3.1. Effects on the liver
Two previous studies showed the beneficial effect of artichoke leaf extract (ALE) alone (Panahi et al., 2018) or in combination with metformin or vitamin E (Majnooni et al., 2021) in individuals with non-alcoholic fatty liver disease (NAFLD). Other scientific articles reported that artichoke extracts improve NAFLD in rodents (Deng et al., 2022; Lee et al., 2021b). Rangboo and colleagues (2016) showed that ALE exerts hepatoprotective activity in a sample of 60 individuals with non-alcoholic steatohepatitis (NASH). A study by Tang et al. (2017) found that an artichoke extract has a beneficial effect on alcoholic liver disease (ALD) in mice. Previous studies demonstrated that ALE exerts hepatoprotective effects in vivo (Ahmadi et al., 2019; Ben Salem et al., 2017b; Ben Salem et al., 2019; Celepli et al., 2022a; Celepli et al., 2022b; El-Boshy et al., 2017; El Morsy and Kamel, 2015; Elsayed Elgarawany et al., 2020; Heidarian and Rafieian-Kopaei, 2013; Küçükgergin et al., 2010; Kurt et al., 2014; Kwon et al., 2018; Liao et al., 2021; Mehmetçik et al., 2008; Nasef et al., 2022; Sharaf El-Deen et al., 2017), in vitro (Menghini et al., 2010) and ex vivo (Wauquier et al., 2021). Sümer and colleagues (2020) demonstrated that stem and receptacle extracts have this effect in rats. A study by Speroni et al. (2003) showed that an extract with high phenolic content exerts hepatoprotective and choleretic effects in rats and scientific articles reported that artichoke has hepatoprotective effects in these laboratory animals (Colak et al., 2016; Metwally et al., 2011; Wang et al., 2021). Qiang and colleagues (2012) found that ALE increases bile acid secretion in hamsters. Scientific articles showed that artichoke extracts exert choleretic activity in vivo (Kirchhoff et al., 1994; Saénz Rodriguez et al., 2002) and in vitro (Frigerio et al., 2021). Previous studies demonstrated that this plant extracts have hepatoprotective (Gebhardt, 1997; Gebhardt and Fausel, 1997; Miccadei et al., 2008) and anticholestatic (Gebhardt, 2001; Gebhardt, 2002b) effects in vitro, which are mainly exerted by phenolics. Gebhardt (2002a) showed that liver cholesterol synthesis can be inhibited by ALE in vitro and flavones are the bioactive compounds mainly involved in this effect.
3.2. Effects on lipid profile
Previous studies found that ALE intake alone (Panahi et al., 2018) or in association with metformin or vitamin E (Majnooni et al., 2021) improves lipid profile in individuals with NAFLD. A study by Rangboo et al. (2016) showed that ALE consumption is effective in lowering triglycerides, total cholesterol and low-density lipoprotein cholesterol (LDL-C) in a cohort of 60 individuals with NASH. Shimoda and colleagues (2003) demonstrated that the beneficial effect of artichoke on lipid profile is exerted by sesquiterpenes. Another study by Bundy et al. (2008) showed that ALE can be effective in reducing total cholesterol in individuals with hypercholesterolemia. Englisch and colleagues (2000) demonstrated that ALE can lower LDL-C and total cholesterol in a cohort of 143 individuals with hyperlipoproteinemia. A previous study by Rondanelli et al. (2013) found that ALE intake reduces total cholesterol and LDL-C and raises high-density lipoprotein cholesterol (HDL-C) in a sample of 92 patients with hypercholesterolemia, while other scientific articles reported that artichoke extracts can decrease triglycerides, total cholesterol and LDL-C and improve HDL-C in rats (Ben Salem et al.,2017b; Deng et al., 2022). Rondanelli and colleagues (2019) demonstrated that ALE improves HDL-C and lowers total cholesterol/HDL-C ratio in a cohort of 20 individuals with mild hypercholesterolemia. Another study found that consumption of an artichoke extract ameliorates lipid profile in a sample of 55 overweight individuals with impaired fasting glycaemia (Rondanelli et al., 2014). Two articles reported the beneficial effect of ALE on cholesterol homeostasis, performing in vitro (Frigerio et al., 2021) and ex vivo (Wauquier et al., 2021) experiments. Previous studies found the beneficial effect of artichoke extracts on lipid profile in rodents (Ben Salem et al., 2019; Ben Salem et al., 2022a; Bogavac-Stanojevic et al., 2018; Heidarian and Rafieian-Kopaei, 2013; Ibrahim  et al., 2022; Küçükgergin et al., 2010; Küskü-Kiraz et al., 2010; Kwon et al., 2018; Liao et al., 2021; Qiang et al., 2012; Qinna et al., 2012; Tang et al., 2017). A study by Gebhardt (1998) showed that ALE is effective in suppressing hepatic cholesterol synthesis in rats and luteolin is implicated in this activity.
3.3. Effects on the cardiovascular system
A previous study by Lupattelli et al. (2004) found that artichoke leaf juice has beneficial effects on endothelial function in a sample of 28 individuals with hyperlipidemia, while Roghani-Dehkordi and Kamkhah (2009) demonstrated that artichoke leaf juice is effective in reducing blood pressure in individuals with mild hypertension. Other studies showed the protective effects of artichoke extracts on the cardiovascular system in vivo (Ben Salem et al., 2022a; Bogavac-Stanojevic et al., 2018; Crevar-Sakac et al., 2016; Küçükgergin et al., 2010) and in vitro (Juzyszyn et al., 2008; Zapolska-Downar et al., 2002). A previous scientific article reported the health benefits of artichoke bud extract in a rat model of hypertension (Wang et al., 2021). Li and colleagues (2004) found that ALE can improve expression and function of endothelial nitric oxide synthase (eNOS), performing in vitro and ex vivo experiments and flavones are involved in this activity. Another study showed that ALE can inhibit the expression of inducible nitric oxide synthase (iNOS) in vascular smooth muscle cells and the phytochemical compounds mainly implicated in this effect are cynarine and cyanidin (Xia et al., 2014).
3.4. Effects on the gastrointestinal system
Previous studies demonstrated the beneficial effect of ALE on the gastrointestinal system in individuals with functional (Holtmann et al., 2003) and mild (Marakis et al., 2002) dyspepsia. Other studies showed that ALE is effective in alleviating irritable bowel syndrome (IBS) symptoms in individuals with this condition (Bundy et al., 2004; Walker et al.,2001). Nassar and colleagues (2013) found that an artichoke head extract can exert antiulcerogenic activity in rats. Other studies showed that cynaropicrin has antispasmodic effect on the gastrointestinal tract of guinea pigs (Emendörfer et al., 2005) and antigastritis activity in rats (Ishida et al., 2010). Verspohl and colleagues (2008) demonstrated the beneficial effect of ALE on IBS in an experiment performed on the ileum of rats and a previous study found the anti-colitis activity of artichoke pectin in mice (Sabater et al., 2019).
3.5. Antimetabolic and antiobesity activity
Previous studies showed that ALE intake is effective in ameliorating metabolic syndrome biomarkers (Ebrahimi-Mameghani et al., 2018; Rezazadeh et al., 2018a; Rezazadeh et al., 2018b). Ardalani and colleagues (2020) found that ALE can reduce body mass index (BMI) in overweight individuals, while Wauquier and colleagues (2021) demonstrated the protective effect of ALE on obesity and metabolic syndrome, performing an ex vivo study. A previous study showed the health benefits of an artichoke extract, studying a cohort of 55 overweight individuals with impaired fasting glycaemia (Rondanelli et al., 2014). Other studies demonstrated the antiobesity and antimetabolic syndrome activities of ALE in rodents (Ben Salem et al., 2019; Ben Salem et al., 2022a; Kwon et al., 2018).
3.6. Anticancer activity
A previous study showed the protective effect of an artichoke extract on pleural mesothelioma in a sample of 18 individuals with asbestos-related benign pleural disease (Muti et al., 2022). A study by Pulito et al. (2015) found the antitumor effect of ALE against malignant pleural mesothelioma in vivo and in vitro. Liu and colleagues (2019) demonstrated the anticancer activity of cynaropicrin in HeLa cells. This bioactive compound found in artichoke may exert an inhibitory effect on thioredoxin reductase and promote oxidative stress, which lead to apoptosis. Previous studies showed the beneficial effects of this plant in a rat model of hepatocellular carcinoma (Metwally et al., 2011) and the potential anticancer effects of artichoke extracts in human hepatocellular carcinoma (Menghini et al., 2010; Miccadei et al., 2008), uterine leiomyoma (Islam et al., 2021), breast cancer (Mileo et al., 2012; Mileo et al., 2015; Mileo et al., 2020) and colon cancer (Villarini et al., 2021) cells. Scientific articles reported that cynaropicrin may exert anticancer activity in anaplastic thyroid cancer (Lepore et al., 2019) and lung carcinoma (Ding et al., 2021) cells. Yang and colleagues (2022) showed the antitumor effects of this bioactive compound against neuroblastoma in vivo and in vitro. A study by Abdel-Moneim et al. (2021) found the beneficial effect of artichoke extracts on lung cancer in rats, which is exerted mainly through antioxidant, proapoptotic and antiproliferative activities.
3.7. Probiotic and prebiotic activities
Previous studies showed that the intake of artichoke fortified with a probiotic (i.e., Lactobacillus paracasei) can improve constipation in individuals with this condition (Riezzo et al., 2012; Valerio et al., 2010). Other scientific articles reported the prebiotic activity of long-chain inulin from artichoke in a sample of 31 healthy individuals (Costabile et al., 2010) and in vitro (López-Molina et al., 2005; Zeaiter et al., 2019). Fissore and colleagues (2015) demonstrated that artichoke fibres (i.e., inulin and pectin of low degree of methylation) have prebiotic effects in vitro. A study by Van den Abbeele et al. (2020) showed that an artichoke extract exerts this activity in vitro.
3.8. Antioxidant activity
A  previous study found that ALE intake exerts antioxidant activity in individuals with metabolic syndrome, lowering oxidized-LDL (ox-LDL) levels (Rezazadeh et al., 2018a). Skarpanska-Stejnborn and colleagues (2008) showed the antioxidant effect of ALE in a sample of 22 rowers during the training. Other studies found the antioxidant activity of cynaropicrin from artichoke in HeLa cells (Liu et al., 2019) and human keratinocytes (Takei et al., 2015). Two scientific articles reported that sesquiterpene lactones (Matsumoto et al., 2021) or cynarine and cyanidin (Xia et al., 2014) from artichoke can inhibit the expression of iNOS in vitro. Previous studies showed that artichoke extracts exert this activity in rodent models of different health conditions (Abdel-Moneim et al., 2021; Ahmadi et al., 2019; Ben Salem et al., 2017b; Ben Salem et al., 2019; Ben Salem et al., 2022a; Ben Salem et al., 2022b; Bogavac-Stanojevic et al., 2018; Celepli et al., 2022a; Celepli et al., 2022b; Cicek et al., 2022; Colak et al., 2016; Crevar-Sakac et al., 2016; Deng et al., 2022; El-Boshy et al., 2017; El Morsy and Kamel, 2015; Elsayed Elgarawany et al., 2020; Gurel et al., 2007; Heidarian and Rafieian-Kopaei, 2013; Ibrahim  et al., 2022; Khattab et al., 2016; Küçükgergin et al., 2010; Küskü-Kiraz et al., 2010; Liao et al., 2021; Magielse et al., 2014; Mehmetçik et al., 2008; Metwally et al., 2011; Mohammed et al., 2020; Nasef  et al., 2022; Nassar et al., 2013; Tang et al., 2017; Wang et al., 2021). Lee and colleagues (2021b) found the protective role of ALE against oxidative stress, performing experiments in NAFLD mice and HepG2 cells. Other studies showed the beneficial effect of artichoke extracts with high phenolic contents on oxidative stress (Biel et al., 2020; Brown and Rice-Evans, 1998; D'Antuono et al., 2018; Speroni et al., 2003). Pérez-García and colleagues (2000) demonstrated the antioxidant effect of ALE in vitro. This artichoke extract is effective in blocking reactive oxygen species (ROS) generation in human leukocytes and the phytochemicals mainly involved are luteolin, caffeic acid, cynarine and chlorogenic acid. Previous studies showed that artichoke extracts exert antioxidant activity in vitro (Carpentieri et al., 2022; Gebhardt, 1997; Gebhardt and Fausel, 1997; Juzyszyn et al., 2008; Menghini et al., 2010; Miccadei et al., 2008; Zapolska-Downar et al., 2002). Sarawek and colleagues (2008) found that luteolin from artichoke is effective in inhibiting xanthine oxidase (XO) in vitro. Two previous studies showed the antioxidant effects of this plant extracts, performing in vivo and in vitro experiments (Ben Salem et al., 2017a; Jiménez-Escrig et al., 2003). Other studies demonstrated that artichoke seeds (Durazzo et al., 2013), rhizome (Lee et al., 2021a), buds (Lin et al., 2022) and pollen (Kostić et al., 2021) have antioxidant activity and phenolics are mainly involved in this beneficial effect.
3.9. Antidiabetic effects
Rondanelli and colleagues (2014) found the beneficial effect of an artichoke extract on glucose metabolism in a sample of 55 overweight individuals with impaired fasting glycaemia. Previous studies demonstrated that artichoke extracts are effective in improving insulin resistance in individuals with metabolic syndrome (Ebrahimi-Mameghani et al., 2018) and rodents (Deng et al., 2022; Kwon et al., 2018; Ibrahim et al., 2022). Ben Salem and colleagues (2017b) found the antihyperglycaemic activity of ALE in diabetic rats. Another study showed the hypoglycaemic activity of an artichoke flower head extract in obese and normal rats (Fantini et al., 2011).
3.10. Antiarthritic effects
Two previous studies found the antiarthritic activity of artichoke. Wauquier and colleagues (2021) showed that ALE has a beneficial effect on osteoarthritis, performing an ex vivo experiment using human articular chondrocytes. Another study demonstrated the beneficial effect of cynaropicrin on the metabolism of cartilage in vitro (Masutani et al., 2016). These two scientific articles represent a preliminary evidence that artichoke exerts antiarthritic activity and other studies are required to confirm these results.
3.11. Renoprotective activity
Previous studies showed the protective effect of artichoke bud (Wang et al., 2021), leaf (Ben Salem et al., 2022b; El-Boshy et al., 2017), receptacle and stem (Sümer et al., 2020) extracts on renal function in rats. Khattab and colleagues (2016) found that ALE exerts a beneficial effect on kidney function in a rat model of gentamicin nephrotoxicity.
3.12. Neuroprotective effects
Two previous studies found that ALE exerts a neuroprotective effect in rodent models and this effect may be mediated by the antioxidant activity of artichoke (Cicek et al., 2022; Ibrahim  et al., 2022). Future studies are needed to confirm these results.
3.13. Effects on the reproductive system
Previous studies found that ALE may ameliorate gonadal health in rat models through antioxidant effects (Gurel et al., 2007; Mohammed et al., 2020). The results show the potential beneficial effects of ALE on the reproductive system, but other studies are required to confirm these results and describe in detail the molecular mechanisms underlying these effects.
3.14. Effects on the immune system
A previous study by El-Boshy et al. (2017) found that ALE is effective in improving the levels of immunostimulatory cytokines in a rat model of cadmium toxicity. Hueza and colleagues (2019) showed that an artichoke extract exerts immunomodulatory activity in rats. These two studies provide evidence of the effects of artichoke on the immune system. Other studies are needed to confirm the results and explain the molecular mechanisms.
3.15. Antiphotoaging effects
A previous study demonstrated that cynaropicrin has antiphotoaging effect in vivo and in vitro by regulating the nuclear factor kappa B (NF-kB) signalling pathway (Tanaka et al., 2013). Takei and colleagues (2015) showed that this bioactive compound from artichoke may prevent ultraviolet B (UVB)-induced photoaging in human keratinocytes through antioxidant effects. These results should be confirmed by future studies.
3.16. Antifungal effects
A previous study showed the antifungal activity of different artichoke extracts in vitro and found that ALE is the most effective. The authors analysed the effect against Candida albicansCandida lusitaniaeSaccharomyces cerevisiae,  Saccharomyces carlsbergensisAspergillus nigerPenicillium oxalicumMucor mucedo and Cladosporium cucumerinum (Zhu et al., 2005). Further studies should corroborate these results.
3.17. Prevention of periodontal diseases
A previous study showed that cynaropicrin from artichoke exerts a preventive effect on periodontal diseases in vitro by modulating the NF-kB signalling pathway (Hayata et al., 2019). Only one study found this activity and these results should be confirmed.
This review has some limitations. We reported only scientific articles published in PubMed indexed journals, personal criteria were utilised for conducting the literature search and many studies are characterized by small sample sizes or require replication of results.
4. Conclusions
In this study, we show the health-promoting properties of artichoke after performing a literature search. The most common beneficial effects of this plant are those on the liver and lipid profile and antioxidant activity. Other health benefits include improved gastrointestinal and cardiovascular health and anticancer, antimetabolic and antiobesity, prebiotic and probiotic, antidiabetic and renoprotective effects. Only few studies found the beneficial effects of artichoke on the immune system, the reproductive system, the nervous system, arthritis, photoaging, periodontal diseases and fungal infections. Phenolics are the bioactive compounds mainly involved in these properties and ALE is the extract most commonly utilised for these purposes. The health benefits of artichoke are well documented in the scientific literature. Further studies should confirm the results of the articles reported in this review and the molecular mechanisms involved in the health-promoting properties of this plant.
Abbreviations
ALD: alcoholic liver disease
ALE: artichoke leaf extract
BMI: body mass index
eNOS: endothelial nitric oxide synthase
HDL-C: high-density lipoprotein cholesterol
IBS: irritable bowel syndrome
iNOS: inducible nitric oxide synthase
LDL-C: low-density lipoprotein cholesterol
NAFLD: non-alcoholic fatty liver disease
NASH: non-alcoholic steatohepatitis
NF-kB: nuclear factor kappa B
ox-LDL: oxidized-LDL
ROS: reactive oxygen species
UVB: ultraviolet B
XO: xanthine oxidase
Declarations
Funding
No funding was received for carrying out this study.
Conflict of interest
None.
Availability of data and material
Data and material available on request from the authors.
Code availability
Not applicable
Authors' contributions
ADN, FG, FP and PZ conceptualised and designed the study. ADN conducted the literature search and drafted the article. All co-authors discussed the findings, critically revised the article and approved the final version of the manuscript.
Ethics approval and consent to participate
Not applicable
Consent for publication
Not applicable
Acknowledgements
We are very grateful to Maurizio Carturan and Lidia Novelli for their helpful suggestions.