Impact of curcuma longa intervention on endothelial glycocalyx and evaluation of interaction with oxidative/inflammatory pathways and exosomal microRNAs: establishing the importance of phytotherapy as an integrative practice in the treatment of type 2 DM

Abstract

Diabetes Mellitus (DM) is a chronic condition characterized by constant hyperglycemia, with significant impact on the health and quality of life of people who live with it, leading to increased cardiovascular risk, loss of kidney function, diabetic neuropathy, and amputations. Brazil is the fifth country in the world with the highest rate of diabetics, with an expectation of 26 million individuals, aged between 20 and 75 years, in 2045. Despite the greater understanding and management of type 2 DM (DM2), the complications associated with this pathology continue unabated, leading to significant morbidity and mortality. It is known that individuals with DM2 are at greater risk of developing micro and macrovascular complications, with the vascular endothelium being the major orchestrator of these complications. The study of therapeutic alternatives supporting traditional treatments should be better investigated, and research with medicinal plants and herbal medicines is encouraged by the National Policy and Program of Medicinal Plants and Phytotherapeutics at the national level. One of the promising species in the area is Curcuma Longa known as turmeric or turmeric. It is a plant widely spread in the national territory, of recognized worldwide use, and already with good indications of its benefits in health. According to the above, the present research proposal is justified, which aims to evaluate the role of Curcuma longa as a modulating agent of oxidative stress, inflammatory response, and miRNAs in individuals with DM2 on endothelial glycocalyx damage, investigating the involvement of its involvement in the activation of transcription factor Nrf2 and SIRT-1, inactivation of the Trx/TXNIP pathway and of MMPs, inhibition of the NF-ºB pathway and of the NLRP3 inflammasome and modulation of miRNAs isolated from circulating exosomes. This double-blind, randomized, placebo-controlled clinical trial is expected to have a positive impact in all parameters analyzed, with high adherence and few reports of adverse events, to contribute to the knowledge of the clinical impact of Curcuma Longa on DM2, showing that this intervention can be safe and effective in this group of patients, being economically viable. (AU)