Abstract
Background: Considering limitations of the established osteoarthritis (OA) medications, attention to adjuvant and complementary treatments has increased in OA individuals. Recent investigations have reported advantages of pomegranate in OA and indicate that pomegranate can be a therapeutic option; nevertheless, no systematic review exists regarding OA and pomegranate. Therefore, we systematically studied accessible researches regarding pomegranate and OA in human, animal, and in vitro models and likely mechanistic pathways. Methods: Present systematic review study was recorded on the international prospective register of systematic reviews database. Electronic databases (Scopus, PubMed, Embase, WOS, ProQuest) and search engine Google Scholar were searched until February 2021. Search alerts were turned on to recognize papers published following the primary search. Two investigators independently searched using MESH and non-MESH words in title, abstract, and keywords. Inclusion criteria were related clinical, animal, and in vitro studies published in any language as a full text. Exclusion criteria were reviews, book chapters, conference abstracts, and articles regarding pomegranate in health problems other than OA. Hand searching was used to check the references or citations of eligible papers and grey literature (theses etc.) to find potential researches. Results: Twenty-three articles were included in our systematic review. Human, animal, and in vitro researches demonstrated favorable properties of pomegranate in improving clinical features and reducing inflammatory, oxidative stress, and apoptosis markers in OA. Conclusion: Present paper provides convincing evidence about the efficacy of pomegranate in OA and gives a justification for the importance of additional clinical studies.
Highlights
In a study on IL-1β-induced primary rat chondrocytes as a model of OA, Lee et al.28 indicated that either 12.5 to 100 μg/mL POMx (70% acetone extract of pomegranate peels) or 6.25 to 50 μg/mL punicalagin decreased inducible nitric oxide synthase (iNOS), matrix metalloproteinase (MMP)-13, and COX-2 proteins production dose-dependently and led to reduction in IL-1β-stimulated prostaglandin E2 (PGE2) production
Present study is the first systematic review assessing the available articles about pomegranate and OA in human, animal, and in vitro models
Recent investigations have indicated that decreasing oxidative stress is helpful for inhibiting apoptosis in chondrocytes and improving OA.50,51
Summary
Osteoarthritis (OA) is a common musculoskeletal disorder and a main reason of disability worldwide. The number of subjects disabled by OA has increased significantly in recent decades. OA can affect different joints in body like hand, knee, and hip leading to pain, stiffness, swelling, and physical dysfunction. OA is a multifactorial disease and some important risk factors include age, sex, genetic, obesity, and joint injury. OA causes articular cartilage erosion, synovial membrane inflammation, and subchondral bone resorption. These pathological alterations are linked with an excessive generation of proinflammatory parameters like tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), which disarrange the balance among synthesis and degradation of matrix components leading to progressive joint destruction. In addition, pro-inflammatory cytokines induce oxidative stress and apoptosis in OA. High concentrations of reactive oxygen species (ROS) modulate numerous signaling pathways initiated by cytokines and further augment inflammatory, catabolic, and apoptotic reactions in chondrocytes causing cartilage matrix destruction. Because oxidative stress and apoptotic signaling pathways have an indispensable role in OA pathogenesis, it is logical to assume that attenuation of these pathways can be helpful for managing OA. OA causes articular cartilage erosion, synovial membrane inflammation, and subchondral bone resorption.. OA causes articular cartilage erosion, synovial membrane inflammation, and subchondral bone resorption.5 These pathological alterations are linked with an excessive generation of proinflammatory parameters like tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), which disarrange the balance among synthesis and degradation of matrix components leading to progressive joint destruction.. We systematically studied accessible researches regarding pomegranate and OA in human, animal, and in vitro models and likely mechanistic pathways. Animal, and in vitro researches demonstrated favorable properties of pomegranate in improving clinical features and reducing inflammatory, oxidative stress, and apoptosis markers in OA. Conclusion: Present paper provides convincing evidence about the efficacy of pomegranate in OA and gives a justification for the importance of additional clinical studies
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
