Received: 16 June 2020 Accepted for publication: 18 February 2022 Slov Vet Res 2022; 59 (1): 31–45 DOI 10.26873/SVR-1150-2022 UDC 636.7.09:616-007.43-089:616-036 Original Research Article Introduction Rheumatoid arthritis (RA) is an autoimmune disorder. In individuals with autoimmune disorders, their immune system attack joints and some other tissues (1). Patients with these disorders have antibodies in their blood that target their own body tissues, resulting to inflammation (2). RA is a systemic (body-wide) disease, involving many organs of the body (3). Symptoms of RA include morning stiffness, joint pain, limited range ANTIOXIDANT EFFECT OF Buchholzia coriacea ETHANOL LEAF- EXTRACT AND FRACTIONS ON FREUND’S ADJUVANT-INDUCED ARTHRITIS IN ALBINO RATS: A COMPARATIVE STUDY Esther U. Alum1*, Udu A. Ibiam1, Emmanuel I. Ugwuja1, Patrick M. Aja1, Ikechuku O. Igwenyi1, Christian E. Offor1, Obasi U. Orji1, Chinyere Aloke2,3, Nkiru N. Ezeani1, Okechukwu P. C Ugwu1, Chinedu O. Egwu2 1Department of Biochemistry, Faculty of Science, Ebonyi State University, PMB 053, Abakaliki, Ebonyi State, 2Department of Medical Biochemistry, Faculty of Basic Medical Sciences, Alex Ekwueme Federal University, Ndufu Alike, Ikwo, Abakaliki, Ebonyi State, Nigeria, 3Protein Structure-Function and Re-search Unit, School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Braamfontein, Johannesburg, 2050, South Africa *Corresponding author, Email: alumesther79@gmail.com Abstract: Several studies have implicated reactive oxygen species in perpetuation of inflammation and subse-quent de- struction of joints in patients with arthritis. Antioxidant effects of Buchholzia coriacea ethanol leaf-extract, aqueous and ethyl acetate fractions on oxidative stress indices in rheumatoid arthritic female Wistar albino rats were examined. 180 rats were randomly divided into 12 groups. Fifteen rats were placed in each group. Rats without arthritis were placed in Group 1. Rheuma- toid arthritis was induced in groups 2 to 12 by intradermal injection of 0.1 ml complete Freund’s adjuvant into the left hind paws of rats. Group 2 (arthritic rats) did not receive any treatment but rather were given normal saline while group 3 (arthritic rats) received 5 mg/kg indomethacinTM (a standard drug). Rats in Groups 4 to 12 were administered the samples at doses of 200, 400 and 800 mg/kg body weight. Freund’s ad-juvant administration led to inflammation and oxidative stress which were marked by significant (P<0.05) increase in paw sizes, oxidative stress markers and reduced body weight of the rats. Arthritic rats were treated with standard drug and samples (at varied doses) and this resulted to reversal of the trend of those parameters in a time and dose-dependent manner. Rats that received 800 mg/kg of the aqueous fraction displayed the best desirable result which was similar to the effect of indomethacin. Thus, Buchholzia coriacea ethanol extract and fractions may be useful in the management of oxidative stress which is very common among individuals with rheumatoid arthritis. Key words: rheumatoid arthritis; Buchholzia coriacea; free radicals; oxidative stress; reactive oxygen species of motion in the affected joints, fatigue, occasional redness, fever, firm bumps (nodules) under the skin and symptoms are always worse in the morning (4). RA is the most common rheumatic disease, affecting about 1 % of individuals world-wide (5). Male to female prevalence is 1:3 (6). Increased risk in family members of patients with RA may suggest that it can be hereditary (7). Increased risk among smokers and women may justify the role of environmental pollution and hormonal factors at perpetuating the inflammatory process and joint destruction (8). The joint-damaging role of free radicals during inflammatory and other immunological response Zbornik_1_2022_22.4.22.indd 31 22/04/2022 09:53:33 E.U. Alum, U.A. Ibiam, E.I. Ugwuja, P.M. Aja, I.O. Igwenyi, C.E. Offor, O.U. Orji, C. Aloke, N.N. Ezeani, O.P.C Ugwu, C.O. Egwu32 is paramount. This is because free radicals can be deposited into joint cartilage, attacking its proteoglycan and hence inhibits its synthesis (9). RA is diagnosed by measurement of acute phase reactants, full blood count, and auto- antibody such as rheumatoid factor and anti- cyclic citrullinated peptide assay (14). The purpose of RA treatments is to inhibit disease severity, reduce symptoms and delay the onset of joint damage and other associated functional limitations (15). Some RA medications include non-steroidal anti-inflammatory agents, steroids and anti- tumor necrosis factor therapy (2, 3). Though these drugs reduce pain but they are unable to repair damaged tissues. They are mainly used for managing the pain and slowing the progression of RA. Therefore, there is no known drug for curing RA completely (16). About 80 % of world’s population depends on use of various plant parts in the prevention and treatment of diseases (17, 18). The adverse reaction and toxicity associated with the use of anti-inflammatory drugs, in addition to the high cost of the drugs have expeditiously promoted the use of natural plant products or procedures to manage RA locally (19). Buchholzia coriacea (B. coriacea) is in the family of Capparidaceae (20, 21). It is commonly called Wonderful kola, Musk tree, Cola pime, and Elephant cola. It has multiple medicinal values. It is useful in treatment of hypertension and also prevents premature aging. Its methanol seed extract has hypoglycemic, hypolipidemic, anti-lipid peroxidation and anti-ulcer effects (22, 23, 24, 25, 26, 27). It has anti-microbial, antihelmintic and antifungal properties (28, 29, 30, 31). B. coriacea has been in use for quite some time by rural dwellers but there is scarce information on its antioxidant potentials. Therefore, this study was aimed at investigating the effect of B. coriacea ethanol leaf extract and fractions on oxidative stress markers in Freund’s adjuvant-induced arthritis in albino rats Material and methods Materials Chemicals and reagents used were of analytical standard. Freund’s adjuvant was purchased from Sigma Aldrich Company, USA. Biological materials: Biological materials used for this study were B. coriacea leaves and female Wistar albino rats. Methods Collection and Identification of Biological Materials: Leaves of B. coriacea were collected from Ngodo Village in Afikpo North Local Government Area of Ebonyi State, South-Eastern Nigeria. B. coriacea leaf was identified by a Taxonomist in Department of Applied Biology, Ebonyi State University, Abakaliki. Female albino rats (Wistar strain) weighing 121–146 g were obtained from the Department of Animal Science, University of Nigeria, Nsukka, Enugu. The rats were acclimatized for a period of two weeks in the Animal House of Divine Analytical Laboratory, Nsukka under standard laboratory conditions and fed with commercial rat feed and were allowed free access to clean water. The study was approved by the Departmental Institutional Ethical Committee of Biochemistry Department, Ebonyi State University Abakaliki, Nigeria with the Ethical approval number: EBSU/BCH/ ET/ 19/010. The guidelines agree with world standard for care and use of laboratory animals in research. Preparation of extract and fractions: B. coriacea leaves were washed and shade dried and later pulverized in a grinder and sifted to obtain powdered sample. Eight hundred grammes of the sample were soaked in 2000 ml of ethanol for 48 hours with intermittent rocking. Thereafter, it was filtered and filtrate was dried. The extracts were stored in airtight container. The dried crude ethanol leaf extract was fractionated in a glass column by eluting in succession with 500 ml water, 500 ml ethyl acetate to obtain aqueous and ethyl acetate fractions, respectively. The crude ethanol leaf extract, aqueous and ethyl acetate fractions were subsequently used for other analyses. Acute Toxicity Study: Modified Lorke (32) method was used in acute toxicity study. The modification was in the use of albino rats instead of mice. This is because the animal model of this work is albino rats. Thirty-six (36) rats were used for the acute toxicity test. The rats were weighed and fasted overnight before the acute toxicity testing. They were assigned to two experimental groups A and B. Group A which had four rats and served as the normal control group was Zbornik_1_2022_22.4.22.indd 32 22/04/2022 09:53:33 Antioxidant effect of Buchholzia coriacea ethanol leaf-extract and fractions on freund’s adjuvant-induced… 33 administered normal saline. The B group received crude ethanol leaf-extracts of B. coriacea. Group B animals were further sub-divided into eight groups with each group having four rats. The sub-groups (B1-B8) were administered orally with B. coriacea ethanol leaf-extracts at 200, 400, 800, 1200, 1800, 2000, 3000 and 5000 mg/Kg body weight, respectively. All the experimental rats were allowed to have access to food and water and were observed for a 24 hours period for possible signs of toxicity and possible death. Induction of arthritis in albino rats: Pearson method (33) was employed in induction of arthritis by intradermal injection of 0.1 ml Complete Freund’s adjuvant (CFA) into the left hind paws of rats in groups 2 to 12, according to their body weights. The paw sizes of all rats were checked with the aid of vernier caliper and this was done before and after administration of the adjuvant. It was observed that by day 10, arthritis had completely set in. Rats and experimental groups: Female albino rats (Wistar) were used in this study and a total of 180 rats were utilized. Rats were distributed into 12 groups comprising fifteen rats in each group. The study lasted for 31 days and route of administration of extract and fractions was via oral intubation. The rats were grouped as follows: Group 1 comprises of non-arthritic rats that were given normal saline (1 ml/kg) while Group 2 are arthritic rats that received normal saline (1 ml/kg). Arthritic rats treated with 5 mg/kg indomethacineTM (standard drug) were placed in Group 3 and this served as standard control. Rats in Groups 4-6 are arthritic rats treated with 200, 400 and 800 mg/kg body weight of B. coriacea ethanol leaf-extract, respectively. Arthritic rats administered with 200, 400 and 800 mg/kg body weight of aqueous fraction of the crude ethanol leaf extract of B. coriacea were placed in Groups 7-9, respectively. Groups 10-12 were arthritic rats treated with 200, 400 and 800 mg/kg body weight of ethyl acetate fraction of ethanol leaf extract of B. coriacea. Administration of drugs and samples was through oral intubation. Determination of Body Weight and Paw Size: The changes in body weight and paw size were measured before and after adjuvant-induced arthritis with the aid of a weighing balance and vernier caliper, respectively. This was done daily. However, records of 10th, 17th, 24th and 31st day of study were used in data analysis. Collection of Blood Samples for Biochemical Evaluation: Blood samples were humanely collected from three rats each from the groups by cardiac puncture via cervical dislocation on days 10, 17, 24, and 31 into plain sterile bottles. Thereafter, the blood samples were centrifuged at 3,000 rpm for 15 min and serum obtained for biochemical studies. Determination of Oxidative stress indices: Malondialdehyde (MDA) was evaluated spec- trophotometrically by measuring thiobarbituric acid reactive substance (TBARS) as outlined by Wallin et al. (34). Nitric oxide (NO) concentra- tion was determined following the procedure described by Bories and Bories (35) based on the Griess reaction in which nitrite is reacted with sulfanilamide (diazotizing reagent) and N-(1-naphthyl) ethylendiamine (a coupling re- agent) to produce an azo dye. NO being a la- bile compound with a brief half-life is rapidly converted to nitrite and nitrate, in oxygenated aqueous solutions. Nitrite levels were measured after the enzymatic reduction of nitrate to ni- trite with nitrate reductase. Reduced glutathi- one (GSH) was assessed following the procedure outlined by Ellman (36). The mechanism was based on the fact that thiols react with Ellman’s reagent (5,5′-dithiobis-(2-nitrobenzoic acid) or DTNB), cleaving the disulfide bond to give 2-ni- tro-5-thiobenzoate (TNB−), that in turn ionizes to the TNB2− dianion in water at neutral and al- kaline pH. The concentration of Tocopherol was determined according to the method described by Desai (37). The activity of superoxide dismu- tase (SOD) was determined as outlined by Mc- Cord and Fridovich (38) based on the produc- tion super-oxide radicals produced by xanthine and xanthine oxidase, which react with 2-(4-io- dophenyl)-3-(4-nitrophenol)-5-phenyltetrazo- lium chloride to form a red formazan dye. Cat- alase was spectrophotometrically determined using the method explained by Sinha (39). The activity of glutathione peroxidase was assayed as outlined by Paglia and Valentine (40) based on the fact that GPX catalyzed the oxidation of glutathione by cumene hydroperoxide. In presence of the glutathione reductase and nicotinamide adenine dinucleotide phosphate (NADPH), the oxidized glutathione was immediately converted to the reduced form with concomitant oxidation of NADPH to NADP+. Zbornik_1_2022_22.4.22.indd 33 22/04/2022 09:53:33 E.U. Alum, U.A. Ibiam, E.I. Ugwuja, P.M. Aja, I.O. Igwenyi, C.E. Offor, O.U. Orji, C. Aloke, N.N. Ezeani, O.P.C Ugwu, C.O. Egwu34 Statistical analysis All results were expressed as Mean ± Standard deviation (SD) and data were subjected to one- way analyses of variance (ANOVA) with Duncan multiple range test for assessment of significant differences between means. A significance threshold of P<0.05 was taken for the analyses. Data were analyzed using IBM statistical package for social sciences (IBM-SPSS), version 20 (IBM, Corp., Atlanta, GA). Value of (P<0.05) was considered statistically significant. Results Acute toxicity study The extracts were subjected to acute toxicity study in Wistar albino rats and the rats were monitored for 24 hours. No mortality was recorded and this revealed that the extracts were not toxic even at a high dose of 5,000 mg/kg. This formed the basis of our dose selection for the study. Effect of Ethanol leaf-extract, Aqueous and Ethyl acetate Leaf Fractions of B. coriacea on Body weight and Paw Size of Adjuvant- induced Arthritic Rats A significant (P<0.05) increase in body weight of rats in the treated groups was observed relative to negative control as shown in Table 1. There were significant (P<0.05) differences in body weight of rats treated with standard drug (indomethacin) relative to those treated with the extract, aqueous and ethyl acetate fractions. However, rats treated with ethyl acetate fraction had highest increase in body weight. There was increase in paw size in the feet of rats injected with Freund’s adjuvant. A significant (P<0.05) reduction in paw size of rats treated with crude ethanol leaf-extract, aqueous and ethyl acetate leaf fractions of B. coriacea at 200, 400 and 800 mg/kg body weight, relative to normal control was observed. The effect was both dose and time-dependent, as shown in Table 2. There were significant (P<0.05) differences in paw size of rats in all the treated groups. Maximum reduction of paw size with aqueous and ethyl acetate fractions at 200 mg/kg and 800mg/kg on day 31, respectively, occurred, relative to normal control. This effect was similar to that of the standard drug. Effect of Ethanol leaf-extract, Aqueous and Ethyl acetate leaf fractions of B. coriacea on Oxidative Stress Indices in Adjuvant-induced Arthritic Rats The results showed that the levels of MDA and NO increased in RA-induced rats relative to normal control as shown Tables 3 and 4, re- spectively. Treatment with varied doses of the ethanol extract and fractions of the sample at 200, 400 and 800 mg/kg body weight signifi- cantly (P<0.05) reduced the levels of MDA and NO in a time-dependent manner. This reduc- tion was comparable to that of indomethacinTM. Treatment with aqueous fraction at doses 200 and 400 mg/kg on day 31 yielded the highest reduction in the level of NO, and this was bet- ter than the effect of the indomethacinTM. Ac- tivities of SOD, CAT and GPx were lowered in adjuvant-induced arthritic rats (Tables 5-7), re- spectively. Treatment with standard drug and varied doses of the ethanol extract, aqueous and ethyl acetate fractions at 200, 400 and 800 mg/ kg body weight caused a significant (P<0.05) in- crease in the activities of SOD, CAT and GPx, likewise an increase in the level of reduced GSH. The observed rise in the activity of SOD during treatment was time-dependent but there was no difference among the treated groups. Aqueous and ethyl acetate fractions at 800 mg/kg on day 31 yielded a significantly (P<0.05) higher value in the activity of catalase and this effect was bet- ter than that of standard drug. Treatment with ethanol extract and aqueous fraction on days 17 and 24 yielded highest increase in the activity of GPx, when compared with indomethacinTM and ethyl acetate fraction. Treatment with aqueous fraction produced the highest increase in the level of GSH especially on day 31. Zbornik_1_2022_22.4.22.indd 34 22/04/2022 09:53:33 Antioxidant effect of Buchholzia coriacea ethanol leaf-extract and fractions on freund’s adjuvant-induced… 35 Table 1: Effect of Ethanol Leaf-extracts, Aqueous and Ethyl acetate Fractions of B. coriacea on Body Weight (g) of Adjuvant-induced Arthritic Rats Groups Day 10 Day 17 Day 24 Day 31 1 145.25 ± 9.53a 146.33 ± 7.57a 147.33 ± 0.58a 147.00 ± 5.29a 2 145.67 ± 8.72a 140.33 ± 4.04q 132.67 ± 5.13e 131.75 ± 3.79e 3 127.17 ± 3.86i 131.00 ± 7.00g 134.00 ± 3.46c 135.00 ± 2.00c 4 125.17 ± 3.33k 127.00 ± 2.65i 132.00 ± 2.65e 136.33 ± 2.08b 5 133.00 ± 3.46d 136.67 ± 4.04b 137.67 ± 1.53b 138.67 ± 2.52b 6 127.50 ± 2.28i 131.67 ± 3.06f 133.00 ± 3.00d 136.00 ± 3.00b 7 126.67 ± 2.57k 130.67 ± 3.06h 136.00 ± 2.65b 132.33 ± 1.53e 8 132.83 ± 4.09e 135.67 ± 1.53b 138.00 ± 2.65b 139.67 ± 3.51b 9 131.92 ± 2.39f 137.00 ± 1.00b 138.33 ± 1.53b 142.00 ± 1.00q 10 121.08 ± 2.94m 122.67 ± 2.52l 131.67 ± 2.08f 134.33 ± 1.53c 11 123.08 ± 2.75l 127.67 ± 1.15i 132.33 ± 4.93e 135.67 ± 5.03b 12 124.50 ± 2.47l 127.33 ± 3.06i 132.33 ± 3.21e 136.00 ± 2.65b The degree of significance was set at P<0.05. Means (on the same column and row) with different superscripts are significantly different at P<0.05. This implies that comparison was done on both rows (point of sampling) and columns (among experimental groups). Values are mean ± standard deviation of 3 results obtained from 3 rats (n=3). BCE=B. coriacea Crude Ethanol extract, BCA=B. coriacea Aqueous fraction, BCZ=B. coriacea Ethyl acetate fraction. 1=normal control, 2= positive control, 3= standard control, 4=200mg/Kg BCE, 5=400mg/Kg BCE, 6=800mg/Kg BCE, 7=200mg/Kg BCA, 8=400mg/Kg BCA, 9=800mg/Kg BCA, 10=200mg/Kg BCZ, 11=400mg/Kg BCZ, 12=800mg/kg BCZ Table 2: Effect of Ethanol Leaf-extract, Aqueous and Ethyl acetate Fractions of B. coriacea on Paw size (mm) of Adjuvant-induced Arthritic Rats Groups Beforeinduction Day 10 Day 17 Day 24 Day 31 1 2.14 ±0.02a 2.14 ± 0.01a 2.14 ± 0.02a 2.14 ±0.01a 2.14 ± 0.02a 2 2.20 ±0.03a 5.39 ±0.20d 6.59 ±0.22q 7.33 ±0.07x 7.78 ± 0.04z 3 2.14 ±0.07a 4.75 ±0.55e 3.89 ±0.59g 2.86 ±0.32gh 2.16 ± 0.22a 4 2.16 ±0.02a 5.60 ±0.20cd 4.53 ±0.42def 3.48 ±0.28efg 3.01 ± 0.14bc 5 2.14 ±0.03a 5.61 ±0.30cd 4.47 ±0.32def 4.00 ±0.22bcd 3.30 ± 0.35b 6 2.21 ±0.04a 5.57 ±0.33cd 4.44 ±0.27def 3.44 ±0.28fg 3.00 ± 0.45bc 7 2.16 ±0.02a 5.80 ±0.20bc 4.48 ±0.38def 3.36 ±0.30g 2.16 ± 0.34a 8 2.15 ±0.02a 5.73 ±0.24bc 4.64 ±0.23cdef 4.13 ± 0.10b 3.34 ± 0.28b 9 2.16 ±0.03a 5.97 ±0.40ab 5.03 ±0.67b 3.66 ±0.48efg 3.25 ± 0.27b 10 2.14 ±0.03a 5.68 ±0.32c 4.70 ±0.26bcde 3.73 ±0.34def 3.10 ±0.23bc 11 2.20 ±0.04a 5.68 ±0.16c 4.26 ±0.42f 3.80 ±0.43cde 3.08 ±0.41bc 12 2.16 ±0.03a 5.70 ±0.40ac 4.33 ±0.55ef 3.53 ±0.40efg 2.16 ± 0.44a The degree of significance was set at P<0.05. Means (on the same column and row) with different superscripts are significantly different at P<0.05. This implies that comparison was done on both rows (point of sampling) and columns (among experimental groups). Values are the mean ± standard deviation of 3 results obtained from 3 rats (n=3). BCE=B. coriacea Crude Ethanol extract, BCA=B. coriacea Aqueous leaf fraction, BCZ=B. coriacea Ethyl acetate leaf fraction. 1=normal control, 2=positive control, 3=stan- dard control, 4=200 mg/Kg BCE, 5=400 mg/Kg BCE, 6=800 mg/Kg BCE, 7=200 mg/Kg BCA, 8=400 mg/Kg BCA, 9=800 mg/Kg BCA, 10=200 mg/Kg BCZ, 11=400 mg/Kg BCZ, 12=800 mg/Kg BCZ Zbornik_1_2022_22.4.22.indd 35 22/04/2022 09:53:34 E.U. Alum, U.A. Ibiam, E.I. Ugwuja, P.M. Aja, I.O. Igwenyi, C.E. Offor, O.U. Orji, C. Aloke, N.N. Ezeani, O.P.C Ugwu, C.O. Egwu36 Groups Day 10 Day 17 Day 24 Day 31 1 6.60 ± 0.27a 6.81 ± 0.19a 6.61 ± 0.58a 6.62 ± 0.42a 2 6.62 ± 0.40a 6.83 ± 0.55a 7.70 ± 0.54a 8.27 ± 0.52a 3 6.68 ± 0.34a 6.20 ± 0.66b 5.68 ± 0.25h 5.70 ± 0.25c 4 6.11 ± 0.61a 6.03 ± 0.83b 5.84 ± 0.08b 5.33 ± 0.30k 5 6.29 ± 0.65a 6.43 ± 0.41a 5.74 ± 0.14c 5.57 ± 0.47f 6 6.35 ± 0.20a 5.68 ± 0.24h 5.70 ± 0.17c 5.54 ± 0.23g 7 6.50 ± 0.34a 5.89 ± 0.16b 5.83 ± 0.11b 5.55 ± 0.17f 8 6.82 ± 0.37a 6.08 ± 0.28b 5.92 ± 0.20b 5.48 ± 0.08i 9 6.93 ± 0.15a 5.76 ± 0.13c 5.80 ± 0.12b 5.59 ± 0.10f 10 6.62 ± 0.43a 5.71 ± 0.13h 5.80 ± 0.07b 5.38 ± 0.23j 11 6.76 ± 0.13a 5.77 ± 0.03c 5.74 ± 0.04c 5.67 ± 0.27d 12 6.66 ± 0.09a 5.80 ± 0.29b 5.71 ± 0.11c 5.52 ± 0.21h Table 3: Effect of Ethanol leaf-extract, Aqueous and Ethyl acetate leaf fractions of B. coriacea on Malondialdehyde (MDA) level (Nmol/g) of Adjuvant-induced Arthritic Rats The degree of significance was set at P<0.05. Means (on the same column and row) with different superscripts are significantly different at P<0.05. This implies that comparison was done on both rows (point of sampling) and columns (among experimental groups). Values are the mean ± standard deviation of 3 results obtained from 3 rats (n=3). BCE=B. coriacea Crude Ethanol ex- tract, BCA=B. coriacea Aqueous fraction, BCZ=B. coriacea Ethyl acetate fraction. 1=normal control, 2=positive control, 3=stan- dard control, 4=200 mg/kg BCE, 5=400 mg/kg BCE, 6=800 mg/kg BCE, 7=200 mg/kg BCA, 8=400 mg/kg BCA, 9=800 mg/kg BCA, 10=200 mg/kg BCZ, 11=400 mg/kg BCZ, 12=800 mg/kg BCZ Table 4: Effect of Ethanol leaf-extract, Aqueous and Ethyl acetate leaf fractions of B. coriacea on Nitric oxide (NO) level (Nmol/ml) of Adjuvant-induced Arthritic Rats Groups Day 10 Day 17 Day 24 Day 31 1 20.32 ± 1.02a 19.78 ± 0.68a 20.35 ± 0.07a 19.21 ± 0.91b 2 17.41 ± 0.95e 18.23 ± 1.00c 19.42 ± 0.15b 22.01 ± 0.07a 3 19.02 ± 2.10b 18.65 ± 0.48c 17.92 ± 1.13d 17.91 ± 2.20d 4 18.71 ± 0.48c 18.38 ± 0.65c 18.35 ± 0.45c 16.81 ± 0.47h 5 18.45 ± 1.54c 18.31 ± 0.82c 18.39 ± 0.46c 16.63 ± 0.59i 6 18.88 ± 0.46d 18.19 ± 1.08c 17.61 ± 0.43c 16.45 ± 0.16j 7 18.79 ± 0.27b 18.66 ± 0.38c 17.99 ± 0.53d 16.34 ± 0,58k 8 18.41 ± 0.55c 18.31 ± 0.83c 17.86 ±0.70d 16.95 ± 0.27g 9 17.92 ± 0.36d 17.72 ± 0.94d 17.91 ± 0.87d 17.86 ± 0.21d 10 18.64 ± 0.38c 18.30 ± 0.42c 17.98 ± 0.67d 16.72 ± 0.50h 11 18.19 ± 1.70c 18.28 ± 0.86c 17.89 ± 1.59d 17.05 ± 0.36f 12 20.97 ± 0.35a 18.34 ± 9.42c 18.11 ± 1.18c 18.14 ± 0.43c The degree of significance was set at P<0.05. Means (on the same column and row) with different superscripts are significantly different at P<0.05. This implies that comparison was done on both rows (point of sampling) and columns (among experimental groups). Values are the mean ± standard deviation of 3 results obtained from 3 rats (n=3). BCE=B. coriacea Crude Ethanol ex- tract, BCA=B. coriacea Aqueous fraction, BCZ=B. coriacea Ethyl acetate fraction. 1=normal control, 2=positive control, 3=stan- dard control, 4=200 mg/kg BCE, 5=400 mg/kg BCE, 6=800 mg/kg BCE, 7=200 mg/kg BCA, 8=400 mg/kg BCA, 9=800 mg/kg BCA, 10=200 mg/kg BCZ, 11=400 mg/kg BCZ, 12=800 mg/kg BCZ Zbornik_1_2022_22.4.22.indd 36 22/04/2022 09:53:34 Antioxidant effect of Buchholzia coriacea ethanol leaf-extract and fractions on freund’s adjuvant-induced… 37 Groups Day 10 Day 17 Day 24 Day 31 1 23.10 ± 0.98a 23.11 ± 2.08a 23.11 ± 1.29a 23.21 ± 1.91a 2 22.25 ± 1.67c 20.72 ± 0.57d 19.50 ± 0.79e 18.47 ± 1.22e 3 22.23 ± 0.92c 23.07 ± 0.56a 24.56 ± 1.16a 26.00 ± 0.48a 4 21.91 ± 1.01c 22.56 ± 1.04c 22.80 ± 0.45b 24.21 ± 0.70a 5 20.91 ± 1.93d 21.96 ± 0.77c 21.41 ± 0.52c 25.21 ± 0.43a 6 22.13 ± 1.51c 21.51 ± 0.18c 21.64 ± 0.83d 22.88 ± 0.73b 7 22.16 ± 0.22c 22.53 ± 1.41c 23.42 ± 1.36a 25.88 ± 0.72a 8 21.14 ± 1.17d 21.67 ± 0.75c 22.30 ± 0.38d 23.48 ± 0.23a 9 21.88 ± 0.66c 22.20 ± 1.09c 24.21 ± 0.56a 26.17 ± 0.32a 10 21.44 ± 1.54d 22.17 ± 0.14c 24.28 ± 0.70a 26.41 ± 1.09a 11 20.91 ± 1.61d 21.55 ± 0.89d 23.41 ± 0.16a 26.48 ± 0.42a 12 20.47 ± 1.18d 20.63 ± 0.09d 23.03 ± 1.65a 25.28 ± 0.26a Table 5: Effect of Ethanol leaf-extract, Aqueous and Ethyl acetate leaf fractions of B. coriacea on SOD activity (u/mg) of Adjuvant-induced Arthritic Rats The degree of significance was set at P<0.05. Means (on the same column and row) with different superscripts are significantly different at P<0.05. This implies that comparison was done on both rows (point of sampling) and columns (among experimental groups). Values are the mean ± standard deviation of 3 results obtained from 3 rats (n=3). BCE=B. coriacea Crude Ethanol ex- tract, BCA=B. coriacea Aqueous fraction, BCZ=B. coriacea Ethyl acetate fraction. 1=normal control, 2=positive control, 3=stan- dard control, 4=200 mg/kg BCE, 5=400 mg/kg BCE, 6=800 mg/kg BCE, 7=200 mg/kg BCA, 8=400 mg/kg BCA, 9=800 mg/kg BCA, 10=200 mg/kg BCZ, 11=400 mg/kg BCZ, 12=800 mg/kg BCZ Table 6: Effect of Ethanol leaf-extract, Aqueous and Ethyl acetate leaf fractions of B. coriacea on Catalase activity (u/mg) of Adjuvant-induced Arthritic Rats Groups Day 10 Day 17 Day 24 Day 31 1 67.67 ± 3.02a 67.84 ± 1.26a 66.52 ± 2.03a 66.63 ± 5.57a 2 58.49 ± 2.73c 55.79 ± 0.41d 52.21 ± 4.34f 45.62 ± 3.16g 3 57.48 ± 2.46d 59.21 ± 1.14b 58.42 ± 2.66c 61.60 ± 1.41a 4 53.25 ± 2.77f 54.19 ± 1.66e 57.31 ± 0.80d 59.84 ± 1.12a 5 54.59 ± 3.25d 55.63 ± 2.35d 57.92 ± 4.32d 59.66 ± 3.22a 6 55.16 ± 2.51d 56.04 ± 1.10d 55.68 ± 1.25d 60.44 ± 0.63a 7 55.44 ± 2.20d 57.57 ± 0.74d 57.58 ± 2.16d 57.99 ± 2.41d 8 55.56 ± 3.13d 57.52 ± 2.52d 56.52 ± 1.50d 58.21 ± 2.28c 9 55.59 ± 0.54d 55.32 ± 2.38d 56.56 ± 4.36d 62.14 ± 1.55a 10 53.90 ± 3.64e 55.95 ± 0.30d 55.61 ± 3.06d 59.65 ± 1.96a 11 54.20 ± 2.74e 54.61 ± 1.32d 56.24 ± 0.97d 59.35 ± 4.88a 12 57.25 ± 2.84d 57.30 ± 2.39d 58.97 ± 2.54c 59.81 ± 1.76a The degree of significance was set at P<0.05. Means (on the same column and row) with different superscripts are significantly different at P<0.05. This implies that comparison was done on both rows (point of sampling) and columns (among experimen- tal groups). Values are the mean ± standard deviation of 3 results obtained from 3 rats (n=3). BCE=B. coriacea Crude Ethanol extract, BCA=B. coriacea Aqueous fraction, BCZ=B. coriacea Ethyl acetate fraction. 1=normal control, 2=positive control, 3=standard control, 4=200 mg/kg BCE, 5=400 mg/kg BCE, 6=800 mg/kg BCE, 7=200 mg/kg BCA, 8=400 mg/kg BCA, 9=800 mg/kg BCA, 10=200 mg/kg BCZ, 11=400 mg/kg BCZ, 12=800 mg/kg BCZ Zbornik_1_2022_22.4.22.indd 37 22/04/2022 09:53:34 E.U. Alum, U.A. Ibiam, E.I. Ugwuja, P.M. Aja, I.O. Igwenyi, C.E. Offor, O.U. Orji, C. Aloke, N.N. Ezeani, O.P.C Ugwu, C.O. Egwu38 Groups Day 10 Day 17 Day 24 Day 31 1 23.64 ± 1.18b 24.37 ± 0.72a 24.43 ± 2.66a 23.89 ± 0.24b 2 21.61 ± 2.16b 20.76 ± 0.41d 19.51 ± 2.70e 18.21 ± 0.66f 3 20.43 ± 0.69c 21.38 ± 0.51b 22.26 ± 2.47b 22.31 ± 0.85b 4 20.63 ± 0.42c 21.42 ± 1.11b 22.31 ± 1.04b 21.58 ± 0.17b 5 19.82 ± 1.23e 20.71 ± 0.56c 21.83 ± 1.02b 21.55 ± 0.59b 6 20.19 ± 0.21d 20.63 ± 0.66c 21.16 ± 0.38b 22.05 ± 1.21b 7 20.73 ± 1.02c 21.07 ± 0.55b 21.96 ± 0.62b 22.21 ± 0.39b 8 20.91 ± 0.64b 21.08 ± 0.54b 21.30 ± 0.52b 22.09 ± 0.61b 9 20.15 ± 0.98d 21.23 ± 0.46b 21.52 ± 1.42b 22.84 ± 0.98b 10 21.23 ± 0.78b 20.51 ± 0.18c 21.64 ± 1.35b 21.64 ± 0.90b 11 21.72 ± 1.67b 20.76 ± 0.55c 21.26 ± 0.13b 22.70 ± 1.06b 12 21.31 ± 0.62b 21.04 ± 0.47b 21.36 ± 0.80b 22.50 ± 0.59b Table 7: Effect of Ethanol leaf-extract, Aqueous and Ethyl acetate leaf fractions of B. coriacea on glutathione peroxidase (GPx) activity (u/l)) of Adjuvant-induced Arthritic Rats Groups Day 10 Day 17 Day 24 Day 31 1 26.45±2.37a 26.82±0.59a 26.760±0.03a 25.99±0.08a 2 22.88±0.71d 19.18±0.62h 16.36±0.18i 10.17±1.43d 3 18.57±0.86h 21.99±0.39f 22.03±0.41e 22.38±0.76c 4 17.09±0.24i 20.42±0.50g 23.80±0.59c 24.82±1.21a 5 15.60±0.25j 19.31±0.33h 22.94±0.58d 25.54±0.33a 6 15.91±0.61j 20.12±1.54g 22.34±1.80d 25.62±0.70a 7 15.26±0.55e 22.53±0.34d 23.54±0.40c 24.51±0.57a 8 16.27±0.97i 22.72±0.32d 22.85±0.14d 25.16±1.46a 9 16.27±0.20i 21.77±0.89f 24.02±0.38b 25.12±0.88a 10 15.46±0.66j 23.22±1.48c 25.14±0.15a 25.48±0.53a 11 15.22±0.43j 22.40±1.63d 22.95±0.73d 23.70±1.11b 12 15.29±0.90j 21.91±1.03f 23.60±0.70c 24.36±0.65a Table 8: Effect of Ethanol leaf-extract, Aqueous and Ethyl acetate leaf fractions of B. coriacea on reduced glutathione (GSH) level (Umol/l) of Adjuvant-induced Arthritic Rats The degree of significance was set at P<0.05. Means (on the same column and row) with different superscripts are significantly different at P<0.05. This implies that comparison was done on both rows (point of sampling) and columns (among experimental groups). Values are the mean ± standard deviation of 3 results obtained from 3 rats (n=3). BCE=B. coriacea Crude Ethanol ex- tract, BCA=B. coriacea Aqueous fraction, BCZ=B. coriacea Ethyl acetate fraction. 1=normal control, 2=positive control, 3=stan- dard control, 4=200 mg/kg BCE, 5=400 mg/kg BCE, 6=800 mg/kg BCE, 7=200 mg/kg BCA, 8=400 mg/kg BCA, 9=800 mg/kg BCA, 10=200 mg/kg BCZ, 11=400 mg/kg BCZ, 12=800 mg/kg BCZ The degree of significance was set at P<0.05. Means (on the same column and row) with different superscripts are significantly different at P<0.05. This implies that comparison was done on both rows (point of sampling) and columns (among experimental groups). Values are the mean ± standard deviation of 3 results obtained from 3 rats (n=3). BCE=B. coriacea Crude Ethanol ex- tract, BCA=B. coriacea Aqueous fraction, BCZ=B. coriacea Ethyl acetate fraction. 1=normal control, 2=positive control, 3=stan- dard control, 4=200 mg/kg BCE, 5=400 mg/kg BCE, 6=800 mg/kg BCE, 7=200 mg/kg BCA, 8=400 mg/kg BCA, 9=800 mg/kg BCA, 10=200 mg/kg BCZ, 11=400 mg/kg BCZ, 12=800 mg/kg BCZ Zbornik_1_2022_22.4.22.indd 38 22/04/2022 09:53:34 Antioxidant effect of Buchholzia coriacea ethanol leaf-extract and fractions on freund’s adjuvant-induced… 39 Discussion In the first week following induction of arthritis, all adjuvant-induced arthritic rats showed a significant (P<0.05) decrease in the body weight relative to rats in normal control group. A significant (P<0.05) increase in the body weight of rats was observed in all the treated groups while progressive weight loss was observed in the untreated-arthritic group till the end of the study. Our present results are in agreement with previous studies that showed that Complete Freund’s Adjuvant (CFA)-injected rats showed decreases in body weight relative to non- arthritic rats (41). Administration of CFA leads to increase in leptin level, anorexia and weight loss (42). In this study, we speculate that the cause of the decrease in body weight on injection of CFA might be due to increase in leptin level in the arthritic rats. Leptin is a hormone secreted by fat cells and is known for suppressing hunger signals, also has influences on the immune system. Elevated level of leptin contributes to chronic inflammation by up-regulating inflammatory cytokines (like tumor necrosis factor-alpha, TNF-α; interleukins, IL-1β, and IL-6) (43). Elevated levels of pro-inflammatory cytokines could exert a strong effect on protein and energy metabolism by promoting muscle breakdown. Increased catabolism leads to resting energy expenditure culminating to weight loss and reduced lean body mass (44). Inflammation can also cause a decrease in absorption capacity of the intestine. Elmali et al. (2005) (45) reported a restoration of absorption capacity of the intestine upon treatment with anti- inflammatory drugs. Thus, increased body weight of the arthritic rats during the course of treatment with an anti-inflammatory drug (indomethacin) and varied doses of the extract and fractions could be due to the reduction of the inflammatory cytokines and subsequent decrease in protein and muscle breakdown. It could also be due to the restoration of absorption capacity of the intestine. Edema is one of the fundamental actions of acute inflammation and is an essential parameter to be considered when evaluating compounds with potential anti-inflammatory activity (46, 47). In this study, there was a two-fold increase in paw size in the feet of rats injected with Freund’s adjuvant. A significant (P<0.05) reduction in paw size of rats treated with standard drug, ethanol leaf-extract, aqueous and ethyl acetate leaf fractions of B. coriacea at varied, was observed. Previous authors have also reported a significant reduction in paw size of rats on treatment with medicinal plants (48, 49). Oxidative stress is a situation in the biological science in which there is an imbalance between oxidants and antioxidants in favor of the oxidants, culminating in interference of redox signaling and control and/or molecular injury (50). In normal physiological processes, reactive oxygen species (ROS) are formed and they play crucial functions in cell signaling and tissue homeostasis (51). Nevertheless, their excessive production culminates in severe alterations to cell components and augment various pathogenesis, such as lipids, proteins, and DNA damage (52). Sequel to high level of polyunsaturated fatty acids (PUFAs) in cellular membranes or organelle membrane, they are prone to ROS damage, which is referred to as lipid peroxidation. Thus, lipid peroxidation is a process that involves the removal of electrons from lipids by free radical species such as oxyl radicals, peroxyl radicals, and hydroxyl radicals leading subsequently to the production of reactive intermediates that can undergo further reactions. This causes damage to phospholipids and function as cell death signal which induces programmed cell death. Hence, oxidized phospholipid mediates important function in several inflammatory disorders and frequently mediate proinflammatory alteration (53). There exist three major classes of antioxidant enzymes in all body cells which include the catalases, superoxide dismutases (SOD), and glutathione peroxidases (GPX). These enzymes play vital functions in cells’ homeostasis. Their induction is a reflection of specific response to pollutant oxidative stress (54). These enzymic and non-enzymic antioxidants such as glutathione (GSH) have the ability to prevent or retard the oxidation of macromolecules. These antioxidants retard or terminate these chain reactions by mopping up free radicals or via inhibition of other oxidation reactions by being oxidized themselves (55). Chemical composition analysis of B. coriacea has been investigated by previous studies. Phyto- chemicals present in B. coriacea ethanol leaf-ex- tract and fractions are terpenoids, phenols, alka- loids, flavonoids, tannins, saponins and steroids (56). Other authors have also corroborated this finding (57, 58, 59, 60, 61). Phytochemicals can act as antioxidants (e.g, flavonoids, alkaloids, tan- Zbornik_1_2022_22.4.22.indd 39 22/04/2022 09:53:34 E.U. Alum, U.A. Ibiam, E.I. Ugwuja, P.M. Aja, I.O. Igwenyi, C.E. Offor, O.U. Orji, C. Aloke, N.N. Ezeani, O.P.C Ugwu, C.O. Egwu40 nins, saponins and terpenoids) antiproliferative and anti-inflammatory compounds for prevention of chronic diseases (62, 63). The results of our study revealed increased oxidative stress in adjuvant-induced arthritic rats as evidenced by increased lipid peroxidation product-MDA and NO production, and impaired enzymatic and non-enzymatic antioxidant defense system of the body (Tables 3- 8). The raised MDA (a consequence of increased extent of lipid peroxidation) might be due to the increased formation of ROS which tends to increase abundantly during chronic inflammation and could result to damage to tissues. Other authors have also reported increase in MDA in liver and brain of rats with arthritis (64, 65, 66). Elevated level of MDA has been found in the serum, plasma and erythrocytes of RA patients (13, 67). Administration of standard drug and samples reduced levels of MDA as shown in Table 3. Some functions of NO include immune response, neural communication and blood pressure maintenance (68). In this study, increased NO level portends oxidative stress and this corroborates previous findings as reported by other authors (64, 13, 67). However, Veselinovic et al. (69) reported unaltered level of NO in the plasma of RA patients. The increase in the level of NO in the plasma of arthritic rats might be due to the hyperactivity of the NO forming enzyme, nitric oxide synthase (70). The observed reduced SOD activity might be due to its depletion caused by increased oxidative stress that occur during inflammatory process. This decreased erythrocyte SOD activity is in agreement with other studies as well (13, 71, 72, 73, 74, 75). However, increased (69, 76), or even unaltered SOD activity (77) has also been reported by some groups. Catalase is an enzyme that catalyses the conversion of hydrogen peroxide into water and oxygen. This protects cells from harmful effects that accumulated hydrogen peroxide could have caused. From our result, catalase activity is lowered in arthritic rats and this might be as a result of catalase being used up by hydrogen peroxide. Diminished catalase activity in brain and liver of arthritic rats have been reported by previous authors (65, 66). This result is in tandem with other findings using human beings (54, 13, 71, 74). However, some groups have also reported unaltered catalase activity in RA patients (64, 75, 78, 72). We also observed a significant decrease in GPx activity in the adjuvant-induced arthritic rats (Table 7). This is in line with the findings of other studies using humans (79, 73, 72). However, two studies reported an increase on GPx activity in RA patients (80, 76). However, three study groups did not report any differences between cases and controls in GPx activity in RA patients (75, 78, 74). We noticed significantly low levels of GSH in arthritic rats as compared to the control rats (healthy rats) (Table 8). GSH is a sulfhydryl molecule that acts as a defense system in the body. It functions as an intracellular reductant in redox reactions taking place in the human body by protecting cellular components from damage caused by ROS. The observed low level of GSH in plasma of arthritic rats has also been reported by previous authors (64, 75, 79, 74, 81, 82, 13). Veselinovic et al. (69) reported that GSH level was unchanged in RA patients. This contradicting report by various authors could be due to differences in RA severity and response to treatments by rats/or patients. ROS are highly reactive chemical species that have the potential to damage lipids, proteins and deoxyribonucleic acid (DNA) in joint tissues. ROS are required in maintaining redox state of cells. Other functions include cell signaling, differentiation, proliferation, growth, apoptosis and phagocytosis. However, if the concentrations of ROS are increased beyond physiological conditions they can damage macromolecules like lipids in the cell membranes, proteins and nucleic acids (83, 81). Oxidative stress results if the concentration of oxidants is higher than antioxidants (84). Under this condition, redox signaling is disrupted leading to macromolecular damage (85, 86, 87). The damaging ROS is annulled by the action of antioxidants. Enzymatic antioxidant response is carried out by SOD, catalase, GPx, glutathione reductase and transferase while non-enzymatic antioxidant includes the action of vitamins (e.g. A, C, and E), β-carotene, some minerals (e.g. copper, zinc, manganese, and selenium), GSH and some phytochemicals (e.g. flavonoids, terpenoids, alkaloids) (85, 64). A large number of authors reported that ROS are implicated in inflammation and destruction in the joints of arthritic animals and RA patients (64, 88, 13, 85, 89, 90, 91). Oxidative stress is implicated in damaging of joints due to RA (87). There is strong evidence that ROS are highly involved in cartilage degradation in experimental arthritic rats (92). Zbornik_1_2022_22.4.22.indd 40 22/04/2022 09:53:34 Antioxidant effect of Buchholzia coriacea ethanol leaf-extract and fractions on freund’s adjuvant-induced… 41 Oxidative stress can also impair DNA mismatch repair mechanism which may result to an increase in the formation of DNA adducts in the joints thereby aggravating the disease symptoms (93). Phytochemicals serve as sources of natural compound for developing novel drugs. This is because of their antioxidant and anti-inflammatory roles in management of inflammatory diseases such as RA. The presence of antioxidant minerals (e.g., copper, zinc, manganese, and selenium) and vitamins (A, C and E) in B. coriacea is well- documented (56, 94). Thus, the anti-RA effect exerted by the samples could be attributed to the action of these antioxidants present in the plant. However, limitation of this study is the small number of rats sampled at each point. Conclusion Induction of RA caused oxidative stress evidenced by elevation of MDA and NO and diminished activities of antioxidants: SOD, GPx, Catalase and GSH. Administration of samples to rats led to decrease in oxidative stress and boosting of the antioxidants. This study has demonstrated in vivo the therapeutic potential of leaf extract and ethyl acetate fraction of B. coriacea at curbing oxidative stress and hence a potential alternative to synthetic drugs in the management of oxidative stress in RA patient. Ethics approval and consent to participate was adequately sought. Acknowledgements Authors acknowledge the management of Divine Analytical Laboratory, Nsukka, Nigeria, where this research was carried out. 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Egwu Izvleček: V več študijah je bil nakazan pomen reaktivnih kisikovih zvrsti pri ohranjanju vnetja in poznejšem uničenju sklepov pri pacientih z osteoartritisom. Proučevali smo antioksidantivne učinke etanolovega izvlečka ter vodnih in etil acetatnih frak- cij listov Buchholzia coriacea na kazalce oksidativnega stresa pri samicah albino podgan Wistar z revmatoidnih artritisom. 180 podgan smo naključno porazdelili v 12 skupin. V vsaki skupini je bilo 15 podgan. Podgane brez artritisa so bile uvrščene v skupino 1. V skupinah 2 do 12 so bile podgane z revmatoidnim artritisom, povzročenim z intradermalno injekcijo 0,1 ml Fre- undovega kompletnega adjuvansa v zadnjo levo taco podgan. Skupina 2 (podgane z artritisom) ni bila zdravljena, prejela je fiziološko raztopino, skupina 3 (podgane z artritisom) pa je prejela 5 mg/kg indometacinaTM (standardno zdravilo). Podgane v skupinah 4 do 12 so prejele vzorce adjuvansa v odmerkih 200, 400 in 800 mg/kg telesne mase. Aplikacija Freundovega adju- vansa je povzročila vnetje in oksidativni stres, kar se je kazalo v značilnem (p<0.05) povišanju velikosti tac in kazalcev oksida- tivnega stresa ter zmanjšanju telesne teže podgan. Podgane z artritisom so bile zdravljene s standardnim zdravilom in vzorci adjuvansa (v različnih odmerkih), kar je vodilo v obrat trenda teh parametrov v odvisnosti od časa in odmerka. Najboljši rezultat, podoben učinku indometacina, je bil pri podganah, ki so prejele 800 mg/kg vodne frakcije adjuvansa. Etanolni izvleček in frak- cije listov Buchholzia coriacea bi zato lahko bili uporabni pri obvladovanju oksidativnega stresa, ki se zelo pogosto pojavlja pri posameznikih z revmatoidnim artritisom. Ključne besede: revmatoidni artritis; Buchholzia coriacea; prosti radikali; oksidativni stres; reaktivne kisikove zvrsti 91. Ozgocmen S, Ozyurt H, Sogut S, Akyol O. Current concepts in the pathophysiology of fi- bromyalgia: the potential role of oxidative stress and nitric oxide. Rheumatol Int 2006; 26: 585– 97. 92. Wruck CJ, Fragoulis A, Gurzynsk A, et al.. Role of oxidative stress in rheumatoid arthri- tis: insights from the Nrf2-knockout mice. Annu Rheum Dis 2011; 70(5): 844–50. 93. Altindag O, Karakoc M, Kocyigit A, Celik H, Soran N. Increased DNA damage and oxidative stress in patients with rheumatoid arthritis. Clin Biochem 2007; 40: 167–71. 94. Ibrahim TA, Fagbonun ED. Antibacterial and antifungal activity of ethanolic and methan- olic extract of dried seeds of Buchhlozia coriacea. Greener J Agric Sci 2013; 3(6): 458–3. Zbornik_1_2022_22.4.22.indd 45 22/04/2022 09:53:35