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Antioxidant Activity of Myrtus communis L. and Myrtus nivellei Batt. & Trab. Extracts PDF

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medicines Review Antioxidant Activity of Myrtus communis L. and Myrtus nivellei Batt. & Trab. Extracts: A Brief Review AichaHennia1,MariaGraçaMiguel2,* ID andSaidNemmiche3 1 DepartmentofAgronomy,FacultyofNatureandLifeSciences,UniversityofMostaganem,BP188/227, Mostaganem27000,Algeria;[email protected] 2 DepartamentodeQuímicaeFarmácia,FaculdadedeCiênciaseTecnologia,UniversidadedoAlgarve, MeditBio,CampusdeGambelas,8005-139Faro,Portugal 3 DepartmentofBiology,FacultyofNatureandLifeSciences,UniversityofMostaganem,BP188/227, Mostaganem27000,Algeria;[email protected] * Correspondence:[email protected];Tel.:+351-289-800-100 (cid:1)(cid:2)(cid:3)(cid:1)(cid:4)(cid:5)(cid:6)(cid:7)(cid:8)(cid:1) (cid:1)(cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:7) Received:30June2018;Accepted:8August2018;Published:11August2018 Abstract: Myrtus communis L. (myrtle) and Myrtus nivellei Batt. & Trab. (Saharan myrtle) have been used in folk medicine for alleviating some ailments. M. communis is largely distributed in the Mediterranean Basin, whereas M. nivellei is confined in specific zones of the central Saharan mountains. Thechemicalcompositionandantioxidantactivityofberryandleafextractsisolated from myrtle are deeply documented, whereas those isolated from Saharan myrtle extracts are less studied. In both species, the major groups of constituents include gallic acid derivatives, flavonols,flavonolderivatives,andhydroxybenzoicacids. Incolouredberries,anthocyaninsarealso present. InM.nivelleiextractsarereportedforsomecompoundsnotdescribedinM.communisso far: 2-hydroxy-1,8-cineole-β-D-glucopyranoside,2-hydroxy-1,8-cineole2-O-α-L-arabinofuranosyl (1→6)-β-D-glucopyranoside,rugosinA,andrugosinB.Berriesandleavesextractsofbothspecies had antioxidant activity. Comparative studies of the antioxidant activity between leaf and berry myrtleextractsrevealedthatleafextractsarebestantioxidants,whichcanbeassignedtothegalloyl derivatives,flavonols,andflavonolsderivatives,althoughtheratioofthesegroupsofcompounds mightalsohaveanimportantroleintheantioxidantactivity. Theanthocyaninspresentinmyrtle berries seem to possess weak antioxidant activity. The antioxidant activity of sample extracts dependedonvariousfactors: harvestingtime,storage,extractionsolvent,extractiontype,andplant part used, among other factors. Leaf extracts of myrtle revealed to possess anti-inflammatory activityinseveralmodelsused. Thispropertyhasbeenattributedeithertotheflavonoidsand/or hydrolysabletannins,neverthelessnonprenylatedacylphloroglucinols(e.g.,myrtucommuloneand semimyrtucommulone)havealsorevealedaremarkableroleinthatactivity. Thebiologicalactivities ofmyrtleextractsfoundsofarmaydirectitsusetowardsforstabilizingcomplexlipidsystems,as prebioticinfoodformulations,andasnoveltherapeuticforthemanagementofinflammation. Keywords:Anti-inflammatory;berries;leaves;galloylderivatives;flavonolderivatives;anthocyanins; myrtucommulone 1. Introduction Myrtaceaeisafamilyofwoodyfloweringplantsthatencompassesaround5500species,classified in 144 genera, and 17 tribes. Within Myrtaceae, the tribe Myrteae represents half of the family’s biodiversity with 51 genera and about 2500 species mostly restricted to the Neotropics, though 15 genera and about 450 species are found in other continents, such as Southeast Asia, Northeast Australia,andthePacificislands,includingNewCaledoniaandNewZealand. ThegenusMyrtus Medicines2018,5,89;doi:10.3390/medicines5030089 www.mdpi.com/journal/medicines Medicines2018,5,89 2of68 isthesolefoundinEuropean/NorthernAfrican,Asia,particularlyintheMediterraneanregionof southernEuropeasfarwestasMacaronesia(MadeiraandtheAzores),theSaharanmountainsandas fareastaswesternAsia(IranandAfghanistan)[1–3]. TwospeciescanbefoundinthegenusMyrtus:MyrtuscommunisL.andMyrtusnivelleiBatt.&Trab. ThelatterisendemictothecentralSaharanmountainsgrowinginrockyandsandywadesandgorges, athighelevations,above1400m. TheformercanbefoundintheMediterraneanBasin,Macaronesia, Iran,andAfghanistan,particularlyatelevationsnotexceedingc.a. 500ma.s.l.[1]. Bothspeciesare shrubswithroughbark,oppositeleaves,whiteflowersthatarestar-like(5–9petals),andwhite,purple, blue,orevenblackberries. Theydifferinthefollowingmorphologicalcharacteristics: theleavesof M.nivelleiarelinear-lanceolate(4–5cminlength)andnarrower(6–8mm)thantheM.communisones, whichareovate-lanceolate(2–5cmlong)andwider(10–20mm);thefruitsofM.communisareellipsoid tosubglobose,pyriform,elongated,orflat(7–9mmlength),whereasthoseofM.nivelleiareglobose andsmaller(4–5mm)[1,4–6]. M.communisgrowsto0.5–3minheight,whileM.nivelligrowsto1–2m inheight[1]. Differentparts(berries,branches,andleaves)ofM.communis(myrtle)havebeenusedinfolk medicinefortreatingdiarrhoea,pepticulcers,haemorrhoids,inflammation,uterinebleeding,headache, palpitation,leucorrhoea,urethritis,epistaxis,conjunctivitis,excessiveperspiration,andpulmonary andskindiseases[4,7]. Onlyfewstudieshavereportedasedativeeffectofmyrtle,asaanxiolyticand musclerelaxantwithoutanticonvulsivantactivity[8,9]. Myrtle leaves have been used for healing wounds or disorders of the digestive and urinary systemsduetotheirastringent,tonic,andantisepticproperties[4,10]. Fromleavesisalsopossible toextractessentialoilsthathavebeenusedasanti-septic,anti-catarrhal,andtotreatchestailments, ulcers,andhemorrhoids[4,10–13]. Althoughtheberriesdecoctionshadbeenusedtobathenewbornswithreddenedskin,andthe decoctionsofleavesandberriesinsorewashing,themostisusedtoproducethecharacteristicmyrtle liqueurobtainedbyhydro-alcoholicinfusionoftheberries[4,14,15]. Thebiologicalpropertiesassignedtodiverseorgans(leavesandberries)ofmyrtlecanbedueto diverse compounds such as volatile compounds or essential oils (terpenoids, particularly α-pinene, 1,8-cineole,geranylacetate,andlinalool),flavonoids(quercetin,catechinandmyricetinderivatives,and anthocyanins),coumarins,oligomericnonprenylatedacylphloroglucinolcompounds(myrtucommulone AandBandsemimyrtucommulone),galloyl-glucosides,ellagitannins,galloyl-quinicacids,caffeic,gallic andellagicacids,fattyacids(linoleic,palmitic,oleic,andstearicacids)indiverseorgans[4]. Table1 showsexamplesofbiologicalpropertiesassignedtoMyrtuscommunis. M.nivellei(Saharanmyrtle)leavesininfusionsareusedagainstintestinaldiseases(diarrhoea), fever,diabetes,andaddedtobarleywafersisemployedagainstblennorrhoea[16–18]. Thecrushed leavesaddedtooilorbutterointmenthasbeenusedinthetreatmentofdermatosisandforhairand bodycare[16,17,19]. Thedecoctionofleavesmixedwithgoatmilkandheatedoncharcoalhasbeen usedforliverdisordersbynomadAlgeriansofTassiliregion[20]. Theleafinfusionisusedinthis regionasacommonbeverage,insteadofgreentea[20]. Berriesareconsumedeitherfreshordriedto treatmouthcankersores[19]. ThechemicalcompositionofSaharanmyrtleislessstudiedthanthatofmyrtle.Themainconstituents reported include volatile essential oils [16,21], phenols (flavonoids, anthocyanins, and tannins), norterpenoids[19–22]. Thepresentreviewwillfocusontheantioxidantandanti-inflammatoryactivitiesofM.communis andM.nivelleiinwhichthechemicalcompositionisdiscriminated. Medicines2018,5,89 3of68 Table1.BiologicalpropertiesattributedtoMyrtuscommunis(antioxidantandanti-inflammatoryactivitiesarenotincluded). PlantPartUsed Compounds BiologicalProperties References Antimicrobial Leaves Notreported Bacterialvaginosis [23] Leaves Notreported Propionibacteriumacnes [24] -SpoilagebacteriaPseudomonasaeruginosaIH,PseudomonasaeruginosaCECT118, PseudomonasaeruginosaCECT110T,PseudomonasfluorescensCECT378andBacillus subtilisDCM3366 Leavesandberries Notreported -Food-bornepathogenicbacteria,namelyEscherchiacoliK12,ListeriainnocuaCECT [25] 4030,ListeriamonocytogenesCECT4032,EnteroccusfaeciumCECT410, StaphylococcusaureusMBLA,StaphylococcusaureusCECT976,Staphylococcusaureus CECT794andProteusvulgarisCECT484 Leaves Notreported OnehundredandtwentystrainsofEscherichiacoliisolatedfromtheurineculture [26] Streptococcuspneumoniae,Streptococcuspyogenes,Streptococcusagalactiae, Leaves Notreported Listeriamonocytogenes,Campylobacterjejuni,Staphylococcusaureus, [27] Micrococcusluteus,Escherichiacoli,Proteusvulgaris,andPseudomonasaeruginosa Aeromonashydrophilicaisolatedfromfourhundredandfiftysamplesfromthe Leaves Notreported [28] intestinesoftheinfectedCyprinuscarpiofish Ninety-sixP.aeruginosastrainsisolatedfrom400burnpatients(menandwomen) Leaves Notreported [29] inIranianhospital StaphylococcusaureusstrainATCC25923giftofE.Udo (KuwaitUniversity,Kuwait) Galloylatednonprenylated S.aureusRN4220containingplasmidpUL5054,whichcarriesthegeneencoding phloroglucinolglucosides: theMsrAmacrolideeffluxprotein,providedbyJ.Cove GallomyrtucommuloneA S.aureusXU-212whichpossessestheTetKtetracyclineeffluxprotein,providedby Leaves [30] GallomyrtucommuloneB E.Udo GallomyrtucommuloneC S.aureusSA-1199B,whichoverexpressesthenorAgeneencodingtheNorAMDR GallomyrtucommuloneD effluxprotein,providedbyG.Kaatz S.aureusEMRSA-15isanepidemicstrainofMRSAgiftofP.Stapleton,Schoolof Pharmacy,UniversityofLondon Medicines2018,5,89 4of68 Table1.Cont. PlantPartUsed Compounds BiologicalProperties References Escherichiacoli(PTCCNo.1330),Pseudomonasaeruginosa(PTCCNo.1074), P.fluorescens(PTCCNo.1181),Klebsiellapneumoniae(PTCCNo.1053), Seeds Notreported Bordetellabronchiseptica(PTCCNo.1025),Staphylococcusaureus(PTCCNo.1112), [31] S.epidermidis(PTCCNo.1114),Micrococcusluteus(PTCCNo.1170),Bacilluscereus (PTCCNo.1015),andB.pumilis(PTCCNo.1319) Hydroxybenzoicacidhexose Delphinidin-3-O-galactoside Delphinidin-3-O-glucoside Quercetinhexoside Delphinidin-3-O-rhamnoside Delphinidinrutinoside Delphinidin-3-(6coumaroyl)-glucoside EscherichiacoliATCC8739,SalmonellatyphimuriumNCTC6017,Staphylococcus Petunidin-3-O-glucoside Berryseeds aureusATCC29213,PseudomonasaeruginosaATCC27853,AeromonashydrophilaEI, [32] Petunidindiglucoside andBacilluscereusATCC1247 Petunidinmalonylglucoside Petunidin-3-O-rutinoside Isorhamnetin-O-rhamnoside Malvidin-O-galactoside Malvidin-O-glucoside Peonidindiglucoside Petunidinmethylpentose Leaves Notreported Streptococcusmutans(PTCC1683) [33] Gram-positive(ListeriamonocytogenesandBacilluscereus) Leaves Notreported Gram-negative(EscherichiacoliO157:H7)bacterialstrains [34] Fungalstrain(Candidaalbicans) Staphylococcusaureus(ATCC6538),Bacillussubtilis(ATCC6059),Micrococcusflavus (SBUG16),Escherichiacoli(ATCC11229),Pseudomonasaeruginosa(ATCC27853), andthreemulti-resistantStaphylococcusstrains(Staphylococcusepidermidis847, Leavesandberries Notreported [35] Staphylococcushaemolyticus535,StaphylococcusaureusnorthGerman epidemicstrain) Candidamaltosa(SBUG) Medicines2018,5,89 5of68 Table1.Cont. PlantPartUsed Compounds BiologicalProperties References Staphylococcusaureus,Staphylococcusepidermidis,Escherichiacoli,Bacillussubtilis Leaves Notreported [36] andSerratiamarcescens MyrtucommulonesJ-L Leaves Staphylococcusaureus(ATCC25923) [37] MyrtucommuloneA Leaves Notreported Enterococcusfaecalis(ATCC29212) [38] Leaves Notreported Bacterialvaginosis [39] Leaves Notreported Pseudomonasaeruginosa [40] MicrosporumcanisATCC32903,M.gypseumATCC14683,andTrichophyton Leaves Notreported mentagrophytesATCC1481(var.interdigitale)fromTehranUniversityof [41] MedicalSciences Trichophytonmentagrophytes,T.interdigitale,Microsporumcanis,andM.gypseum Aerialparts Notreported [42] (10strainofeach) EscherichiacoliO157:H7,YersiniaenterocoliticaO9,Proteusspp.,and Leaves Notreported [43] Klebsiellapneumoniae Berries Notreported Helicobacterpylori(12clinicalisolates) [44] Staphylococcusaureus(489samples)isolatedeitherfromhealthycarriers(noseand Leaves Notreported throat)orclinicalsamplesS.aureususedasreferencestrainsforcomparison: [45] ATCC25923,ATCC9144,ATCC29737,ATCC12596,andBristolA9596 5-Acetoxy-4-hydroxy-4-isobutyl-2,2,6,6- tetramethylcyclohexan-1,3-dione β-Sitosterol Isomyrtucommulone-B Leaves Endoperoxide-G-3-hormone PropionibacteriumacnesNRRL(B-4224) [46] Gallicacid Myricetin-3-O-α-L-rhamnoside Myricetin-3-O-β-D-glucoside Myricetin-3-O-β-D-galactoside-6”-O-gallate(8) Medicines2018,5,89 6of68 Table1.Cont. PlantPartUsed Compounds BiologicalProperties References Bacillussubtilis,Staphylococcusaureus,Escherichiacoli,Saccharomycescerevisiae, EscherichiacoliB,E.coliCW3747,E.coliK-12,Klebsiellapneumoniae, Proteusmirabilis,Proteusmorganii,Shigelladysenteriae,S.flexneri, Leaves MyrtucommuloneA [47] Salmonellatyphimurium,Pseudomonasfluorescens,Vibriocholerae,Serratia, Staphylococcusaureus,S.albus,BacillussubtilisW23,B.subtilis16,B.pumilus, Streptococcusfaecalis,Corynebacteriumdiphtheriae,andC.xerosis Leaves Notreported Helicobacterpylori [48] MyrtucomvalonesA–C Leaves Respiratorysyncytialvirus(RSV) [49] CallistivimineneJ-N MyrtucommuloneB-E UsnoneA Tectochrysine 2,5-Dihydroxy-4-methoxybenzophenone (cearoin) β-Sitosterol Escherichiacoli,Bacillussubtilis,Shigellaflexneri,Staphylococcusaureus, Aerialparts Sideroxylin [50] Pseudomonasaeruginosa,andSalmonellatyphi Ursolicacid Corosolicacid Arjunolicacid Erythrodiol Oleanolicacid Betulin Semimyrtucommulone StaphylococcusaureusstrainsRN4220(Msr(A)),XU212(Tet(K)),1199-B(Nor(A)), Leaves [51] myrtucommuloneA andATCC25923 MyrtucommuninsA-D 6-Methyl-isomyrtucommuloneB 4-MethylmyrtucommuloneB Escherichiacoli,Staphylococcusaureus(MRSA),Staphylococcusaureus(MSSA),and Leaves 2-Isobutyryl-4-methylphloroglucinol [52] Bacillussubtilis 1-O-β-D-glucopyranoside Chromonederivative,undulatosideA 6’-O-gallate Medicines2018,5,89 7of68 Table1.Cont. PlantPartUsed Compounds BiologicalProperties References Silvernanoparticlessynthesizedusing Escherichiacoli,Bacillussubtilis,Pseudomonasaeruginosa,Staphylococcusaureus Leaves [53] MyrtuscommunisL.leafextract methicillin-resistant,Staphylococcusaureus,andEnterococcusfaecalis Staphylococcusaureus(ATCC25923),Staphylococcusepidermidis(ATCC12228), Staphylococcusmutans(ATCC31989)andStaphylococcusviridans(ATCC19952), Pseudomonasaeruginosa(ATCC27853),Escherichiacoli(ATCC25922), Leaves Beforeandafterencapsulationinliposomes [54] Enterobactercloacae(ATCC13047)andKlebsiellapneumoniae(ATCC13883), Candidaalbicans(ATCC10231),Candidatropicalis(ATCC13801)and Candidaglabrata(ATCC28838),andListeriamonocytogenes Otherorganisms Leaves Notreported Anti-Leishmaniatropicaonaninvitromodel [55] Invivo,anti-PlasmodiumbergheiinfemaleSwissalbinomice,weight18–20g Aerialparts Notreported [56] Invitro,chloroquine-sensitivestrain(3D7)ofP.falciparum Notreported(myrtlewas obtainedfromalocal Notreported Inducedprogrammedcelldeathinhydatidcystprotoscolices [57] groceryforherbalplants) Invitro,anti-chloroquine-resistant(K1)andchloroquine-sensitive(3D7)strainsof Aerialpart Notreported Plasmodiumfalciparum [58] Invivo,anti-Plasmodiumbergheiinfectioninadultmalealbinomice Cytotoxicity Leaves Notreported CytotoxicactivitiesagainstJ774cells(MouseBALB/cmonocytemacrophage) [55] Cytotoxicactivitiesagainsturinarybladder5637andhumanbreastcarcinoma Leavesandberries Notreported [35] MCF-7celllines CytotoxicactivitiesagainsthumanhaematologicaltumorcelllineMT-4. MyrtucommulonesJ-L Cytotoxicactivitiesagainstagainstsolidtumorcelllines(HepG2orhumanliver Leaves [37] MyrtucommuloneA cancer,DU145orhumanprostatecancercelllines),andagainst“normal”human tissuecells(CRL7065) CytotoxicactivitiesagainstU-937(humanlung(lymphoblast),K-562(human Leaves MyrtucommuloneA blood(chronicmyelogenousleukemia),leukemiccelllineKBM-5,andMEG-01 [59] (humanbonemarrow)celllines Medicines2018,5,89 8of68 Table1.Cont. PlantPartUsed Compounds BiologicalProperties References CytotoxicactivitiesagainstMCF7(breastadenocarcinoma),HepG2 Aerialpart Notreported (hepatocellularcarcinoma),WEHI(fibrosarcoma),andMDBK(normal [58] kidneycells) L20B(celllineamousecell-linegeneticallyengineeredtoexpresshuman Notreported Notreported poliovirusreceptor,CD155celllines),RD(rhabdomyosarcom),andVero(African [60] greenmonkeykidney) Notreported MyrtucommuloneA MitochondriallysatesfromleukemicHL-60cells [61] Jurkat-A3cells,caspase-8-deficientJurkatcells,FADDdeficientJurkatcells,PC-3 (androgen-independentprostatecarcinoma),LNCaP(androgen-dependent prostatecarcinoma),H9(cutaneousT-celllymphoma),DLD-1(colorectal Myrtucommulone Leaves adenocarcinoma),HL-60(acutepromyelocyticleukaemia),Jurkat(acuteT-cell [62] Semi-myrtucommulone leukaemia)andJurkatDD3(mutatedinCD95),KFR(rhabdomyosarcoma)and UKF-NB-3(neuroblastoma)cells,monoMac6(MM6,acutemonocyticleukaemia) cells,andhumanperipheralbloodmononuclearcells(PBMC) MouseBreastcancercellline4T1,mouseembryonicfibroblasts,andhuman Notreported Myrtucommulone [63] dermalfibroblasts(hDFs) MyrtucomvalonesA–C Leaves Humanlarynxepidermoidcarcinomacells(HEp-2)cells [49] CallistivimineneJ-N Myricetin-3-O-galactoside Leaves HumanchronicmyelogenousleukemiacelllineK562 [64] Myricetin-3-O-rhamnoside Leaves 3,5-O-Di-galloylquinicacid HumanchronicmyelogenousleukemiaCMLcelllineK562 [65] Genotoxicity/mutagenicity ProtectiveeffectagainstgenotoxicityontheSOSreponseinducedbyAflatoxinB1 Leaves Notreported [66] (AFB1)andNifuroxazideinEscherichiacoliPQ37 ProtectiveeffectagainstthemutagenicityinducedbyaflatoxinB1(AFB1)in Leaves Notreported SalmonellatyphimuriumTA100andTA98assaysystems,andagainstthe [67] mutagenicityinducedbysodiumazideinTA100andTA1535assaysystem Medicines2018,5,89 9of68 Table1.Cont. PlantPartUsed Compounds BiologicalProperties References ProtectiveeffectagainstonthemutagenicityinducedbyaflatoxinB1in Leaves Notreported [68] SalmonellatyphimuriumTA100orTA98 Myricetin-3-O-galactoside ProtectiveeffectagainstthemutagenicityinducedbyaflatoxinB1in Leaves [64] Myricetin-3-O-rhamnoside EscherichiacoliPQ37strain Leaves 3,5-O-Di-galloylquinicacid InhibitoryeffectagainstH O -inducedgenotoxicity,usingthecometassay [65] 2 2 Gastrointestinalsystem Hydroxybenzoicacidhexose Delphinidin-3-O-galactoside Delphinidin-3-O-glucoside Quercetinhexoside Delphinidin-3-O-rhamnoside Delphinidinrutinoside Delphinidin-3-(6coumaroyl)-glucoside Petunidin-3-O-glucoside Berryseeds Anti-diarrhoealinadultmaleWistarratsaftercastoroiladministration [32] Petunidindiglucoside Petunidinmalonylglucoside Petunidin-3-O-rutinoside Isorhamnetin-O-rhamnoside Malvidin-O-galactoside Malvidin-O-glucoside Peonidindiglucoside Petunidinmethylpentose Anti-diarrhoealinSwissalbinomiceofeithersexweighing20–30gandaged Leaves Notreported [69] 6–8weeks,aftercastoroiladministration Protectiveeffectongastriculceragainstethanol,indomethacin,andpyloric Berries Notreported [70] ligationinducedmodelsinalbinoratsofWistarstrainweighing150–200g ProtectiveeffectonoralulcerrecoveryprocessinwhiteSpraque–Dawleyrats Stemsandseeds Notreported weighing250–300gafterpunchtocreateawoundinthehardpalateinthe [71] oralcavity Medicines2018,5,89 10of68 Table1.Cont. PlantPartUsed Compounds BiologicalProperties References Palmiticacid Stearicacid Oleicacid ProtectiveeffectonpepticulceragainstethanolinducedinadultmaleWistarrats Berryseeds [72] Linoleicacid (weighing220–240g) Linolelaidic(trans,trans-C18:2) Arachidicacid Hydroxybenzoicacidhexose Delphinidin-3-O-galactoside Delphinidin-3-O-glucoside Quercetinhexoside Delphinidin-3-O-rhamnoside Delphinidinrutinoside Delphinidin-3-(6coumaroyl)-glucoside Petunidin-3-O-glucoside Protectiveeffectonaceticacid-inducedulcerativecolitisinadultmaleWistarrats Berryseeds [73] Petunidindiglucoside (weighing220–240g) Petunidinmalonylglucoside Petunidin-3-O-rutinoside Isorhamnetin-O-rhamnoside Malvidin-O-galactoside Malvidin-O-glucoside Peonidindiglucoside Petunidinmethylpentose Protectiveeffectonaceticacid-inducedulcerativecolitisinWistaralbinorats Leaves Notreported [74] (weighing250–300g) ProtectiveeffectonliverinjuryandfibrosisoccurringinWistaralbinorats Leaves Notreported [75] (weighing250–300g)withbiliaryobstructionbydoubleligatureswithsuturesilk Decreaseofrefluxanddyspepticscoresascomparedwiththebaseline,in Berries Notreported [76] double-blindrandomizedcontrolledclinicaltrialinadultagedfrom18to60years Decreaseoftherecurrenceofsymptomsinrefluxpatientsafterthediscontinuance Berries Notreported ofprotonpumpinhibitors,inoutpatient,double-blind,randomized,parallel [77] treatmentgroupsstudy Decreaseoftherecurrentaphthousstomatitisinrandomized,doubleblind, Leaves Notreported [78] controlledbefore–afterclinicaltrial

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Medicines 2018, 5, 89; doi:10.3390/medicines5030089 www.mdpi.com/journal/medicines. Review. Antioxidant Activity of Myrtus communis L. and.
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