Volume 9, Issue 4, April – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24APR1164

Inflammation in Health and Disease: Novel

Therapeutic Approaches
M. Ganga Raju*; G. Kaveri; N.V. L.V. Suvarchala Reddy; P. Manasa, B. Archana
Department of Pharmacology, Gokaraju Rangaraju College of Pharmacy, Bachupally, Hyderabad, Telangana, India

Corresponding Author:
Dr. M. Ganga Raju,
Professor and Principal,
Department of Pharmacology,
GRCP, Hyderabad, Telangana State.

Abstract:- Inflammation, which is regarded as an innate Inflammation, a component of the immune response, is
immune mechanism, is a part of the intricate biological crucial for protecting the body from pathogens like bacteria,
reactions of a tissue to injury that shield the organ by fungus, viruses, and other parasites [5]. However, an
eliminating harmful stimuli and starting the healing unchecked inflammatory response is the primary cause of a
process. The majority of non-steroidal anti- wide range of disorders, including cancer, autoimmune
inflammatory medications on the market work well for diseases, allergies, cardiovascular dysfunction, metabolic
inflammatory diseases. Several compounds that disrupt syndrome, and metabolic disorders, which have a significant
the inflammatory response have also been identified in financial impact on both the individual and the larger society
Indian Medicinal Plants (IMP). The multitude of side [6]. Infections by bacteria, viruses, or fungi that enter the
effects associated with the anti-inflammatory body, settle in specific tissues, or move through the
medications now on the market has a negative impact on bloodstream typically result in inflammation [7-9].
human well-being. Advent of novel anti-inflammatory Inflammation is primarily caused by both the innate and
therapies such as herbal preparations, recent adaptive immune responses. The primary defense system
developments in the use of bioactive ingredients from against cancer cells and invasive microbes is the innate
herbal remedies to treat osteoarthritis and in the immune system, which is composed of mast cells, dendritic
application of synthetic COX-2 inhibitors, chitosan as a cells, and macrophages. More specialized lymphocytes, such
therapy for oral mucosal irritation, improvement in the B and T cells, are involved in the adaptive immune system
medication used to treat acute pancreatitis, extracellular [7,10,11]. Numerous treatments are available for managing
vesicles from mesenchymal cells for the therapy of and repressing inflammatory crises; examples of these
inflammation, oral colonic drug delivery methods for include immunosuppressants, steroids, and non-steroid anti-
treating inflammatory bowel disease and combined inflammatory pharmaceuticals. However, several of these
targeting therapy for inflammatory bowel management medications have negative side effects. In actuality, though,
will not only effectively manage the inflammation and its we want to use the lowest possible effective dose while
associated disorders but also helps to significantly maintaining the greatest level of efficacy and minimizing
improve the quality of life. Hence the current review side effects. In order to maximize pharmaceutical efficacy
reveals the recent advances in the field of inflammation and minimize undesirable side effects, we must therefore
and anti-inflammatory activity in detail. incorporate natural anti-inflammatory components into
medicine therapy [6,12]. Inflammation can be caused by a
Keywords:- Inflammation, Anti-Inflammatory Activity, wide range of substances, but the most common ones are
Recent Advances. infections brought on by bacteria, viruses, or fungi; wounds,
cuts, or scrapes; damage to the body from foreign objects,
I. INTRODUCTION such as a splinter or thorn in the finger; and the effects of
toxic compounds, chemicals, or radiation [13].
The term "inflammation," which comes from the Latin
word "inflammare," which means "to set fire," refers to our
body's defensive reaction to harmful stimuli like allergens
and/or tissue damage [1,2]. An internal or external infection,
irritation, or damage can cause inflammation, which is a
localized reaction characterized by redness, warmth,
swelling, and pain [3]. The intricate biological reaction of
vascular tissues to damaging stimuli such as pathogens,
irritants, or damaged cells is known as inflammation. It is an
attempt on behalf of the organism to both eliminate harmful
stimuli and start the tissue's healing process [4]. Fig 1: Inflammation

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Volume 9, Issue 4, April – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24APR1164

The two stages of the inflammatory process are acute Monocytes/macrophages, neutrophils, platelets, and mast
and chronic, and both are recognized to be complex cells are among the cells that mediate them, along with
processes that are brought on by various chemical plasma protein. A variety of receptors, including those
mediators, such as prostaglandins, leukotrienes, platelet involved in vascular muscle contraction, direct permeability,
activating factor, etc. [14] neutrophil chemotaxis, smooth enzymatic activity
stimulation, induced pain, and mediated oxidative stress, are
A. Acute Inflammation: bound by chemical mediators, which are produced by viral
It can manifest as redness, heat, or oedema, and it or host proteins. When an inflammatory response occurs, a
typically appears minutes or hours after tissue damage. It is wide variety of inflammatory mediators are created and
a quick procedure. Fluids and plasma proteins exude from released. The pro- and anti-inflammatory groups of
the wounded area, and leukocytes particularly neutrophils chemicals are typically used to categorize compounds that
move in. The defensive mechanism that seeks to eradicate cause inflammation. Still, some mediators have both pro-
bacteria, viruses, and parasites benefits from this acute and anti-inflammatory qualities, such as interleukin (IL)-12.
inflammatory response [15,16]. Acute inflammation goes Many inflammatory mediators and cellular pathways have
away when the immune system successfully gets rid of been thoroughly investigated in relation to pathological
harmful substances; if not, a chronic phase develops. diseases in humans. Two general categories of chemical
Diseases including psoriasis, multiple sclerosis, rheumatoid mediators can be distinguished:
arthritis, persistent asthma, and inflammatory bowel disease
can all be brought on by cascades of inflammation [17].  Mediators Generated from Cells:
 Vasoactive amines (Histamine, neuropeptides, and 5-
B. Chronic Inflammation: hydrocyhistamine)
It is longer-lasting and associated with lymphocytes  Arachidonic acid metabolites (Eicosanoids)
and macrophages present histologically, which causes  Metabolite through cyclo-oxygenase pathway
fibrosis and necrosis of the tissue. Chronic inflammation (Prostaglandins, thromboxane A2, Prostacyclin,
promotes the development of degenerative illnesses, resolvins)
including multiple sclerosis, diabetes, aging, Alzheimer's,  Metabolites metabolism through lipo-oxygenase
asthma, rheumatoid arthritis, atherosclerosis, heart disease, pathway (5-HETE, leukotrienes, lipoxins)
cancer, congestive heart failure, multiple sclerosis, gout, and  Lysosomal components (from PMNS, macrophages).
other neurodegenerative CNS depressions. Additionally,  Platelet activating factor
aging-related muscle loss has been linked in part to chronic  Cytokines which include IL-1, TNF-α, TNF-β, TNF-γ,
inflammation [18,19]. Vascular growth, fibrosis, tissue chemokines.
damage, and the presence of lymphocytes and macrophages  Free radicals (oxygen metabolites, nitric oxide)
are all linked to chronic inflammation. Chronic infections
and inflammation have been found to be important risk  Mediators Derived from Plasma:
factors for a number of cancer types in experimental and  The Kinin system
clinical research as well as epidemiological observations  The Clotting system
[17].  The Fibrinolytic system
 The Complement system [14]

II.RECENT ADVANCES IN THE FIELD OF

INFLAMMATION AND ANTI-INFLAMMATORY
ACTIVITY

 Need for Development of New Anti-Inflammatory Agents

The existing anti-inflammatory drugs reported to
possess an array of side effects which adversely effects the
quality of life of the mankind. Advent of new interventions
for inflammation will not only effectively manage the
inflammation and its associated disorders but also helps to
significantly improve the quality of life. Recently attempts
were being made to develop new avenues for controlling
inflammation and finding new targets. Some of them were
enlisted below:

A. Herbal Preparations:
Fig 2: Acute and Chronic inflammation In order to treat disease, maintain health, and
reestablish the body's natural ability to defend, regulate, and
Chemical mediators play a crucial part in the repair itself, herbal therapy typically employs different plant
inflammatory process and are the substances that tend to components or botanical extract mixes [20] Several herbal
steer it, which makes comprehending them comprehensive. anti-inflammatory remedies have been shown in a few

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Volume 9, Issue 4, April – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24APR1164

clinical investigations to be effective in treating between herbal medicines and synthetic preparations, as
inflammation with little adverse effects (see table 1). There well as serious side effects from several of them [21].
are reports of major negative effects and interactions

Table 1: Clinical Trials on Selected Herbal Extract

S.no Herbal formulation Type of trial Inference
1) Ethyl acetate extract of purified Randomized and double-blind trial No adverse effects during the analgesic and
(gugulu commiphora mukul) digestive phases
2) Turmeric extract Large, double-blind study Osteoarthritis and rheumatoid arthritis
3) Boswellia serrate extract Randomized, double-blind, verum Decreased inflammatory response when
controlled, parallel group treating Crohn's illness
4) White willow bark extract A four-week crossover study that Treatment for acute episodes of persistent
was double-blind and placebo- lower back pain in the short term.
controlled
5) Ethanolic extract of Devil’s Randomized, double-blind, parallel Increased effectiveness in treating
claw group study rheumatism, lower back pain, and knee and
hip pain associated with osteoarthritis.

B. Recent Developments in The Use of Bioactive insufficient when compared to other types of arthritis, such
Ingredients From Herbal Remedies To Treat as rheumatoid arthritis (RA). There are certain
Osteoarthritis: pathophysiological similarities between RA and OA,
In recent research, 43 herbal substances with anti-OA including oxidative stress, apoptosis, and inflammation.
properties were examined in relation to the treatment of Thus, future studies will examine the possibility of anti-RA
osteoarthritis (OA). For the treatment of osteoarthritis (OA), medications in the management of OA [22].
articular cartilage, subchondral bone, synovial membrane,
muscle, and circulatory system are the primary therapeutic  Heterocyclic compounds as anti-inflammatory agents
sites of these molecules. There is potential for additional Various families of heterocyclic compounds, including
research and development as more than half of these pyrazole, pyrimidine, benzimidazole, indole, and others,
compounds have good drug-like characteristics. Based on have been identified as heterocyclic anti-inflammatory
cheminformatics analysis, these constituents' drugs. These compounds can be classified as non-selective,
pharmacokinetic behaviour still need refinement, which will COX-2 selective, LOX selective, or COX/LOX dual
help to improve their drug-like qualities. In the treatment of inhibitors. Table 2 lists the lead drugs with varying stages of
osteoarthritis, the use of herbal substances has advanced clinical studies against inflammation [23].
somewhat. Yet, the use of herbal remedies in OA is still

Table-2: Clinical trials on novel compounds

S.no Novel compound Indications Clinical trial reference

1 Bromfenac and Extra (pulse) dose on the day of surgery for treatment of ocular NCT0239465
Nepafenac inflammation associated with cataract surgery.

2 Escitalopram Analyse its impact on inflammation-causing depression NCT02389465

3 Propofol To assess how it affects the inflammatory process by regulating NCT01115179

Apo A-1

4 Captopril Both alone and in conjunction with telmisartan to combat a NCT01271478

patient's systemic inflammation while receiving hemodialysis

5 Riluzole and Clinical advancements NCT02074462

Dexlansoprazole NCT01093755
6 Oral vitamin C Evaluation in opposition to inflammation NCT01356433

 Developments in the Application of Synthetic COX-2 rofecoxib such as anti-inflammatory activity, gastrointestinal
Inhibitors: protection, and a safer profile [24].
The researchers found biological activity of synthetic
COX-2, dual COX-2/lipoxygenase, and COX-2/soluble  Chitosan as a Therapy for Oral Mucosal Irritation:
epoxide hydrolase hybrid inhibitors, which offer a number Chitosan may lessen discomfort and promote better
of benefits over NSAIDs like celecoxib, valdecoxib, and oral lesion healing in patients with oral mucositis (OM),

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Volume 9, Issue 4, April – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24APR1164

recurrent aphthous stomatitis (RAS), and denture stomatitis involve clarifying the molecular causes of IBD disorders and
(DS). There is insufficient data to definitively support conducting additional in vivo tests to confirm the stability
chitosan's superiority over other available treatments for oral and specificity of the developed systems [29].
mucositis, and their high risk of bias and poor quality
exclude any suggestion about their therapeutic use [25].  Combined Targeted Therapy for Inflammatory Bowel
Disease Management:
 New Lead Structures with Anti-Inflammatory Properties: Treating IBD patients with combined biological or
Several alluring therapeutic targets, agents, and small-molecule medicines that target diverse sites creates a
diagnostic indicators for the treatment of inflammatory new therapeutic option. There is growing data on
disorders. The signalling pathway proteins, transcriptional combination target therapy in two clinical scenarios: "double
factors (such as nuclear receptors), oncogenes, and lncRNA indication," with active EIMs, and "complex refractory
make up these biomarkers and targets. O-substituted IBD," when no mono therapeutic approach proved effective.
tryptanthrin oxime derivatives are an example of a synthetic For bio-naïve IBD patients, combination targeted therapy is
compound. Natural substances that are therapeutic agents not yet advised outside of clinical trials. It's uncertain if
include ginsenoside Rc and others. Along with defining combination therapy should be used as maintenance therapy
complex gene-chemical connections, the researchers also or just during the induction phase. Recent results from the
outlined molecular pathways involved in the genesis of VEGA trial suggested that golimumab and guselkumab, two
inflammatory illness. For the future management of innovative biologics, might be used together as a new kind
inflammatory illnesses, our work may produce novel anti- of treatment for individuals with high-risk UC [30].
inflammatory lead structures with established
pharmacokinetics and efficacy in vivo. A more targeted and III. CONCLUSION
efficient approach to treating disease states would come
from more research to determine which patients might Established therapeutic anti-inflammatory drugs
benefit from a specific anti-inflammatory medication possess few adverse effects which slowly discriminating its
activity [26]. use. Hence it is concluded that few recent advances in the
therapy of inflammation might reduce the established side
 Improvements in the Medication Used to Treat Acute effects with more efficacy and long-term use. Further
Pancreatitis: studies are required to provide a better mechanistic view.
In order to validate their application in clinical
practice, the discovered prospective therapeutics for acute ACKNOWLEDGEMENTS
pancreatitis (AP) are awaiting additional development and
clinical evaluation from big trials. Future research efforts The authors are grateful to the Principal Prof. M.
must center on these three critical areas of AP management: Ganga Raju and Management of the Gokaraju Rangaraju
early diagnosis, risk stratification, and efficacious treatment College of Pharmacy, for the constant support and
strategies. These components are essential to changing the encouragement during the course of the work.
trajectory of the disease. In order to develop effective
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