Evaluation of the Hepatoprotective Activity of Curcuma xanthorrhiza, Garcinia mangostana Rind, Scurrula atropurpurea, and their Combination based on Biochemical and Histopathological Parameters

Background: Hepatotoxicity is a major side effect of Fixed Dose Combination (FDC-ATD) antituberculosis drugs that can hinder the success of therapy. Curcuma xanthorrhiza (CXE), Garcinia mangostana peel (MRE), and Tea Mistletoe (TME) extracts rich in flavonoids and polyphenols have been reported to have antioxidant and anti-inflammatory activities, but comparison of the hepatoprotective effects between single extracts and their combinations is still limited. Aim: This study aimed to evaluate and compare the hepatoprotective effects of CXE, MRE, TME, and their combination on FDC-ATD-induced liver damage. Methods: A pre-post test experimental study with a control group involved 25 male Wistar rats divided into five groups, consisting of Hepatotoxic Control (Hepa-C) and four treatment groups (CXE, MRE, TME, and the combination of extracts), with hepatotoxicity induced by administration of FDC-ATD for seven days at an isoniazid-equivalent dose of 300 mg/kg body weight; evaluation was conducted by measuring Serum Glutamic Pyruvic Transaminase (SGPT) levels, Glutathione (GSH) concentrations, and liver histopathology examination. Results: Compared to the Hepa-C group, all treatment groups showed a significant decrease in SGPT levels and an increase in GSH levels (p < 0.05), accompanied by a decrease in the degree of hepatocellular degeneration and necrosis and better preservation of liver lobule structure in all extract groups (p < 0.05); the combination of extracts provided the greatest hepatoprotective effect although not statistically significantly different from the single extracts. Conclusion: CXE, MRE, and TME, both individually and in combination, are able to reduce oxidative stress and maintain liver cell integrity, thus having the potential to be developed as a complementary therapy to reduce hepatotoxicity caused by antituberculosis drugs. Major Findings: The combination and single extracts of CXE, MRE, and TME demonstrated consistent hepatoprotective activity against FDC-ATD-induced hepatotoxicity through decreased SGPT, increased GSH, and improved liver histology.