Table 5.

Pharmacological effects of natural antioxidants in β-thalassemia major treatment.

Bioactive Compound	Doses	In Vitro/ In Vivo/ Clinical Study	Route of Administration	Model	Bioactive Effect	References
Silymarin	140 mg/kg + DFO	clinical study	three times/ day	59 patients with thalassemia major	↑ GSH levels of RBCs ↑ alkaline phosphatase ↓ serum iron and ferritin	[180]
Silymarin	Legalon capsules (140 mg)	clinical study	9 months	97 patients with β-thalassemia major	↓ ferritin and iron levels ↓ TIBC levels ↓ serum levels of hepcidin and soluble transferrin receptor (sTfR)	[166]
Nigella sativa	2 g/day	clinical study	Nigella sativa powder added to foods or drinks for 3 consecutive months	25 blood transfusion-dependent childrens with β-thalassemia major	↑ Hb, WBCs ↑ neutrophils ↓ MDA ↑ TAC	[181]
Fermented papaya	3 g	clinical study	3 g three times a day after meals for three months	patients with β-thal major	↑ GSH in RBCs ↓ ROS in RBCs ↓ lipid peroxidation	[182]
Curcumin	500 mg capsules (total: 1000 mg)	clinical study	twice daily for 12 weeks	68 β-thalassemia major patients	↓ NTBI ↓ ALAT, ASAT -alleviated iron burden and liver dysfunction	[183]
Green tea extract (GTE)	GTE+DFP (50 mg/kg)		daily orally for 3 months	β-thalassemic mice with iron overload	↓ plasma non-transferrin bound iron concentrations ↓ plasma ALAT activity ↓ tissue iron deposition ↓ plasma NTBI levels ↓ liver oxidative damage	[184]

DFO, deferoxamine; sTfR, soluble transferrin receptor; β-thal, β-thalassemia; PS, phosphatidylserine; GTE, green tea extract; DFP, deferiprone; TAC, total antioxidant activity.