Medicinal plants with promising antileishmanial activity in Ethiopia: A systematic review and meta-analysis

Introduction: Toxicity and resistance to chemotherapy used to treat leishmaniasis are increasing. Research on natural plant compounds has revealed their antileishmanial effects on certain Leishmania organisms. This review aimed to estimate the pooled IC50 values of medicinal plants with promising antileishmanial activity in Ethiopia. Methods: A systematic literature search was conducted using Science Direct, PubMed, Cochrane Library, and Google Scholar to locate potential studies. Studies published in peer-reviewed journals and gray literature in university repositories before April 1, 2022, which included a full-length study reporting the half-maximal inhibitory concentration (IC50) of Ethiopian medicinal plants that were written in English were included. Conference proceedings, review articles, letters to the editor, and correspondence were excluded. The quality of the included studies was assessed using the GIVIMP critical appraisal tools. Heterogeneity between studies was verified using Cochrane Q test statistics and I 2 test statistics, and the effects were checked using Egger statistical test at a level of significance. A random-effects model was used to estimate the pooled IC50 of the medicinal plants. Results: Six articles that were conducted in Ethiopia that fulfilled the inclusion criteria, with a total of 62 in vitro experiments, were reviewed. The aggregated mean IC50 for medicinal plants in Ethiopia was 16.80 (95% CI: 12.44, 21.16) and 13.81 (95% CI: 13.12, 14.50) µg/mL for antipromastigote and antiamastigote activity, respectively. Aqueous was the significant preparation with IC50 of 0.53 (0.34, 0.73) µg/mL against promastigote and 0.98 (0.20, 1.76) µg/mL against the amastigote stage. Discussion: This review indicated that the pooled mean of IC50 for Ethiopian medicinal plants against promastigotes and amastigotes was relatively low and showed better efficacy. This strongly suggests the need to focus on antipromastigote and antiamastigote medicinal plants in Ethiopia for the development of antileishmanial drugs. It is necessary to identify their active components, and their potential toxic effects can lead to the production of well-tolerated and safe drugs for leishmaniasis. The high heterogeneity is the limitation of this study. Registration: The review has been registered at Prospero with identification number CRD42022343543.