The protective effect of Azadirachta indica (neem) against metabolic syndrome: A review

Metabolic syndrome is a condition associated with obesity, diabetes, dyslipidemia, and high blood pressure. Recently, the use of phytochemicals is suggested in the control and treatment of metabolic syndrome. The Azadirachta indica (neem) is an evergreen tree belonging to the family of Meliaceae. Multiple studies have been confirmed the antidiabetic and antihypertension, antihyperlipidemia, and antiobesity effects of neem. In this review, we reported the protective effects of neem against the complications of metabolic syndrome with a special focus on mechanisms that are involved. It has been shown that neem can control hyperglycemia and hypertension through overexpression of transcription factor nuclear factor erythroid 2–related factor 2 (Nrf2) and antioxidant effects. Neem also reduced the glucose uptake through upregulation of glucose transporter 4 (GLUT4) and inhibition of key intestinal enzymes such as glucosidases. Moreover, neem showed antihypertensive effects possibility via the block of calcium channels, upregulation of endothelial nitric oxide synthase (eNOS), and extracellular signalregulated kinases 1/2 (ERK1/2) signaling pathway. Antioxidant effects play an important role in protective mechanisms of neem against metabolic syndrome and its complications.