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Zhu D, Jiang N, Wang N, Zhao Y, Liu X. A Literature Review of the Pharmacological Effects of Jujube. Foods 2024; 13:193. [PMID: 38254493 PMCID: PMC10814260 DOI: 10.3390/foods13020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Jujube is a plant native to China that could be used in medicine and food. Its dried fruit is a superior herb commonly used in traditional Chinese medicine formulations for its calming effect and for nourishing the blood and strengthening the spleen and stomach. Jujube contains numerous active components including polysaccharides, phenols, and triterpene acids, which show a diverse array of pharmacological activities such as neuroprotection and the prevention and treatment of cardiovascular diseases. In this paper, the research status of jujube over the past two decades has been statistically evaluated. Meanwhile, by tracking the latest research advances, the pharmacological efficacy and molecular mechanisms of jujube are exhaustively expounded to provide specific and systematic references for further research on the pharmacological effects of jujube and its application in the food and pharmaceutical industries.
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Affiliation(s)
- Deqi Zhu
- Institute of Drug Discovery Technology, Ningbo University, Ningbo 315211, China (N.W.); (Y.Z.)
| | - Ning Jiang
- Research Center for Pharmacology and Toxicology, Institute of Medicinal Plant Development (IMPLAD), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China;
| | - Ning Wang
- Institute of Drug Discovery Technology, Ningbo University, Ningbo 315211, China (N.W.); (Y.Z.)
| | - Yufen Zhao
- Institute of Drug Discovery Technology, Ningbo University, Ningbo 315211, China (N.W.); (Y.Z.)
| | - Xinmin Liu
- Institute of Drug Discovery Technology, Ningbo University, Ningbo 315211, China (N.W.); (Y.Z.)
- Research Center for Pharmacology and Toxicology, Institute of Medicinal Plant Development (IMPLAD), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China;
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Kim MJ, Jung JE, Lee S, Cho EJ, Kim HY. Effects of the fermented Zizyphus jujuba in the amyloid β 25-35-induced Alzheimer's disease mouse model. Nutr Res Pract 2020; 15:173-186. [PMID: 33841722 PMCID: PMC8007403 DOI: 10.4162/nrp.2021.15.2.173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/28/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUD/OBJECTIVES Alzheimer's disease (AD) is the most common cause of dementia in the elderly. Due to the increased incidence of dementia, there is a corresponding increase concerning the importance of AD. In this study, we investigated the protective effects conferred by Zizyphus jujuba (Zj) and Zizyphus jujuba fermented by yeast (Zj-Y), on cognitive impairment in an AD mouse model. MATERIALS/METHODS AD was induced by injecting amyloid beta25-35 (Aβ25-35) in ICR mice, and subsequently 200 mg/kg Zj or Zj-Y was administered daily for 14 days. The cognitive ability of AD mice was observed through behavioral experiments in T-maze, novel object recognition, and Morris water maze tests. We subsequently measured the levels of malondialdehyde (MDA), nitric oxide (NO), aspartate aminotransferase, and alanine aminotransferase in either tissues or serum. RESULTS In behavioral tests, deterioration was revealed in the short- and long-term learning and memory functions in the Aβ25-35-injected control group compared to the normal group, indicating that Aβ25-35 injection impairs cognitive functions. However, administration of Zj and Zj-Y improved cognitive function in mice, as compared to the Aβ25-35-injected control mice. In addition, the Aβ25-35 induced elevations of MDA and NO in the brain, kidney, and liver were suppressed after exposure to Zj and Zj-Y. Especially, Zj-Y showed stronger scavenging effect against MDA and NO, as compared to Zj. CONCLUSIONS Results of the present study indicate that Zj-Y exerts a protective effect on cognitive impairment and memory dysfunction, which is exerted by attenuating the oxidative stress induced by Aβ25-35.
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Affiliation(s)
- Min Jeong Kim
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Korea
| | - Ji Eun Jung
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Korea
| | - Sanghyun Lee
- Department of Plant Science and Technology, Chung-Ang University, Anseong 17546, Korea
| | - Eun Ju Cho
- Department of Food Science and Nutrition, Pusan National University, Busan 46241, Korea
| | - Hyun Young Kim
- Department of Food Science, Gyeongnam National University of Science and Technology, Jinju 52725, Korea
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Liu Y, Zhang P, Geng Y, Xie X, Wen P. Cracking of jujube fruits is associated with differential expression of metabolic genes. FEBS Open Bio 2020; 10:1765-1773. [PMID: 32619338 PMCID: PMC7459416 DOI: 10.1002/2211-5463.12925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/25/2022] Open
Abstract
Cracks in the skin of jujube fruit reduce freshness and quality; thus, greater understanding of the molecular mechanism that underlies cracking is required to improve fruit production. In this study, we profiled genes that are differentially expressed between cracked and normal jujube fruits through RNA sequencing (RNA‐seq). We selectively confirmed differentially expressed genes (DEGs) using quantitative RT‐PCR. Among 1036 DEGs, 785 genes were up‐regulated and 251 genes were down‐regulated in cracked jujube fruits. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis indicated that some of these DEGs encode proteins involved in metabolic processes (including growth hormone and surface wax production) in cracked jujube fruits. In summary, we have identified differentially expressed metabolic genes between cracked and normal jujube fruits, which may serve as the basis for further studies of fruit quality control.
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Affiliation(s)
- Yaling Liu
- College of Life Science, Shanxi Agricultural University, Taigu, China
| | - Pengfei Zhang
- College of Horticulture, Shanxi Agricultural University, Taigu, China
| | - Yaping Geng
- College of Life Science, Shanxi Agricultural University, Taigu, China
| | - Xiaodong Xie
- College of Life Science, Shanxi Agricultural University, Taigu, China
| | - Pengfei Wen
- College of Horticulture, Shanxi Agricultural University, Taigu, China
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Mesaik AM, Poh HW, Bin OY, Elawad I, Alsayed B. In Vivo Anti-Inflammatory, Anti-Bacterial and Anti-Diarrhoeal Activity of Ziziphus Jujuba Fruit Extract. Open Access Maced J Med Sci 2018; 6:757-766. [PMID: 29875842 PMCID: PMC5985874 DOI: 10.3889/oamjms.2018.168] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Ziziphus jujuba belongs to family Rhamnaceae widely distributed in subtropical and tropical countries. It is used traditionally for several pharmacological purposes including anti-inflammation, antidiarrhoeal and antibacterial, as well as tonic and sometimes as hypnotic (sedative). AIM To determine the in vivo antidiarrhoeal, antibacterial and anti-inflammatory activities of Z. jujuba fruit ethanolic extract. METHOD The fruit was macerated and extracted by 95% (v/v) ethanol. The antidiarrhoeal activity was evaluated using castor oil and Escherichia coli induced diarrhoea mouse model. The antidiarrhoeal and antibacterial activity was investigated at graded doses (400-1200 mg/kg). The anti-inflammatory effects were tested using the carrageenan-induced paw oedema in female Wistar rats. Rat's treatment groups received tragacanth, 100 mg/kg diclofenac sodium, 800 mg/kg, 1200 mg/kg or 1600 mg/kg of an ethanolic extract of Z. jujuba (EEZJ). All treatment groups were fed with the compounds one hour before carrageenan injection at of rat's paw. Also, the EEZJ was further analysed by HPLC-PDA system for identification of the presence of betulinic acid and quercetin. RESULTS EEZJ different doses did not show inhibitory activity against castor oil induced diarrhoea except for the higher (1200 mg/kg) dose. However, the frequency of defecation of stools and watery stool were reduced significantly when compared to control group (P ≤ 0.05 and P ≤ 0.01 respectively), resulted in overall 67% inhibition of diarrhoea. Our anti-inflammatory results demonstrated that EEZJ was able to inhibit the carrageenan-induced paw oedema in rats to a significant degree (p ≤ 0.05) and the paw volume and thickness of both left and right paw were affected compared to the negative control group. CONCLUSION EEZJ possesses antidiarrhoeal and antibacterial activity in a dose depending manner and may provide a pharmacological basis for its clinical use in diarrheal diseases. The activity may partially be due to the presence of betulinic acid and quercetin.
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Affiliation(s)
- Ahmed M. Mesaik
- Faculty of Medicine, University of Tabuk (UT), P.O. Box 741, Tabuk 71491, Saudi Arabia
| | - Hiap Wei Poh
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia (UKM), 43600 Bangi, Selangor, Malaysia
| | - Ooi Yan Bin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia (UKM), 43600 Bangi, Selangor, Malaysia
| | - Izzaddinn Elawad
- Faculty of Medicine, University of Tabuk (UT), P.O. Box 741, Tabuk 71491, Saudi Arabia
| | - Badr Alsayed
- Faculty of Medicine, University of Tabuk (UT), P.O. Box 741, Tabuk 71491, Saudi Arabia
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Xie JH, Tang W, Jin ML, Li JE, Xie MY. Recent advances in bioactive polysaccharides from Lycium barbarum L., Zizyphus jujuba Mill, Plantago spp., and Morus spp.: Structures and functionalities. Food Hydrocoll 2016. [DOI: 10.1016/j.foodhyd.2016.03.030] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tahergorabi Z, Abedini MR, Mitra M, Fard MH, Beydokhti H. "Ziziphus jujuba": A red fruit with promising anticancer activities. Pharmacogn Rev 2015; 9:99-106. [PMID: 26392706 PMCID: PMC4557242 DOI: 10.4103/0973-7847.162108] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 12/10/2014] [Accepted: 08/04/2015] [Indexed: 12/16/2022] Open
Abstract
Ziziphus jujuba Mill. (Z. jujuba) is a traditional herb with a long history of use for nutrition and the treatment of a broad spectrum of diseases. It grows mostly in South and East Asia, as well as in Australia and Europe. Mounting evidence shows the health benefits of Z. jujuba, including anticancer, anti-inflammation, antiobesity, antioxidant, and hepato- and gastrointestinal protective properties, which are due to its bioactive compounds. Chemotherapy, such as with cis-diamminedichloroplatinium (CDDP, cisplatin) and its derivatives, is widely used in cancer treatment. It is an effective treatment for human cancers, including ovarian cancer; however, drug resistance is a major obstacle to successful treatment. A better understanding of the mechanisms and strategies for overcoming chemoresistance can greatly improve therapeutic outcomes for patients. In this review article, the bioactive compounds present in Z. jujuba are explained. The high prevalence of many different cancers worldwide has recently attracted the attention of many researchers. This is why our research group focused on studying the anticancer activity of Z. jujuba as well as its impact on chemoresistance both in vivo and in vitro. We hope that these studies can lead to a promising future for cancer patients.
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Affiliation(s)
- Zoya Tahergorabi
- Department of Pharmacology and Physiology, Berberis and Jujube Research Center, South Khorasan, Birjand, Iran
| | - Mohammad Reza Abedini
- Department of Pharmacology and Physiology, Berberis and Jujube Research Center, South Khorasan, Birjand, Iran
| | - Moodi Mitra
- Social Determinants of Health Research Center, South Khorasan, Birjand, Iran
| | - Mohammad Hassanpour Fard
- Department of Pharmacology and Physiology, Berberis and Jujube Research Center, South Khorasan, Birjand, Iran
| | - Hossein Beydokhti
- Departments of Public Health, Medical Library and Information Sciences, Birjand University of Medical Sciences, South Khorasan, Birjand, Iran
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JING XY, PENG YR, WANG XM, DUAN JA. Effects of Ziziphus jujuba fruit extracts on cytochrome P450 (CYP1A2) activity in rats. Chin J Nat Med 2015; 13:588-94. [DOI: 10.1016/s1875-5364(15)30054-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Indexed: 10/23/2022]
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Grygorieva O, Abrahamová V, Karnatovská M, Bleha R, Brindza J. Morphological characteristic of fruit, drupes and seeds genotypes of Ziziphus jujuba Mill. POTRAVINARSTVO 2014. [DOI: 10.5219/414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The aim of this work is to discriminate 28 Ziziphus jujuba Mill. genotypes (ZJ-01 - ZJ-28) based on weight and morphological characteristics of fruit, stones and seeds. These genotypes maintained in a clone repository (Nova Kachovka, Ukraine) were chosen for investigation as potential species for cultivation and use in Slovakia. The fruits were collected at the period of their full maturity (October); their morphometric parameters were following: weight from 2.90 g (ZJ-13) to 28.99 g (ZJ-22), length from 20.73 mm (ZJ-08) to 44.84 mm (ZJ-04), and width from 16.64 mm (ZJ-13) to 38.87 mm (ZJ-22). Isolated stones were also analysed, and their weight was from 0.173 g (ZJ-07) to 0.731 g (ZJ-20), length from 12.84 mm (ZJ-08) to 28.67 mm (ZJ-04), and width from 5.06 mm (ZJ-07) to 9.74 mm (ZJ-01). The weight of the seeds was ranging from 20.00 mg (ZJ-25) to 69.11 mg (ZJ-12), length from 7.24 mm (ZJ-15) to 11.85 mm (ZJ-04), and width was from 3.86 mm (ZJ-05) to 6.84 mm (ZJ-12). Significant differences in the size, shape and color of fruits, stones and seeds were also identified. The pulp, seedless stones and seeds constitute 92.81% (ZJ-26) - 98.32% (ZJ-04), 1.36% (ZJ-04) - 6.27% (ZJ-20), and 0.25% (QA-24, QA-25) - 1.21% (ZJ-16) of the total fruits weight, respectively The shape index of the fruits was found in the range of 1.04 (ZJ-08) to 2.00 (ZJ-12 and ZJ-25). The shape indexes of stones and seeds were found ranging from 1.74 (ZJ-08) to 4.53 (ZJ-05) and from 1.32 (ZJ-23) to 2.74 (ZJ-04), respectively. The relative weight of pulp was determined in the range from 92.76% (ZJ-13) to 98.32% (ZJ-04) and the relative weight of seed was determined in the range of 0.25% (ZJ-24 and ZJ-25) to 1.16% (ZJ-26). The Chinese jujube genotypes of this study were grouped based on hierarchical clustering of the fruit, stone and seed characteristics.
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Bai HL, Wang J, Liu CM, Li L. Isolation and Purification of Flavonoids fromZiziphus jujubaby High-Speed Counter-Current Chromatography. J CHIN CHEM SOC-TAIP 2013. [DOI: 10.1002/jccs.201000150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Memarpoor-Yazdi M, Mahaki H, Zare-Zardini H. Antioxidant activity of protein hydrolysates and purified peptides from Zizyphus jujuba fruits. J Funct Foods 2013. [DOI: 10.1016/j.jff.2012.08.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Yu L, Jiang BP, Luo D, Shen XC, Guo S, Duan JA, Tang YP. Bioactive components in the fruits of Ziziphus jujuba Mill. against the inflammatory irritant action of Euphorbia plants. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2012; 19:239-244. [PMID: 21982434 DOI: 10.1016/j.phymed.2011.09.071] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/20/2011] [Accepted: 09/13/2011] [Indexed: 05/31/2023]
Abstract
Chinese jujube (also known as Chinese date) is the fruit of Ziziphus jujuba Mill. (Rhamnaceae). As a famous folk medicine, it is used as antidote in traditional Chinese formula, Shi Zao Decoction, to relieve the drastic inflammatory irritant nature of Euphorbia species. The irritant activities may cause serious adverse effects in clinical practices. This study aimed to investigate the active components of Z. jujuba through the inhibitory effects on the inflammatory cells activated by Euphorbia kansui and prostratin, a phorbol ester isolated from Euphorbia fischeriana. Peritoneal macrophage of rat and splenic lymphocyte (splenocyte) of mouse were selected to evaluate these actions in vitro. Nitric oxide (NO) release of macrophage and the proliferation of splenocyte were examined through Griess method and MTT assay. TNF-α, as an important pro-inflammatory cytokines, was detected with enzyme-linked immunosorbent assay (ELISA) method. Six fractions extracted from Z. jujuba were evaluated and fraction F (triterpene acids fraction) was demonstrated to be the most active part, and then, 21 compounds isolated from Z. jujuba were tested at the concentrations range from 1 μg/ml to 100 μg/ml. The results show that 7 compounds of them are likely to be active compounds concerning to their pronounced inhibitory action on the activated inflammatory cells. These effects might be helpful to attenuate the irritant action of Euphorbiaceae plants and protect the gastrointestinal tissue from potent inflammatory injury, which should be beneficial to some diseases, like inflammatory bowel disease.
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Affiliation(s)
- L Yu
- Jiangsu Key Laboratory for TCM Formulae Research, Nanjing University of Chinese Medicine, Nanjing 210046, China
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Liao L, Won TH, Kang SS, Shin J. Simultaneous analysis of bioactive metabolites from Ziziphus jujuba by HPLC–DAD–ELSD–MS/MS. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2012. [DOI: 10.1007/s40005-012-0004-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Egyptian sweet marjoram leaves protect against genotoxicity, immunosuppression and other complications induced by cyclophosphamide in albino rats. Br J Nutr 2011; 108:1059-68. [DOI: 10.1017/s0007114511006210] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cyclophosphamide (CP) is one of the most popular alkylating anticancer drugs that show a high therapeutic index, despite the widespread side effects and toxicity particularly in high-dose regimens and long-term use. Here, we evaluated and compared the efficacy of two different doses (50 and 100 mg/kg body weight, given orally for 30 consecutive days) of Egyptian sweet marjoram leaf powder (MLP) and marjoram leaf aqueous extract (MLE) in alleviating the genotoxicity, immunosuppression and other complications induced by CP in non-tumour-bearing albino rats. The present study showed (probably for the first time) that both MLP and MLE significantly alleviated (P < 0·05–0·001) most side effects and toxicity of CP-treated rats including the increase in chromosomal aberrations of bone marrow cells and serum malondialdehyde level, the decrease in the level of serum Ig, the delayed type of hypersensitivity response as also the weights and cellularity of lymphoid organs, and myelosuppression, leucopenia, macrocytic normochromic anaemia as well as thrombocytopenia by reactivating the non-enzymic (reduced glutathione) and enzymic (catalase, glutathione peroxidase, glutathione S-transferase, superoxide dismutase) antioxidant system and increasing the mitotic index of bone marrow cells. The modulatory effects of marjoram leaves shown in the present study were dose dependent in most cases and much higher in MLE (21–23 % for all parameters taken together). In addition, the doses used in the present study were considered safe. In conclusion, sweet marjoram leaves (especially in the form of a herbal tea) may be useful as an immunostimulant and in reducing genotoxicity in patients under chemotherapeutic interventions.
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Chen CF, Lee JF, Wang D, Shen CY, Shen KL, Lin MH. Water extract of Zizyphus Jujube attenuates ischemia/reperfusion-induced liver injury in rats (PP106). Transplant Proc 2010; 42:741-3. [PMID: 20430161 DOI: 10.1016/j.transproceed.2010.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Ischemia and reperfusion (I/R) injuries in the liver remain important clinical problems. Free oxygen radicals and nitrosative stress have been shown to be involved in the pathogenesis I/R-related liver injury. The purpose of this study was to characterize the effects of an extract of Zizyphus Jujube (ZJ), which has strong antioxidant effects, on I/R-induced liver injury. MATERIALS AND METHODS Ischemia (I) was induced in rat livers by clamping the common hepatic artery and portal vein for 40 minutes, after which flow was restored, and the liver was reperfused for 90 minutes. Blood samples were collected prior to I and after reperfusion to assay blood levels of alanine transaminase (ALT), lactic dehydrogenase (LDH), oxygen radical (OH), and nitric oxide (NO). In the pharmacologic intervention group a water extract of the fruit of ZJ was administered orally to rats (100 mg/mL for 7 days) that were subsequently exposed to the I/R liver injury. RESULTS The data showed that reperfusion (R) of the liver produced increases in blood concentrations of ALT (41.9+/-8.2 vs 338.0+/-89.6; P<.01; N=7) and LDH (317+/-129 vs 4073+/-950; P<.001; N=7). Oxygen radicals (55.1+/-14.3 vs 262.4+/-60.3; P<.001; N=7) and NO (69.3+/-14.9 vs 121.6+/-27.1; P<.01; N=7) also increased significantly in this R group. In the ZJ intervention group the liver injury, oxidative stress, and nitrosative stress were all significantly attenuated. CONCLUSION These results suggested that I/R-induced liver injury with white blood cell activation, oxidative stress, and nitrosative stress. Pretreatment with an extract of ZJ, which shows high antioxidant effects, significantly attenuated the I/R-induced liver injury.
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Affiliation(s)
- C F Chen
- Division of Gastroenterology, Department of Internal Medicine, Cheng Hsin General Hospital and Department of Healthcare Information, School of Health, Ming Chuan University, Taipei, Taiwan
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