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On the other hand, changes in total cholesterol, LDL-cholesterol, and HDL-cholesterol levels were not statistically significant ( 3.4 The role of Spirulina in the immune system The immune system has a complex structure consisting of innate and adaptive immune mechanisms to protect the body against microorganisms and harmful pathogens ( Clinical studies have shown that using Spirulina as a feed supplement improves antioxidant biomarkers, including inflammatory and anti-inflammatory cytokines, and enhances growth performance, intestinal health, and immunity in fish and poultry

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Another study showed that a synergistic antitumor effect of melatonin in combination with vincristine or ifosfamide was observed in Ewing sarcoma, the second most frequent type of bone cancer, with significantly elevated activation of caspase-3, -8, -9, and Bid [51]

Moreover, compared with the mild group, the concentration of malondialdehyde (MDA, a typical lipid peroxide (LPO)) increased with glutathione (GSH, an important intracellular antioxidant) declining in the severe group (Fig