dental caries is closely related with cariogenic biofilm, an oral biofilm containing a high proportion of Streptococcus mutans ¹. Generally, oral biofilm is structurally and functionally organized and contains a balance of normal flora and pathogenic bacteria like S. mutans ²². Su-Kyung Jwa has studied the antimicrobial effects of the M. oleifera leaf extracts on S. mutans and formation of cariogenic biofilm. Extract from M. oleifera leaves was derived using distilled water (DW) and ethyl alcohol (EtOH). S. mutans susceptibility assays were performed for each extract. Cariogenic biofilm was formed with or without DW and EtOH extract, and cariogenic biofilm was treated with both extracts. Both extracts showed antimicrobial activity against S. mutans and inhibited formation of cariogenic biofilm. ²³

 

 

 

Figure 1: Various parts of Moringa Oleifera ^8-15

 

 

As Antimicrobial Agent

The leaf extracts of M. oleifera showed varying antimicrobial activity on wide range of microorganisms. 

In a study by Singh et al. (2012), the antimicrobial activity of Moringa oleifera was examined using the main model Kirby-bauer disc diffusion method in which 50% of Moringa oleifera leaf extract was used. The results showed that 50% ethanolic extract successfully displayed anti-bacterial activity however only little. Even at higher concentration, the extract displayed mild inhibitory activity and no activity at all against pseudomonas. ²⁴

Hanaa Elgamily et al carried out a study to assess the antibacterial and antifungal potentials of different parts of Moringa oleifera plant using different extraction methods in attempts to formulate natural dental remedies from this plant. The different extracts of different parts of Moringa oleifera showed an antibacterial effect against Staphylococcus aureus and Streptococcus mutans growth. The novel toothpaste of ethanolic leaves extract has antimicrobial and antifungal potential effects all selected strains.¹⁹

Another study indicated that E.coli was found to be equally sensitive to ethyl acetate, acetone and chloroform extracts and had the maximum antibacterial activity among the extracts. S.aureus was sensitive to all the extracts studied. The ethyl acetate had maximum antibacterial activity against S. aureus in comparison to the other extracts. The study revealed that S. gallinarum was also sensitive to all the extracts showing maximum antibacterial activity with ethyl acetate extracts and moderate and equal sensitivity to methanol and chloroform extracts. The ethyl acetate, acetone and methanol extracts showed maximum and equal antibacterial activity against P.aeruginosa. The disc diffusion study revealed that both the Gram positive and Gram-negative organisms showed variablesensitivity to different extracts of M. oleifera. In general, ethyl acetate and acetone extracts showed maximum antibacterial activity against E. coli, S. aureus, S. gallinarum and P. aeruginosa. The antibacterial potential of different extracts of M. oleifera specially of those of ethyl acetate and acetone extracts, demand further in vitro and in vivo studies to exploit their antibacterial action in the treatment of bacterial diseases of man and animals²⁵.

As anti-diabetic agents

Ajit et al., 2003 reported that hypoglycemic activity of Moringa oleifera, with significant blood glucose lowering activities has been confirmed.²⁶ From work of Francis et al., 2004 et al, Methanolic extract of its dried fruits powder has produced N-Benzyl thiocarbamates, N-benzyl carbamates, benzyl nitriles and a benzyl; which prove to trigger insulin release significantly from the rodent pancreatic beta cells and have cyclooxygenase enzyme and lipid peroxidation inhibitory activities .²⁷

As anti-inflammatory agents

Now a days, herbal medicine is being widely used as alternative medicine in developed countries. Leaves of Moringa plant have been shown to have   anti-inflammatory   activities.    Moringa leaves contains flavonoids and tannins   that are    thought   to   have    anti-inflammatory   effects.²⁸

Tannins are polyphenolic compounds that are abundant in Moringa leaves.  The amount of tannin in M.  oleifera ranged between 13.2 gTAE/kg and 20.6 gTAE/kg   in   dry    leaves.   Tannins   have    anti-inflammatory   activity   and    antioxidant   activity.   In    the   inflammatory   process, tannins   can    inhibit   the   production    of   oxidants by neutrophils, monocytes, and macrophages and directly inhibit reactive oxidants such  as   OH  and  NO.^29-31

Utilization  of   the  efficacy  of   moringa  leaves developed  in   various  dosage  forms   has  also  begun   to  be  widely   studied.  The  results showed that moringa leaves extract could  be   applied  topically  in   the  form  of   gels, ointments, and creams. The advantage of     giving      topical     anti-inflammatory     drug   preparations  is  that   it  is  easy   to  use  because   it  can  be   directly  applied  to  the  inflamed   area  and  has   fast  absorption,  therefore,     it    can    directly     provide    a    therapeutic   effect.  Previous research has  conducted   an  anti-inflammatory  test   of  5%  moringa   extract  in  gel   preparations  and found that inflammation was reduced by   47.09%.³²   Similar   research    was   also   carried    out   using   preparations   in    the   form  of   cream  of  Moringa   leaves  extract  with    a   concentration   of    12%,   and   the    results showed that the cream of Moringa leaves   extract    had   a   fairly    good   anti-inflammatory effect.³³

Hepatoprotective Activity³⁴

Alaaeldin     A.    Hamza    et     al investigated    that    the administration of M.O seed extract decreased the CCl4-induced elevation of serum aminotransferase activities and    globulin    level³⁵.    The     elevations    of    hepatic hydroxyproline content and myeloperoxidase activity were also reduced by M.O treatment. Liver fibrosis was induced   by   the    oral   administration   of    20%   carbon tetrachloride (CCl4), twice weekly and for 8 weeks³⁶.   The biochemical and histological results showed that M.O. reduced liver damage as well as symptoms of liver fibrosis.   S.  Fakurazi  et   al  showed  that   initiation  of acetaminophen  toxicities   is  believed  to   be  promoted  by oxidative   stress  during  the   event  of  overdosage.   MO showed    that    the hepatoprotective    activity     gives significant histopathological analysis and reduction of level of   alanine   aminotransferase (ALT), aspartate aminotransferase (AST), and   alkaline   phosphatase (ASP)  in   the  group  treat   with  MO  compared   to  those treated    with     acetaminophen    alone.    The     level    of glutathione (GSH)  was   found  to  be   restored  in  MO treated animal^37,38

 

 

 

 

Table 1: Some reported work of Moringa oleifera ⁷

S.N.	Author	Objective of study	Application	Ref
1	Rao P K, et al 2011	To assess the antibacterial activity of isolated compounds from M. oleifera against selected oral bacteria	All the isolated compounds from M. oleifera were active against Streptococcus mutans (MTCC 497), Streptococcus salivarius, Lactobacillus fermentum, Streptococcus anginosus, Streptococcus gordonii, Lactobacillus acidophilus.	39
2	Hanaa Elgamily et al 2016	To assess the antibacterial and antifungal potentials of different parts of Moringa oleifera	For dental remedies, experimental toothpaste exhibited higher mean inhibition than the mouthwash against Staphylococcus aureus, Streptococcus mutans and only the toothpaste revealed antifungal effect against Candida albicans	18
4	Carranza J B, 2017	To identify the secondary compounds of three varieties of Moringa oleifera Lam. Extracts namely; Native, Chinese, and Yard Long malunggay using phytochemical analysis	The extracts of moringa varieties contain flavonoids, alkaloids and tannins that are known to have antimicrobial and anti-inflammatory properties; thus, these have potential natural components in the manufacture of toothpastes	40
5	Su-Kyung Jwa et 2019	to investigate the antimicrobial effects of the M. oleifera leaf extracts	extracts showed antimicrobial activity against S. mutans and inhibited formation of cariogenic biofilm	23
6	Piasti Sopandani et al 2020	to assess the antibacterial effect of M. oleifera extract as an irrigation solution against E. faecalis	M. oleifera extract solution at concentrations of 75% and 100% is as effective as 5.25% NaOCl against E. faecalis	41
7	Mahassen M Farghaly et al 2020	to formulate a nontoxic mouthwash from Moringa oleifera	Moringa extract showing antibacterial and antiplaque effect will be used	42
8	Younis SH 2020	To assess the effect of Leaves extract of Moringa oleifera loaded-varnish groups IV & V on enamel	Moringa leaf extract loaded-varnish groups had significantly higher Ca, P, and O deposition than the fluoride varnish group. Leaves extract of Moringa oleifera might be considered as a biomimetic material which having capacity to guiding enamel tissue remineralization	18
9	Anas R et al 2021	To study the Effectiveness of Paste Based Moringa oleifera To Increase Calcium Levels Human Tooth	Results of this research showed that Moringa Oleifera paste has higher calcium level compared to Pre-test groups and  Moringa oleifera paste can be effective in increasing calcium levels of human teeth	20
10	Nawal Aidaros et al 2021	To investigate and compare the effect of green tea, black tea and Moringa oleifera on artificially demineralized enamel and dentin	In dentin, the highest mean value was found in Moringa oleifera. Study concluded that Moringa tree enhanced the remineralization process and thus, might be considered as an effective natural remineralizing agents	43
11	Buakaew et al 2021	Moringa oleifera and Azadirachta indica were assessed for oral healthcare and gingivitis adjunctive treatment	Author state that accumulative reduction percentages of both Staphylococcus spp. and Candida spp. were found and indicated that the herbal mouthwashes reduced Gingival index and plaque index and showed potential as oral healthcare products	44

 

 

Conclusion

 

M. oleifera contains active compounds such as flavonoids, tannins, saponins, alkaloids, phenolics, and triterpenoids which possess antibacterial effects hence it can be used as safe and cheap plant antimicrobial agent. The extract from leaves of Moringa oleifera has high mineral and protein content. As traditional medicine it has potential in treating different oral soft tissue diseases. Study by Nawal Aidaros et al concluded that Moringa oleifera enhanced the remineralization process of demineralized enamel and dentin, and thus, might be considered as an effective natural remineralizing agent²⁷. Further research on Moringa oleifera needed to exploit the pharmacological uses for management and prevention of oral disease.

References

1 Dhakar RC, Maurya SD, Pooniya BK, Bairwa N, Gupta M, S. Moringa: The herbal gold to combat malnutrition. Chron Young Sci 2011; 2:119-25.  https://doi.org/10.4103/2229-5186.90887

2. Dahot MU, Memon AR, Nutritive significance of oil extracted from Moringa oleifera seeds. J Pharm Univ Kar 1985; 3:75-80

3. Ram J. Moringa a highly nutritious vegetable tree, Tropical Rural and Island/ Atoll Development Experimental Station (TRIADES), Technical Bulletin. 1994; 2.

4. Abrams B, Duncan D, Hertz Piccioto I. A prospective study of dietary intake and acquired immune deficiency syndrome in HIV sero-positive homosexsual men. J Acquir Immune Defic Syndr 1993; 8:949-58.

5. Anwar F, Bhanger MI. Analytical characterization of Moriga oleifera seed oil growth in temperate region of Pakistan. J Agric Food Chem 2003; 51:6558- 63. https://doi.org/10.1021/jf0209894 PMid:14558778

6. Prakash AO. Ovarian response to aqueous extract of Moringa oleifera during early pregnancy in rats. Fitoterapia 1988; 59:89-96

7. Meena R, Prajapati SK, Nagar R, Porwal O, Nagar T, Tilak VK, Jayakumararaj R, Arya RKK, Dhakar RC. Application of Moringa oleifera in Dentistry. Asian J Dental Health Sci. 2021;1(1):10-3. https://doi.org/10.22270/ajdhs.v1i1.5

8. Gopalan, C, Rama BV, Balasubramanian SC. Nutritive value of Indian foods. Hyderabad, India: (National Institute of Nutrition), 1971

9. Fuglie, Lowell J, editor. The miracle tree-Moringa oleifera: Natural nutrition for the tropics. Training Manual. 2001. Dakar, Senegal: Church World Service; 2002.

10. Price ML. "The Moringa Tree." Educational Concerns for Hunger Organization (ECHO) Technical Note. 1985 (revised 2002). May 2002.

11. De Saint Sauveur, Armelle. "Moringa exploitation in the world: State of knowledge and challenges." Development Potential for Moringa Products. Dar es Salaam, Tanzania, International Workshop; 2001. https://doi.org/10.1007/BF02887070

12. Morton JF. "The horseradish tree, Moringa pterygosperma (Moringaceae)-A boon to arid lands?" Econ Bot 1991; 5:318-33. https://doi.org/10.1007/BF02887070

13. Indian Gyan. The source for alternative medicines and holistic health. Home Remedies for Common Ailments. 2002.

14. Bakhru HK. Foods that heal: The natural way to good health. South Asia, South Asia Books; 1995.

15. New Crop Resource Online Program (NewCROP). "Moringa Oleifera Lam." 1998. Purdue U. Jan. 2005.

16. El-sharkawy R.T., El-kammar H.A., Obeid R.F., Bdelkhalek A.A. Effects of moringa oleifera aqueous leaf extract on submandibular salivary glands of diabetic albino rats. Egypt. Dent. J. 2018; 64(Issue 2-April):1293-1303. https://doi.org/10.21608/edj.2018.77385

17. Elkammar Hala, Obeid Raneem F., Radwa T.E. 2019. Potential Therapeitic Effect of Moringa Oleifera on Tongue; pp. 2-8. (June)

18. Younis SH, Obeid RF, Ammar MM, Subsurface enamel remineralization by Lyophilized Moringa leaf extract loaded varnish, Heliyon. 2020; 6(9):e05054. https://doi.org/10.1016/j.heliyon.2020.e05054 PMid:33015394 PMCid:PMC7522384

19. Elgamily H, Moussa A, Elboraey A, EL-Sayed H, Al-Moghazy M, Abdalla A. Microbiological Assessment of Moringa Oleifera Extracts and Its Incorporation in Novel Dental Remedies against Some Oral Pathogens. Open Access Maced J Med Sci. 2016; 4(4):585-90.  https://doi.org/10.3889/oamjms.2016.132 PMid:28028395 PMCid:PMC5175503

20. Anas R, Mattulada IK, Akbar FH, Indriany L, Asmah N, Irawati E, Utama MD, Effectiveness of Paste Based Moringa Oleifera to Increase Calcium Levels Human Tooth (In Vitro), Nat. Volatiles & Essent. Oils, 2021; 8(4):15193-15201

21 Lee SH, Kim YJ. A comparative study of the effect of probiotics on cariogenic biofilm model for preventing dental caries. Arch Microbiol. 2014; 196:601-609. https://doi.org/10.1007/s00203-014-0998-7 PMid:24919536

22 Marsh PD. Microbial ecology of dental plaque and its significance in health and disease. Adv Dent Res. 1994; 8:263-271. https://doi.org/10.1177/08959374940080022001 PMid:7865085

23. Jwa SK. Efficacy of Moringa oleifera Leaf Extracts against Cariogenic Biofilm. Prev Nutr Food Sci. 2019; 24(3):308-312. https://doi.org/10.3746/pnf.2019.24.3.308 PMid:31608256 PMCid:PMC6779079

24. Singh GP, Sharma SK. Antimicrobial evaluation of leaf extract of Moringa oleifera Lam. Int Res J Pharm, 2012; 3:1-4.

25. Maurya, S. and Singh A. Clinical Efficacy of Moringa oleifera Lam. Stems Bark in Urinary Tract Infections. Hindawi International Scholarly Research Notices. [Online]. 2014. https://doi.org/10.1155/2014/906843 PMid:27437504 PMCid:PMC4897232

26. Ajit K, Choudhary BK, Bandyopadhyay NG. Comparative evaluation of hypoglycaemic activity of some Indian medicinal plants in alloxan diabetic rats. J Ethnopharmacol, 2002;  84:105-108. https://doi.org/10.1016/S0378-8741(02)00144-7 PMid:12499084

27. Francis JA, Jayaprakasam B, Olson LK, et al. Insulin secretagogues from Moringa oleifera with cyclooxygenase enzyme and lipid peroxidation inhibiting activities. Helvitica Chimica Acta, 2004;87:317-26; https://doi.org/10.1002/hlca.200490029

28. Darmaputra IGN, Pramita IGAS, Winaya KK, Application of Moringa Oleifera leaves extract cream inhibits paw edema in white male Wistar rat (Rattus norvegicus) induced by carrageenan 1%. Bali Medical Journal 2022; 11(1):122-126. https://doi.org/10.15562/bmj.v11i1.3384

29. Ulvian F and Yusriadi KK. Pengaruh Gel Ekstrak Daun Sirih Merah (Piper crocatum Ruiz &Pav) Terhadap Penyembuhan Luka Bakar Pada Kelinci. Galenika Journal of Pharmacy; 2016;2(2): 103-110. https://doi.org/10.22487/j24428744.2016.v2.i2.5977

30 Erwiyani AR, Haswan D, Agasi A, et al. Pengaruh sediaan gel dan krim ekstrak etanol daun kelor (Moringa oleifera Lamk) terhadap penurunan luas luka bakar pada tikus. Indonesian Journal of Pharmacy and Natural Product. 2020;3(2). https://doi.org/10.35473/ijpnp.v3i2.666

31. Lee S, Lee I, Mar W. Inhibition of inducible nitric oxide synthase and cyclooxygenase-2 activity by 1,2,3,4,6-penta-O-galloyl-beta-D-glucose in murine macrophage cells. Arch. Pharm. Res. 2003;26:832-839. https://doi.org/10.1007/BF02980029 PMid:14609132

32. Ulfa M, Hendrarti W, Muhram PN. Formulasi Gel Ekstrak Daun Kelor (Moringa oleifera Lam.) Sebagai Anti Inflamasi Topikal Pada Tikus (Rattus novergicus). J. Pharm. Med. Sci. 2016;1:30-35.

33. Nanaryain MF. Efek antiinflamasi sediaan krim ekstrak etanol daun kelor (moringa oleifera lam.) Pada tikus putih jantan yang diinduksi karagenin. Surakarta: Universitas Setiabudi. 2016.

34. Singh U, Dwivedi C, Kulsum U, Verma N, Saraf S, Pradhan DK , Phytochemistry and medicinal uses of moringa oleifera: an overview,Journal of Drug Delivery and Therapeutics. 2017; 7(6):104-116 https://doi.org/10.22270/jddt.v7i6.1522

35. Gilani AH, Aftab K, Suria A et al.. Pharmacological studies on hypotensive and spasmodic activities of pure compounds from Moringa oleifera. Phytother Res 1994a; 8:87-91. https://doi.org/10.1002/ptr.2650080207

36.Pal SK, Mukherjee PK, Saha BP. Studies on the antiulcer activity of Moringa oleifera leaf extract on gastric ulcer models in rats. Phytother Res 1995a; 9:463-465. https://doi.org/10.1002/ptr.2650090618

37.Gilani AH, Janbaz KH, Shah BH. 1997. Quercetin exhibits hepatoprotective activity in rats. Biochem Soc Trans 25: 85. https://doi.org/10.1042/bst025s619 PMid:9450047

38. Ruckmani K, Kavimani S, Anandan R, Jaykar B. Effect of Moringa oleifera Lam on paracetamol-induced hepatotoxicity Indian J Pharm Sci1998; 60:33-35

39. Rao PK, Rao DB, Kiran C, et al. In vitro antibacterial activity of Moringa oleifera against dental plaque bacteria. Journal of Pharmacy Research 2011; 4(3):695-742

40. Carranza JB, Molina PG, Ortañez JJR, et al. Flavonoids, alkaloids and tannins of three varieties of horse radish

(Moringa oleifera Lam.) extracts: potential components of toothpastes. International Scholars Conference Proceeding 2017; 5(1):30-3.

41. Piasti S, Ongki IB, Taufiq A, Sadono DM, Antibacterial effects of Moringa oleifera leaf extract against enterococcus faecalis in vitro. Scientific Dental Journal, 2020; 4(1):16-20. https://doi.org/10.4103/SDJ.SDJ_43_19

42. Mahassen M Farghaly, Shahinaz G Elashiry, Anticariogenic Effect of Moringa Oleifera Mouthwash Compared to Chlorhexidine Mouthwash ClinicalTrials.gov Identifier: NCT04575948.

43. Aidaros N, Mosallam R, Farouk H, Effect of Green Tea, Black Tea and Moringa Oleifera on Remineralization of Artificially Demineralized Enamel and Dentin: An In-vitro Microhardness Analysis, Advanced Dental Journal, 2021; 3(1):24-34 https://doi.org/10.21608/adjc.2020.34873.1072

44. Buakaew W, Sranujit RP, Noysang C, Sangouam S, Suphrom N, Thongsri Y, Potup P, Usuwanthim K. Evaluation of Mouthwash Containing Citrus hystrix DC., Moringa oleifera Lam. and Azadirachta indica A. Juss. Leaf Extracts on Dental Plaque and Gingivitis. Plants. 2021; 10(6):1153.  https://doi.org/10.3390/plants10061153 PMid:34204096 PMCid:PMC8226465