RESUMO
The liver is a central target organ of heavy metals toxicity, and secondary metabolites of several plant species are suggested to attenuate lead (Pb)-induced hepatotoxicity through antioxidant and anti-inflammatory mechanisms. We used a systematic review framework to map the impact of plant extracts and bioactive secondary metabolites on immunological markers and liver redox metabolism in preclinical models of Pb exposure. This is a systematic review performed according to PRISMA guidelines. The structured research of publications was done through PubMed, Scopus, Web of Science, and Embase databases, selecting and analyzing 41 original studies included via the eligibility criteria. Evidence indicates that Pb-exposure increases reactive oxygen/nitrogen species (ROS/RNS) production by δ-aminolevulinic acid auto-oxidation, xanthine dehydrogenase, and xanthine oxidase upregulation. Pb exposure also inhibits antioxidant enzymes, potentiating ROS/NOS levels and reactive cell damage. Plant extracts rich in flavonoids, tannins, alkaloids, anthocyanins, and vitamins exerted hepatoprotective effects by chelating and decreasing Pb bioaccumulation. In addition, plant extracts reinforce exogenous and endogenous antioxidant defenses, attenuating liver oxidative stress and cell death. The lack of blinded evaluators and randomized experimental groups were the main sources of bias identified, which need to be controlled in toxicological studies aimed at identifying natural products applied to the prevention or treatment of Pb poisoning.