Impact of Sappan Wood Extract as Iron Chelator Adjuvant on Iron Concentration and Macrophage Polarization in Rat Spleen.

BACKGROUND: Iron accumulation in the spleen of thalassemia patients disrupts macrophage polarization, impairs immune function, and increases mortality. Sappan wood (Biancaea sappan L.) extract exhibits iron-chelating and immunomodulatory properties, making it a potential adjuvant with Deferiprone (DFP). This study aimed to assess the effects of Sappan wood extract (SWE) as a DFP adjuvant in rat models of iron overload. METHODS: This experimental study was conducted from January to March 2024 at Padjadjaran University, Indonesia. Thirty-five rats were divided into seven groups: normal, iron overload (IO) induced by iron dextran (ID) at a cumulative dose of 60 mg/Kg body weight (BW), positive control receiving DFP, and four groups receiving DFP+SWE at different doses of 50, 100, 150, and 200 mg/Kg BW. Iron levels and macrophage polarization (pro-inflammatory M1 and anti-inflammatory M2) in the spleen were assessed. RESULTS: SWE at 50 mg/Kg BW significantly reduced spleen iron levels to 60.77 ppm/mg and increased M2 intensity (P<0.001 compared to the IO group). At 100 mg/Kg BW, SWE effectively decreased M1 macrophage intensity (P=0.001 compared to the IO group). CONCLUSION: SWE at 50 mg/Kg BW was comparable to DFP in reducing the spleen iron levels and M1 macrophage intensity, while 100 mg/Kg BW enhanced M2 macrophage polarization. These findings highlighted SWE's potential as a therapeutic adjuvant in IO conditions.