ROLE OF NONI IN TRANSVERSE MYELITIS

Transverse myelitis is a neurological disorder caused by inflammation across both sides of one level, or segment, of the spinal cord. The term myelitis refers to inflammation of the spinal cord; transverse simply describes the position of the inflammation, that is, across the width of the spinal cord. Attacks of inflammation can damage or destroy myelin, the fatty insulating substance that covers nerve cell fibers. This damage causes nervous system scars that interrupt communications between the nerves in the spinal cord and the rest of the body Symptoms of transverse myelitis include a loss of spinal cord function over several hours to several weeks. What usually begins as a sudden onset of lower back pain, muscle weakness, or abnormal sensations in the toes and feet can rapidly progress to more severe symptoms, including paralysis, urinary retention, and loss of bowel control. Although some patients recover from transverse myelitis with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Most patients will have only one episode of transverse myelitis; a small percentage may have a recurrence. The segment of the spinal cord at which the damage occurs determines which parts of the body are affected. Nerves in the cervical (neck) region control signals to the neck, arms, hands, and muscles of breathing (the diaphragm). Nerves in the thoracic (upper back) region relay signals to the torso and some parts of the arms. Nerves at the lumbar (mid-back) level control signals to the hips and legs. Finally, sacral nerves, located within the lowest segment of the spinal cord, relay signals to the groin, toes, and some parts of the legs. Damage at one segment will affect function at that segment and segments below it. In patients with transverse myelitis, demyelination usually occurs at the thoracic level, causing problems with leg movement and bowel and bladder control, which require signals from the lower segments of the spinal cord. What causes transverse myelitis?

Researchers are uncertain of the exact causes of transverse myelitis. The inflammation that causes such extensive damage to nerve fibers of the spinal cord may result from viral infections, abnormal immune reactions, or insufficient blood flow through the blood vessels located in the spinal cord. Transverse myelitis also may occur as a complication of syphilis, measles, Lyme disease, and some vaccinations, including those for chickenpox and rabies. Cases in which a cause cannot be identified are called idiopathic. Diseases of the central nervous system frequently cause transverse myelitis. These include: multiple sclerosis, Neuromyelitis optica, lupus, etc

Role of Noni Role of Oxidative stress in patient with Transverse myelitis (TM) It is well known that brain and nervous system cells are prone to oxidative damage because of their relatively low content of antioxidants, especially enzymatic ones, and of the high levels of both membrane polyunsaturated fatty acids (PUFA) and iron easily released from injured cells. Accumulating data indicate that oxidative stress (OS) plays a major role in the pathogenesis of Transverse myelitis. Reactive oxygen species (ROS), leading to oxidative stress, generated in excess primarily by macrophages, have been implicated as mediators of demyelination and axonal damage in transverse myelitis in its animal model. ROS cause damage to cardinal cellular components such as lipids, proteins and nucleic acids (e. g., RNA, DNA), resulting in cell death by necrosis or apoptosis. In addition, weakened cellular antioxidant defense systems in the central nervous system (CNS) in transverse myelitis, and its vulnerability to ROS effects may increase damage. The blood of patients with transverse myelitis shows the signs of a significant oxidative stress. The possibility of counteracting it by antioxidant administration plus an appropriate diet might represent a promising way of inhibiting the progression of the disease. Indian Noni is an effective powerful antioxidant which contains all vitamins, trace minerals, amino acids, essential fatty acids and lots of phytonutrients.

Antioxidant property of Noni Endogenous antioxidants and role of Noni Our body has evolved with endogenous defense mechanisms to protect against free radical induced cell damage. Glutathione peroxidase, catalase, and Superoxide dismutases are three primary antioxidant enzymes in our body, which involved in direct elimination of free radicals or reactive oxygen species from our body. They require micronutrient such as selenium, iron, copper, zinc, and manganese as cofactors for their formation and optimum catalytic and effective antioxidant activity. Noni contain all the trace minerals that help for optimum catalytic activity of those three important antioxidant enzymes for an effective antioxidant defense mechanism. Glutathione, ascorbic acid, alpha-tocopherol, beta-carotene, bilirubin, selenium, dihydrolipoic acid, melatonin, uric acid etc., as a whole play a homoeostatic or protective role against ROS. Noni contains all the above phyto chemicals and vitamins in abundant quantity. Glutathione (GSH) is the most significant component which directly quenches Reactive Oxygen Species (ROS) such as lipid peroxides and plays major role in xenobiotic metabolism. Glutathione is a tripeptide made up of the amino acids gamma-glutamic acid, cysteine, and glycine. Noni contain all those glutathione making amino acids in abundant number. Thus Noni increases the bodys glutathione level. Noni stimulates more melatonin secretion from the pineal body. It also maintains ascorbate (vitamin C) and alpha-tocopherol (vitamin E), in their reduced form, which also exert an antioxidant effect by quenching free radicals. Exogenous antioxidants: Contribution from Noni A number of other dietary antioxidants known as phytonutrients or phytochemicals that are being increasingly appreciated for their antioxidant activity. One example is flavonoids which are a group of polyphenolic compounds. Noni contain 150 above phytochemicals including all

flavonoids. Noni is rich with many flavonoids. Due to the inefficiency of our endogenous defense systems as well as highly exposure to adverse environmental factors such as, cigarette smoke, air pollutants, UV radiation, the ROS are produced in excess, and therefore increasing amounts of antioxidants present in Noni will be needed for diminishing the cumulative effect of oxidative damage over an individuals life span. The various antioxidant and neuroprotective ingredient present in Indian Noni can be considered as pathogenic treatment in relapsing-remitting transverse myelitis. Role of various micronutrients of Indian Noni in Multiple Sclerosis Vitamin E: Vitamin E has direct neuroprotective antioxidant effects as well as anti-inflammatory indirect effects. Vitamin E inhibits microglial activation by suppressing the LPS-induced p38 MAPK and Nfkappa B signaling effects necessary for microglial activation. Noni is rich with alfatocopherol or Vitamin E and with all vitamins in natural form. Melatonin Melatonin functions as an antioxidant and has the ability to protect neurons from lipopolysaccharide-induced oxidative stress. Noni stimulates more melatonin secretion from the pineal body and thus helps in transverse myelitis. Essential Fatty Acids Dietary omega-3 fatty acids can be of great benefit to transverse myelitis patients. Omega-3 fatty acids have been shown to alleviate pain in autoimmune disorders by inhibiting inflammatory mediators (eicosanoids and cytokines) in peripheral tissues as well as in glial cells. Noni contain all essential fatty acids. Magnesium Magnesium, zinc and calcium have been found to be deficient in central nervous system tissue in transverse myelitis patients, especially in white matter tissue. Magnesium is important for

the metabolism of thiamine, calcium, potassium, phosphorus, iron, sodium, hydrogen chloride, acetylcholine, nitric oxide, and for many enzymes, and for the elimination of lead and cadmium. Calcium and magnesium are also important in the development, structure and stability of myelin. A magnesium deficiency is associated with increased inflammation. Noni contain lots of trace minerals like magnesium, calcium, potassium, zinc, phosphorus, sodium etc. Thus Noni provides all those important trace minerals which are found deficient in CNS tissue in transverse myelitis. Vitamin B12 A severe vitamin B12 deficiency can cause breakdown of the myelin sheath, similar to what occurs in MS. Noni contain all the vitamins in natural form including this vitamin B12.