A new tactic to treat postprandial hyperlipidemia in diabetic rats with gastroparesis by improving gastrointestinal transit

Early detection of gastroparesis with diabetic ketoacidosis as initial manifestation: A case-control study

BACKGROUND

Gastroparesis may repeatedly induce diabetic ketoacidosis (DKA), and the differential diagnosis of these diseases is challenging because of similar gastrointestinal symptoms. If DKA is accompanied by gastroparesis, patients present with persistent gastrointestinal symptoms without relief and may even experience recurrent DKA. Misdiagnosis results in poor treatment outcomes and prognosis. We hypothesized that biomarkers or screening tools can be identified by comparing the clinical data between DKA alone and DKA + gastroparesis to facilitate early screening.

AIM

To achieve early detection and diagnosis of DKA + gastroparesis to enable early treatment aimed at relieving gastrointestinal symptoms and preventing re-induction of DKA.

METHODS

We conducted a case-control study in which 15 patients hospitalized for DKA at the Endocrinology Department of Peking Union Medical College Hospital and diagnosed with DKA and gastroparesis between December 1999 and January 2023 (DKA + gastroparesis group) were included. Then, we selected 60 DKA patients without DKA as a control group (DKA alone group) based on gender, age, disease course, and diabetes subtype in a 1:4 matching ratio. Clinical manifestations and physical and laboratory examination results were statistically compared between the groups.

RESULTS

The DKA + gastroparesis group was composed of nine males and six females, with a mean age of 35 ± 11 years, while the DKA alone group included 34 males and 26 females, with a mean age of 34 ± 17 years. In the DKA + gastroparesis group, urine ketone levels normalized, while gastrointestinal symptoms persisted despite treatment, and the tests indicated lower glycosylated hemoglobin levels (HbA1c; 7.07% vs 11.51%, P < 0.01), largest amplitude of glycemic excursions (5.86 vs 17.41, P < 0.01), standard deviation of blood glucose (SDBG; 2.69 vs 5.83, P < 0.01), and coefficient of blood glucose variation (0.31 vs 0.55, P = 0.014) compared with the DKA alone group. Probable gastroparesis was considered at HbA1c < 8.55%. Besides, the patients in the DKA + gastroparesis group had lower body mass index (19.28 kg/m2 vs 23.86 kg/m2, P = 0.02) and higher high density lipoprotein cholesterol level (2.34 mmol/L vs 1.05 mmol/L, P = 0.019) compared to the DKA alone group, but no difference was observed in the remaining lipid profiles between the two groups.

CONCLUSION

Gastroparesis should be considered in DKA patients who fail to have improved gastrointestinal symptoms after ketone elimination and acidosis correction, particularly when the HbA1c level is < 8.55%.

Effects of Emodin on Protein Expression Related to Autophagy of Interstitial Cells of Cajal in Diabetic Rats

This work aims to investigate the effects and mechanism of emodin in treating diabetic gastroenteropathy and colonic dysmotility in STZ + HS/HF diet induced diabetic gastroenteropathy rats. Diabetic colonic dysmotility model was established by high-fat/high-glucose (HS/HF) feeding combined with streptozotocin (STZ). Emodin was divided into high, medium and low dose groups. After eight weeks of intervention, fasting blood glucose (FBG) and body weight were measured. Gastrointestinal transmission time was evaluated. Serum vasoactive intestinal peptide (VIP) and substance P (SP) were detected. Colonic protein expression of selective autophagy adaptor proteins p62 and beclin1 were detected by immunohistochemistry. Colonic protein expression of beclin1, autophagy related gene 5 (Atg5), C-kit and p62 were detected by Western blot. After treating with emodin, gastrointestinal transmission rate was improved. The expression of serum SP was increased and serum VIP was decreased. Colonic c-kit and p62 were up-regulated. The expressions of beclin1 and Atg5 were down-regulated. Emodin can improve colonic dysmotility and promote the recovery of colonic motility and intestinal defecation in diabetic rats. Its mechanism may involved with up-regulating the expression of C-kit and P62, down-regulating the expression of Beclin1 and Atg5 in colon, which are associated with colon over-autophagy of Cajal interstitial cell (ICC).

A Review on Rhubarb-Derived Substances as Modulators of Cardiovascular Risk Factors—A Special Emphasis on Anti-Obesity Action

The currently available anti-obesity therapies encounter many associated risks and side effects often causing the ineffectiveness of treatment. Therefore, various plant-derived substances have been extensively studied as a promising support or even an alternative for existing anti-obesity therapies. This review is dealing with the anti-obesity potential of edible and ethnomedicinal rhubarb species and emerging possible role of the rhubarb-derived extracts or individual compounds in the prevention of obesity and perspectives for their use in an anti-obesity treatment. A special emphasis is put on the most popular edible specimens, i.e., Rheum rhabarbarum L. (garden rhubarb) and Rheum rhaponticum L. (rhapontic rhubarb, Siberian rhubarb); however, the anti-obesity potential of other rhubarb species (e.g., R. officinale, R. palmatum, and R. emodi) is presented as well. The significance of rhubarb-derived extracts and low-molecular specialized rhubarb metabolites of diversified chemical background, e.g., anthraquinones and stilbenes, as potential modulators of human metabolism is highlighted, including the context of cardiovascular disease prevention. The available reports present multiple encouraging rhubarb properties starting from the anti-lipidemic action of rhubarb fibre or its use as purgative medicines, through various actions of rhubarb-derived extracts and their individual compounds: inhibition of enzymes of cholesterol and lipid metabolism, targeting of key molecular regulators of adipogenesis, regulators of cell energy metabolism, the ability to inhibit pro-inflammatory signalling pathways and to regulate glucose and lipid homeostasis contributing to overall in vivo and clinical anti-obesity effects.

Molecular Mechanisms of Hawthorn Extracts in Multiple Organs Disorders in Underlying of Diabetes: A Review

Diabetes mellitus (DM) is one of the most important metabolic disorders associated with chronic hyperglycemia and occurs when the body cannot manage insulin secretion, insulin action, or both. Autoimmune destruction of pancreatic beta cells and insulin resistance are the major pathophysiological factors of types 1 and 2 of DM, respectively. Prolonged hyperglycemia leads to multiple organs dysfunctions, including nephropathy, neuropathy, cardiomyopathy, gastropathy, and micro- and macrovascular disorders. The basis of the metabolic abnormalities in carbohydrate, fat, and protein in diabetes is insufficient action of insulin on various target tissues. Medicinal plants are rich sources of bioactive chemical compounds with therapeutic effects. The beneficial effects of leaves, fruits, and flowers extracts of Crataegus oxyacantha, commonly called hawthorn, belonging to the Rosaceae family, are widely used as hawthorn-derived medicines. Data in this review have been collected from the scientific articles published in databases such as Science Direct, Scopus, PubMed, Web of Science, and Scientific Information Database from 2000 to 2021. Based on this review, hawthorn extracts appear both therapeutic and protective effects against diabetic-related complications in various organs through molecular mechanisms, such as decreasing triglyceride, cholesterol, very low density lipoprotein and increasing the antioxidant activity of superoxide dismutase, catalase, glutathione peroxidase, total antioxidant capacity, decreasing malondialdehyde level, and attenuating tumor necrosis factor alpha, interleukin 6 and sirtuin 1/AMP-activated protein kinase (AMPK)/nuclear factor kappa B (NF-κB) pathway and increasing the phosphorylation of glucose transporter 4, insulin receptor substrate 1, AKT and phosphoinositide 3-kinases, and attenuating blood sugar and regulation of insulin secretion, insulin resistance, and improvement of histopathological changes in pancreatic beta cells. Collectively, hawthorn can be considered as one new target for the research and development of innovative drugs for the prevention or treatment of DM and related problems.

A Novel Herbal Medicine for Dyslipidemia: Assessments in Experimental Models

Dyslipidemia substantially contributes to the risk of cardiovascular diseases. The polyherbal formulation has been a traditional therapeutic strategy used to treat dyslipidemia. This study was designed to evaluate the effects of a novel herbal medicine called "GANMO" on an experimental animal model with endogenous dyslipidemia and exogenous dyslipidemia. In the endogenous hyperlipidemia model, rats were previously treated with GANMO tablets and intraperitoneally injected with poloxamer 407 to induce hyperlipidemia. In the exogenous hyperlipidemia model, rats were given oral administration of oil-cholesterol mixture and GANMO for 4 consecutive weeks. Serum lipid profiles were assessed at all experimental animals. In both models, GANMO at both doses significantly decreased the serum total cholesterol (TC) level and non-high-density lipoprotein (HDL) cholesterol level as compared with the model group. HDL cholesterol levels increased in rats with high doses of GANMO compared to those with low doses. GANMO at both doses substantially reduced TG level in the endogenous hyperlipidemia model. In conclusion, GANMO tablets posed a positive effect on serum lipid modulations in dyslipidemia models.

The Effect of Different Doses of Mesobuthus eupeus (Scorpionida: Buthidae) Scorpion Venom on the Production of Liver Necrosis in Nmri Mice

Background:

Scorpion venom has a variety of different components considerably. Some of these compounds are proteins such as Phospholipase A2 which is one of the most important. Use of scorpion venom for the treatment of any disease requires an initial study to determine the therapeutic dose or safe dose. Therefore, due to the necessity of studying scorpion venom, it is of special importance to study the effects of its dose response in animal tissues.

Methods:

To determine the inflammatory effects of scorpion’s venom (Mesobuthus eupeus), 50 Nmri mice with an average weight of 24±7g were selected for investigation in two experiments. In first-round 25 of them were divided into 5 groups and were exposed to different doses of venom injection paralleling the control group. Single-injection of various doses on 25 mice was performed and results were compared.

Results:

There was a significant differences between the test and control groups (in most groups). Liver necrosis was one of the important symptoms in this study, the severity of which was measured and statistically analyzed.

Conclusion:

It was determined that 0.05ppm is a safe dose and sub-lethal doses can use for the investigation of therapeutic effects of venom on cancer, diabetes, dermatitis, and so on.

Ethnobotanical Uses, Phytochemistry and Pharmacology of Different Rheum Species (Polygonaceae): A Review

Today, there is an increased tendency to use herbal remedies. Rhubarb refers to several species of the genus Rheum L. in the Polygonaceae family. This species-rich genus is mainly distributed in Asian countries. Several medicinal effects have been attributed to the Rheum spp. in the traditional and modern medicine such as healing lungs, liver, kidney, womb and bladder diseases, cancer, diabetes, insect bites, relapsing fevers, diarrhea and constipation. Various in vitro, in vivo and clinical studies have investigated the therapeutic effect of extracts, fractions and pure compounds isolated from different species of this genus. Considering the positive findings, several pharmaceutical formulations containing rhubarb extract like capsules, drops, mouthwashes and different topical formulations are now present in the market. However, there are other traditional therapeutic effects of rhubarb that have not been studied yet and it is of great importance to perform confirmatory experiments or clinical investigations. The current review summarizes general information regarding botany, phytochemistry, ethnobotany and pharmacological aspects of Rheum spp. It is hoped that the present review could motivate subsequent research on the other medicinal properties of these plants that have been neglected until today.

Berberine prevents stress-induced gut inflammation and visceral hypersensitivity and reduces intestinal motility in rats

BACKGROUND

Irritable bowel syndrome (IBS) is a common chronic non-organic disease of the digestive system. Berberine (BBR) has been used to treat patients with IBS, but the underlying therapeutic mechanism is little understood. We believe that BBR achieves its therapeutic effect on IBS by preventing stress intestinal inflammation and visceral hypersensitivity and reducing bowel motility.

AIM

To test the hypothesis that BBR achieves its therapeutic effect on IBS by preventing subclinical inflammation of the intestinal mucosa and reducing visceral hypersensitivity and intestinal motility.

METHODS

IBS was induced in rats via water avoidance stress (WAS). qRT-PCR and histological analyses were used to evaluate the levels of cytokines and mucosal inflammation, respectively. Modified ELISA and qRT-PCR were used to evaluate the nuclear factor kappa-B (NF-κB) signal transduction pathway. Colorectal distention test, gastrointestinal transit measurement, Western blot, and qRT-PCR were used to analyze visceral sensitivity, intestinal motility, the expression of C-kit (marker of Cajal mesenchymal cells), and the expression of brain derived neurotrophic factor (BDNF) and its receptor TrkB.

RESULTS

WAS led to mucosal inflammation, visceral hyperalgesia, and high intestinal motility. Oral administration of BBR inhibited the NF-κB signal transduction pathway, reduced the expression of pro-inflammatory cytokines [interleukin (IL)-1β, IL-6, interferon-γ, and tumor necrosis factor-α], promoted the expression of anti-inflammatory cytokines (IL-10 and transforming growth factor-β), and improved the terminal ileum tissue inflammation. BBR inhibited the expression of BDNF, TrkB, and C-kit in IBS rats, leading to the reduction of intestinal motility and visceral hypersensitivity. The therapeutic effect of BBR at a high dose (100 mg/kg) was superior to than that of the low-dose (25 mg/kg) group.

CONCLUSION

BBR reduces intestinal mucosal inflammation by inhibiting the intestinal NF-κB signal pathway in the IBS rats. BBR reduces the expression of BDNF, its receptor TrkB, and C-kit. BBR also reduces intestinal motility and visceral sensitivity to achieve its therapeutic effect on IBS.

Brain-derived neurotrophic factor accelerates gut motility in slow-transit constipation

BACKGROUND & AIMS

Brain-derived neurotrophic factor (BDNF) may play a critical role in gut motility. We aimed to investigate BDNF's physiologic effects on gut motility in slow-transit constipation (STC) and to explore the underlying molecular mechanisms.

METHODS

BDNF expression and alterations of colonic nerve fibre density in STC patients were first investigated. BDNF's effects on gastrointestinal motility of both BDNF(+/-) mice and loperamide-induced constipation mice were then examined in vivo and in vitro. Smooth muscle α-actin (α-SMA) expression, and nerve fibre, neuromuscular junction (NMJ) and smooth muscle cell (SMC) alterations were investigated. Finally, the effects of BDNF-induced TrkB-phospholipase C/inositol trisphosphate (TrkB-PLC/IP3) pathway activation on gut motility were investigated.

RESULTS

In STC patients, BDNF expression and nerve fibre density were decreased, and mucosal nerve fibre ultrastructural degenerations were demonstrated. Gut motility was decreased in vivo and in vitro in BDNF(+/-) and constipation mice, with BDNF dose-dependently increasing gut motility. In BDNF(+/-) mice, α-SMA expression and nerve fibre density were decreased, and nerve fibre, NMJ and SMC ultrastructural degenerations were observed. Finally, TrkB-PLC/IP3 pathway antagonists dramatically attenuated BDNF's excitatory effect on gut motility, and exogenous BDNF induced an obvious increase in IP3 expression.

CONCLUSIONS

BDNF plays an important regulatory role in gut motility in STC. It was mediated by altering the intestinal innervation structure, as well as smooth muscle secondary degeneration through a mechanism involving TrkB-PLC/IP3 pathway activation.

Pseudodyslipidemia: are we over-treating dyslipidemia in diabetic patients with undiagnosed gastroparesis?

Management of dyslipidemia in diabetic patients poses a major burden on both patients and healthcare providers. Gastroparesis, a condition in which gastric emptying is delayed, is a common condition in diabetes. Given the fact that normal values of plasma lipids are standardized to be measured after several hours of fasting, delayed transit of food and nutrients into the small bowel (as occurs in gastroparesis) may result in an artificial increase in plasma lipids, causing misdiagnosis of dyslipidemia (pseudodyslipidemia), and lead to overtreatment with lipid-lowering agents.

Review of the mechanism of cell death resulting from streptozotocin challenge in experimental animals, its practical use and potential risk to humans

Streptozotocin (STZ) (2-deoxy-2-({[methyl(nitroso)amino]carbonyl}amino)-β-D-glucopyranose) is a naturally occurring diabetogenic compound, produced by the soil bacterium streptomyces achromogenes, that exhibits broad spectrum of antibacterial properties. Streptozotocin functions as a DNA synthesis inhibitor in both bacterial and mammalian cells. In mammalian cells, the actual mechanism and metabolic targets of STZ toxicity that results in cell death is not known. This review identifies four key areas that explain the mechanism of the cytotoxicity of STZ in mammalian cell lines, investigates the practical aspects of using STZ in experimental animals and the potential risks of its exposure to human health.

Sesamol treatment reduces plasma cholesterol and triacylglycerol levels in mouse models of acute and chronic hyperlipidemia

The active constituents of Sesamum indicum, sesamin and sesamolin, have already been explored for hypolipidemic action. In this study we have explored the anti-dyslipidemic activity of another active component and metabolite of sesamolin (sesamol), by using acute models of hyperlipidemia viz., a fat tolerance test, a tyloxapol-induced hyperlipidemia model and a chronic model of hyperlipidemia viz., a high-fat diet-induced hyperlipidemia model in Swiss albino mice. Sesamol (100 and 200 mg/kg) significantly (P < 0.05) decreased triacylglycerol absorption in the fat tolerance test by showing a dose-dependent decrease in triacylglycerol levels. The hypolipidemic effect of sesamol at 200 mg/kg was equivalent to 10 mg/kg of orlistat. In the tyloxapol-induced hyperlipidemia model, Sesamol at 200 mg/kg reversed the elevated levels of cholesterol and triacylglycerol compared with the tyloxapol group at 12 and 24 h, which indicates its probable effect on cholesterol synthesis. Chronic hyperlipidemia in mice was produced by feeding a high-diet, a mixture of cholesterol (2 % w/w), cholic acid (1 % w/w) and coconut oil 30 % (v/w) with standard powdered standard animal chow (up to 100 g). Niacin (100 mg/kg) and sesamol (100 mg/kg) significantly (P < 0.05) reduced the elevated body weight compared with the high fat diet control group. Elevated levels of cholesterol and triacylglycerol were significantly (P < 0.05) reversed by the sesamol (50 and 100 mg/kg), implying that it might reduce the absorption and increase the excretion of cholesterol as well.

Study of the pharmacokinetic changes of Tramadol in diabetic rats

Background

Besides the pathological states, diabetes mellitus may also alter the hepatic biotransformation of pharmaceutical agents. It is advantageous to understand the effect of diabetes on the pharmacokinetic of drugs. The objective of this study was to define the pharmacokinetic changes of tramadol and its main metabolites after in vivo intraperitoneal administration and ex vivo perfused liver study in diabetic rat model.

Tramadol (10 mg/kg) was administered to rats (diabetic and control groups of six) intraperitoneally and blood samples were collected at different time points up to 300 min. In a parallel study, isolated liver perfusion was done (in diabetic and control rats) by Krebs-Henseleit buffer (containing 500 ng/ml tramadol). Perfusate samples were collected at 10 min intervals up to 180 min. Concentration of tramadol and its metabolites were determined by HPLC.

Results

Tramadol reached higher concentrations after i.p. injection in diabetics (C_max of 1607.5 ± 335.9 ng/ml) compared with control group (C_max of 561.6 ± 111.4). M1 plasma concentrations were also higher in diabetic rats compared with control group. M2 showed also higher concentrations in diabetic rats. Comparing the concentration levels of M1 in diabetic and control perfused livers, showed that in contrast to intact animals, the metabolic ratios of M1 and M5 (M/T) were significantly higher in diabetic perfused liver compared to those of control group.

Conclusions

The pharmacokinetic of tramadol and its three metabolites are influenced by diabetes. As far as M1 is produced by Cyp2D6, its higher concentration in diabetic rats could be a result of induction in Cyp2D6 activity, while higher concentrations of tramadol can be explained by lower volume of distribution.

Impact of obesity and diabetes on arthritis: An update

The incidence of obesity and diabetes has been increased with alarming rate in recent years and became a common problem around the globe including developing as well as in developed countries with incalculable social costs. Obesity and type 2 diabetes are two common co-morbidities occur together. Obesity and diabetes is closely associated with many diseases, osteoarthritis, hypertension, certain form of cancer, sleep-breathing disorders and coronary heart disease. Impacts of obesity and diabetes (insulin resistance) on arthritis have been seen in patients that we associated with combination of various factors like increased availability of high- energy foods, genetic susceptibility and decreased physical activity in modern society. Arthritis is becoming pandemic around the globe and its occurrence with obesity and diabetes has been observed more common than ever. Combination of these two chronic conditions makes these diseases more vulnerable for human health. Till now very limited information is established about the pathological and mechanistic correlation among these health ailments. In this review article we aimed to survey the literature covering the influence of obesity and diabetes on arthritis pathology and tried to establish correlation with these diseases.

Impairment of gastric nitrergic and NRF2 system in apolipoprotein E knockout mice

BACKGROUND AND AIM

Gastric motility dysfunction is most commonly seen in diabetic and idiopathic gastroparesis patients. Recently we reported that impaired nitrergic relaxation and a reduced NO (nitric oxide) bioavailability were responsible for gastric motility dysfunction in diabetic female rats. One of the main factors involved in the inactivation of the nitrergic system is oxidative stress commonly seen in diabetic patients. Hyperlipidemia may also be one of the detrimental causes for impaired gastric motility associated with diabetes. In the current study, we investigated whether apolipoprotein E knockout mice (ApoE-KO), an oxidative stress animal model with a hyperlipidemia burden, also displays an impaired nitrergic system. To test this, nitrergic relaxation (AUC/mg tissue) was measured at 2 Hz through electric field stimulation using gastric pyloric strips prepared from C57BL WT or ApoE-KO female mice. Protein expression was determined by Western blots.

RESULTS

Nitrergic relaxation was reduced in gastric strips from ApoE-KO versus WT mice. Protein levels of nNOS (neuronal nitric oxide synthase), GCH-1 (GTP cyclohydrolase 1), Nrf2 (nuclear factor E-2 related factor 2) and GCSc (glutamate-cysteine ligase catalytic) were also reduced in ApoE-KO compared to controls, with no significant change in GCSm (glutamate-cysteine ligase modifier) and HO-1 (heme oxygenase 1). The activities of DHFR (dihydrofolate reductase) and antioxidant enzymes were also reduced in ApoE-KO mice.

CONCLUSIONS

This novel study is the first to reveal that a deficiency in ApoE impairs gastric motility functions, and that hyperlipidemia and the suppression of selective antioxidants may be an underlying mechanism for this pathological change.

Emerging approaches of traditional Chinese medicine formulas for the treatment of hyperlipidemia

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional Chinese medicine (TCM) formulas have been widely used in China since ancient times to treat certain diseases (e.g., phlegm, dampness and blood stasis). Recently, the effects of these medicines have been increasingly demonstrated to be helpful for hyperlipidemic patients.

AIM OF THE STUDY

This manuscript aims to describe the scientific evidence for the efficacy of TCM and attempts to identify potential TCM formulas for treating hyperlipidemia.

MATERIALS AND METHODS

TCM formulas approved by the State Food and Drug Administration of China (SFDA) were sourced from the official SFDA website (http://www.sda.gov.cn/). Human and animal evidence for the hypolipidemic effects of herbs from TCM formulas were reviewed via the Internet (Elsevier, ACS, Wiley Online Library, SpringerLink, PubMed, Web of Science, CNKI, Baidu, and Google) and libraries up to October 31, 2011.

RESULTS

More than 50 TCM formulas have been used to treat hyperlipidemia. These herbs can primarily be grouped into three categories: (1) herbs promoting excretions, generally by reducing food retention, enhancing purgative effects, and promoting diuresis and choleretic effects, e.g., Fructus Crataegi (), Radix Polygoni Multiflori (), Semen Cassiae (), and Radix et Rhizoma Rhei (), Rhizoma alismatis (), and Herba Artemisiae Scopariae (); (2) herbs acting on the cardiovascular system, generally by improving blood circulation based on TCM theories, e.g., Radix Salviae Miltiorrhizae (), Radix Puerariae (), Rhizoma Chuanxiong (), Flos Carthami (), and Folium Nelumbinis (); and (3) herbs that have tonic effects, e.g., Fructus Lycii (), Radix Ginseng (), and Radix Astragali ().

CONCLUSIONS

Three basic approaches, including excretory function enhancement, cardiovascular system improvement, and tonic effect reinforcement, are emerging among TCM formulas for the treatment of hyperlipidemia. These approaches may be useful in controlling blood lipid levels, preventing cardiovascular complications, and adjusting bodily functions in hyperlipidemic patients. However, solid evidence of the efficacy of these treatments is required.

Impairment of nitrergic system and delayed gastric emptying in low density lipoprotein receptor deficient female mice

BACKGROUND

In the current study, we have investigated whether low density lipoprotein receptor knockout mice (LDLR-KO), moderate oxidative stress model and cholesteremia burden display gastroparesis and if so whether nitrergic system is involved in this setting. In addition, we have investigated if sepiapterin (SEP) supplementation attenuated impaired nitrergic system and delayed gastric emptying.

METHODS

Gastric emptying and nitrergic relaxation were measured in overnight fasting mice. nNOSα dimerization, anti-oxidant markers such as Nrf2, GCLM, GCLC, HO-1, catalase (CAT), and superoxide dismutase (SOD1) were measured using standard methods. Biopterin levels and intestinal transit time were measured using HPLC and dye migration assay, respectively. Wild type (WT) and LDLR-KO were supplemented with SEP.

KEY RESULTS

In LDLR null stomachs: (i) significant reduction in rate of gastric emptying, gastric pyloric and fundus nitrergic relaxation and nNOSα dimerization, (ii) elevated oxidized biopterins and reduced ratio of BH(4) /BH(2)  + B, (iii) reduced Nrf2 and GCLC protein expression and no change in GCLM, HO-1, CAT, SOD1, and (iv) accelerated small intestinal motility were noticed. Supplementation of SEP restored delayed gastric emptying, impaired pyloric and fundus nitrergic relaxation with restoration of nNOS dimerization and nNOS expression.

CONCLUSIONS & INFERENCES

This novel data suggests that hyperlipidemia and/or suppression of selective antioxidants may be a potential cause of developing gastroparesis in diabetic patients.

Differences and similarities of postprandial lipemia in rodents and humans

Background

The rat has been a mainstay of physiological and metabolic research, and more recently mice. This study aimed at characterizing the postprandial triglyceride profile of two members of the Muridae family: the Wistar rats (Rattus norvegicus albinus) and C57BL/6 mice (Mus musculus) plus comparing them to the profile obtained in humans.

Methods

Thirty-one male and twelve female Wistar rats, ten C57BL/6 male and nine female mice received a liquid meal containing fat (17%), protein (4%) and carbohydrates (4%), providing 2 g fat/Kg. Thirty-one men and twenty-nine women received a standardized liquid meal containing fat (25%), dextromaltose (55%), protein (14%), and vitamins and minerals (6%), and providing 40 g of fat per square meter of body surface. Serial blood samples were collected at 2, 4, 6, 8 and 10 h after the ingestion in rats, at 1, 2, 3, 4, 5 and 6 h in mice and in humans at 2, 4, 6 and 8 h. Wilcoxon and Mann-Whitney tests were used.

Results/Discussion

The triglyceride responses were evaluated after the oral fat loads. Fasting and postprandial triglyceridemia were determined sequentially in blood sample. AUC, AUIC, AR, RR and late peaks were determined.

Conclusions

Rats are prone to respond in a pro-atherogenic manner. The responses in mice were closer to the ones in healthy men. This study presents striking differences in postprandial triglycerides patterns between rats and mice not correlated to baseline triglycerides, the animal baseline body weight or fat load in all animal groups.

Regulation effects of Crataegus pinnatifida leaf on glucose and lipids metabolism

The leaf of Crataegus pinnatifida (Rosaceae) is commonly consumed either raw or cooked to improve digestion and promote blood circulation in China. To investigate the regulation effects of it on glucose and lipid metabolism, the flavonoids fraction was prepared and analyzed by HPLC and LC-MS. In vivo, at doses of 250 and 500 mg/kg, the flavonoids fraction showed inhibitory effects on TG and glucose absorption, accelerating effects on gastrointestinal transit but no effect on gastric emptying. In vitro, treatment of 3T3-L1 preadipocytes with 30 μg/mL flavonoids fraction significantly suppressed the accumulation of TG and free fatty acid. It also suppressed the gene expressions of C/EBPα, PPARγ, SREBP 1c, aP2 and adiponectin but did not affect that of leptin. C. pinnatifida leaf may be useful for type 2 diabetics and hyperlipidemics as a foodstuff.

Traditional chinese medicines in treatment of patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) occurs in 95% of the diabetic populations. Management of T2DM is a challenge. Traditional Chinese medicines (TCM) are usually served as adjuvants used to improve diabetic syndromes in combination of routine antidiabetic drugs. For single-herb prescriptions, Ginseng, Bitter melon, Golden Thread, Fenugreek, Garlic, and Cinnamon might have antidiabetic effects in T2DM patients. Among 30 antidiabetic formulas approved by the State Food and Drugs Administrator of China, top 10 of the most frequently prescribed herbs are Membranous Milkvetch Root, Rehmannia Root, Mongolian Snakegourd Root, Ginseng, Chinese Magnoliavine Fruit, Kudzuvine Root, Dwarf Lilyturf Tuber, Common Anemarrhena Rhizome, Barbary Wolfberry Fruit, and India Bread, which mainly guided by the theory of TCM. Their action mechanisms are related to improve insulin sensitivity, stimulate insulin secretion, protect pancreatic islets, and even inhibit intake of intestinal carbohydrates. However, it is very difficult to determine antihyperglycemic components of TCM. Nevertheless, TCM are becoming popular complementary and alternative medicine in treatment of syndromes of T2DM. In the future, it requires further validation of phytochemical, pharmacological, and clinical natures of TCM in T2DM in the future studies, especially for those herbs with a high prescription frequency.

Hypolipidemic effects of three purgative decoctions

In traditional Chinese medicine (TCM), purgation is indicated when a person suffers an illness due to the accumulation of evil internal heat. Obese individuals with a large belly, red face, thick and yellow tongue fur, constipation, and avoidance of heat are thought accumulates of evil internal heat, and they are also treated with purgatives such as Ta-Cheng-Chi-Tang (TCCT), Xiao-Chen-Chi-Tang (XCCT), and Tiao-Wei-Chen-Chi-Tang (TWCCT) by TCM doctors. In previous studies, our group found that TCCT has potent anti-inflammatory activity, and that XCCT is an effective antioxidant. Since rhubarb is the principle herb in these three prescriptions, we will first present a thorough review of the literature on the demonstrated effect (or lack of effect) of rhubarb and rhubarb-containing polyherbal preparations on lipid and weight control. We will then continue our research with an investigation of the anti-obesity and lipid-lowering effect of TCCT, XCCT, TWCCT, and rhubarb extracts using two animal models. TWCCT lowered the serum triglyceride concentration as much as fenofibrate in Triton WR-1339-treated mice. Daily supplementation with XCCT and TWCCT significantly attenuated the high-fat-diet-induced hypercholesterolemia in rats. In addition, TWCCT also significantly lowered the high-fat-diet-induced hypertriglycemia. Although feeding high-fat diet rats with these extracts did not cause loose stools or diarrhea or other deleterious effects on renal or hepatic function. None of these extracts lowered the body weight of rats fed on high-fat diet. In conclusion, the results suggest that XCCT and TWCCT might exert beneficial effects in the treatment of hyperlipidemia.

Screening for anti-lipase properties of 37 traditional Chinese medicinal herbs

BACKGROUND

To find new, crude anti-obesity drugs from natural sources through the inhibition of adsorption of dietary lipids, in vitro porcine pancreatic lipase (PPL; triacylglycerol lipase, EC 3.1.1.3) inhibitory tests were carried out on selected plants with weight-reducing or related potential, used in Chinese traditional medicine.

METHODS

The methanolic extracts of 37 traditional Chinese herbal medicines of different families were assayed for their in vitro activity against PPL by using spectrophotometry with 2,4-dinitrophenyl butyrate as a synthetic substrate. Coexistent phytochemicals, or those present in high levels, in the 3 most promising Chinese herbs were tested for their anti-lipase activity.

RESULTS

Extracts from 2 herbs, Prunella vulgaris L. (Labiatae) and Rheum palmatum L. (Polygonaceae), at a concentration of 200 mg/mL, significantly inhibited PPL-by 74.7% and 53.8%, respectively. Quercetin exhibited better activity (27.4%) than all the other phytochemicals at a final concentration of 25 mg/mL in the assay system, followed by luteolin, with an activity of 17.3%.

CONCLUSION

The results support the view that herbs represent a rich source of anti-lipase compounds. The screening of the methanolic extracts of 37 Chinese medicinal plants in vitro led to the identification of several extracts with potential activity against PPL, in particular, P. vulgaris and R. palmatum. We also found that several monomeric chemicals in these herbs exhibited good or moderate activity against PPL. To the best of our knowledge, these traditional Chinese herbal medicines or phytochemicals have not been previously screened for their lipase inhibitory activity.

The protective effect of Daming capsule on heart function in streptozocin-induced diabetic rats with hyperlipidemia

Impaired heart function is the main reason for increased mortality of diabetes mellitus. Development of drugs with cardioprotective effects against diabetic myocardiopathy would benefit patients with diabetes. In this study, we tested the cardioprotective effects of Daming capsule (DMC), a traditional Chinese formula, on heart function in streptozocin (STZ)-induced diabetic rats with high fat-diet (HFD). DMC 100 mg/kg/d markedly decreased fasting blood glucose (FBG) and total cholesterol (TC), but did not affect triglycerides (TG) in diabetic rats at 30 d. The decreased heart rate (HR) and prolonged QT and PR interval induced by diabetes mellitus were significantly reversed by DMC (p<0.05). The mechanism may involve that DMC attenuated L-type calcium channel alpha(1c) subunit increasing and Kv4.2 decreasing at both mRNA and protein level in diabetic rats. Additionally, DMC could obviously ameliorate the impaired heart function of diabetic rats by decreasing elevated left ventricular end-diastolic pressure (LVEDP) and increasing the attenuated maximum change velocity of left ventricular pressure in the isovolumic contraction or relaxation period (+/-dp/dt(max)). Transmission electron microscopy (TEM) results showed that myocardium injury was attenuated by DMC (100 mg/kg/d) in STZ-induced diabetic rats with HFD. In conclusion, DMC could recover the prolonged QT interval and PR interval and elevated diastolic and systolic function of diabetic heart. This protective effect may partially be mediated through affecting the mRNA and protein expression of Kv4.2 and alpha(1c) as well as preventing cardiomyocyte morphological remodeling.

Pharmacokinetics of drugs in rats with diabetes mellitus induced by alloxan or streptozocin: comparison with those in patients with type I diabetes mellitus

Objectives

In rats with diabetes mellitus induced by alloxan (DMIA) or streptozocin (DMIS), changes in the cytochrome P450 (CYP) isozymes in the liver, lung, kidney, intestine, brain, and testis have been reported based on Western blot analysis, Northern blot analysis, and various enzyme activities. Changes in phase II enzyme activities have been reported also. Hence, in this review, changes in the pharmacokinetics of drugs that were mainly conjugated and metabolized via CYPs or phase II isozymes in rats with DMIA or DMIS, as reported in various literature, have been explained. The changes in the pharmacokinetics of drugs that were mainly conjugated and mainly metabolized in the kidney, and that were excreted mainly via the kidney or bile in DMIA or DMIS rats were reviewed also. For drugs mainly metabolized via hepatic CYP isozymes, the changes in the total area under the plasma concentration–time curve from time zero to time infinity (AUC) of metabolites, AUCmetabolite/AUCparent drug ratios, or the time-averaged nonrenal and total body clearances (CLNR and CL, respectively) of parent drugs as reported in the literature have been compared.

Key findings

After intravenous administration of drugs that were mainly metabolized via hepatic CYP isozymes, their hepatic clearances were found to be dependent on the in-vitro hepatic intrinsic clearance (CLint) for the disappearance of the parent drug (or in the formation of the metabolite), the free fractions of the drugs in the plasma, or the hepatic blood flow rate depending on their hepatic extraction ratios. The changes in the pharmacokinetics of drugs that were mainly conjugated and mainly metabolized via the kidney in DMIA or DMIS rats were dependent on the drugs. However, the biliary or renal CL values of drugs that were mainly excreted via the kidney or bile in DMIA or DMIS rats were faster.

Summary

Pharmacokinetic studies of drugs in patients with type I diabetes mellitus were scarce. Moreover, similar and different results for drug pharmacokinetics were obtained between diabetic rats and patients with type I diabetes mellitus. Thus, present experimental rat data should be extrapolated carefully in humans.

A randomized, multicentre, open-label, parallel-group trial to compare the efficacy and safety profile of daming capsule in patients with hypercholesterolemia

To study the efficacy and tolerability of Daming capsule (DMC) in Chinese patients with hyperlipidemia, a randomized, multi-centre, open-label, parallel-group trial was conducted. Sixty enrolled patients with hyperlipidemia allocated to six medical centers were randomly divided into two groups of 30 individuals each. One group received DMC 2 g b.i.d. for 6 weeks, and the other received pravastatin 10 mg o.d. for 6 weeks. For efficacy assessment, serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were measured before and after drug treatment. Serum TC and LDL-C levels in the DMC-treatment group were significantly decreased compared with those before treatment (p < 0.05), while TG and HDL-C levels did not change much. Tolerability was assessed by heart rate (HR), blood pressure (BP), body mass index (BMI), alanine aminotransferase (ALT) and creatinine (Cr), which were not changed in either the DMC or pravastatin groups at 3 and 6 weeks (p > 0.05). Besides, eight patients experienced diarrhea during DMC treatment and two experienced myalgia and epigastric discomfort during pravastatin treatment. Based on the above results, it was concluded that DMC may be a good candidate for the treatment of hyperlipidemia and further clinical trials are warranted.

Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

AIM: To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (≥ 60 years of age).

METHODS: We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007.

RESULTS: In 169 patients with SAP, 94 were elderly and 16 died. Biliary and idiopathic etiologies were the first two causes that accounted for over 90% of SAP in the elderly. Biliary, hyperlipemic and alcoholic etiologies were the first three causes in the young. The proportion of co-morbidity of cholelithiasis, biliary infection, hypertension and coronary heart disease in the aged was significantly higher than that in their young partners. The scores of APACHE II and Ranson were also significantly higher in the elderly except the CT score. Organ failures were more common in the elderly, but the local pancreatic complications were not different between the two groups. Mortality of the aged was correlated with the severity of SAP, multiple co-morbidity and incidence of multiple organ dysfunction syndrome (MODS). MODS was the main cause of death.

CONCLUSION: The etiology of SAP in the elderly is quite different from that in the young. Biliary and unknown factors are main causes in the aged. The elderly are subject to major organ failures but there is no difference in the occurrence of local pancreatic complications between the elderly and the young. It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with SAP.

Hypolipidemic Mechanisms of Ananas comosus L. Leaves in Mice: Different From Fibrates but Similar to Statins

In this study, we investigated hypolipidemic mechanisms of the ethanolic extract of Ananas comosus L. leaves (AC) in mice and then determined its activities in related enzymes. The results showed that AC (0.40 g/kg) significantly inhibited the increase in serum triglycerides by 40% in fructose-fed mice. In mice induced by alloxan and high-fat diets, serum total cholesterol remained at a high level (180 - 220 mg/dl) within 7 days of removing high-fat diets but reached normal level (120 - 140 mg/dl) after AC (0.40 g/kg per day) treatment. Also, AC (0.40 and 0.80 g/kg) significantly inhibited serum lipids from the increase in Triton WR-1339-induced hyperlipidemic mice. AC (0.01 - 100 microg/ml) selectively activated lipoprotein lipase (LPL) activity by 200% - 400% and significantly inhibited 3-hydroxyl-methyl glutaryl coenzyme A (HMGCoA) reductase activity by 20% - 49% in vitro. Furthermore, 2 months of fenofibrate (0.20 g/kg) administration particularly increased mice liver weights (0.0760 +/- 0.0110 g/g) while AC (0.40 g/kg) had no effect (0.0403 +/- 0.0047). Taken together, these results suggest that AC will be a new potential natural product for the treatment of hyperlipidemia that exerts its actions through mechanisms of inhibiting HMGCoA reductase and activating LPL activities. Its action mechanisms differentiate from those with fibrates but may be partly similar to those with statins. It is hopeful that AC may serve as the adjuvant for fibrates.

Effect of ethanolic extracts of Ananas comosus L. leaves on insulin sensitivity in rats and HepG2

Ethanolic extracts of Ananas comosus L. leaves (AC) enriched with phenols have hypoglycemic activity in diabetic rats. Here, we investigated the effect of AC on insulin sensitivity in rats and HepG2. In high-fat diet-fed and low-dose streptozotozin-treated diabetic Wistar rats subjected to challenge with exogenous human insulin, AC treatment at an oral dose of 0.40 g/kg could significantly improve sensitivity to exogenous insulin. After a sub-acute treatment, AC also could inhibit the development of insulin resistance in high-fat diet-fed and low-dose streptozotozin-treated diabetic rats following the test of loss of tolbutamide-induced blood glucose lowering action. For intravenous insulin/glucose infusion test, high-fat diet-fed and low-dose alloxan-treated Wistar rats were associated with insulin resistance, which was improved after AC or fenofibrate treatment. AC application inhibited the development of insulin resistance in HepG2 cells. The above animal models were well developed to simulate type 2 diabetes. Taken together, our results suggest that AC may improve insulin sensitivity in type 2 diabetes and could be developed into a new potential natural product for handling of insulin resistance in diabetic patients.