Boerhavia diffusa (Punarnava) as an Adjunctive Therapy for Chemotherapy-Induced Organ Toxicity

Abstract

Chemotherapeutic agents such as cisplatin and doxorubicin are limited by dose-dependent toxicities to the kidneys, heart, and liver, which compromise treatment tolerability and patient outcomes. Boerhavia diffusa (Punarnava), a traditional herb with documented anti-inflammatory and antioxidant properties, may serve as a safe adjunctive therapy to mitigate these adverse effects. The evidence demonstrates that Boerhavia diffusa root extract at 200 mg/kg significantly reduces serum creatinine, blood urea nitrogen, malondialdehyde, and active caspase-3 in cisplatin-treated rats, while whole-plant ethanolic extract attenuates doxorubicin-induced cardiotoxicity by lowering lactate dehydrogenase and creatine kinase-MB levels. These protective effects are mediated through suppression of the NF-kappaB pathway, modulation of Bax/Bcl-2 ratios, and restoration of antioxidant enzyme activities. However, significant research gaps remain: no tumor-bearing models have been tested, pharmacokinetic interactions with chemotherapeutic agents are uncharacterized, and effects on intestinal mucositis, gut microbiota, and drug transporters have not been investigated. Furthermore, direct evidence for Nrf2 pathway activation is absent. Our findings support the potential of Boerhavia diffusa as an adjunctive therapy, but they also underscore the necessity for rigorous preclinical studies in tumor-bearing models and pharmacokinetic assessments before clinical translation can be considered.