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Teixeira-Fonseca JL, Souza DS, Conceição MRDL, Marques LP, Durço AO, Silva PLD, Joviano-Santos JV, Santos-Miranda A, Roman-Campos D. In vivo tebuconazole administration impairs heart electrical function and facilitates the occurrence of dobutamine-induced arrhythmias: involvement of reactive oxygen species. Food Chem Toxicol 2024; 187:114596. [PMID: 38556154 DOI: 10.1016/j.fct.2024.114596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
Tebuconazole (TEB), a widely used pesticide in agriculture to combat fungal infections, is commonly detected in global food, potable water, groundwater, and human urine samples. Despite its known in vivo toxicity, its impact on heart function remains unclear. In a 28-day study on male Wistar rats (approximately 100 g), administering 10 mg/kg/day TEB or a vehicle (control) revealed no effect on body weight gain or heart weight, but an increase in the infarct area in TEB-treated animals. Notably, TEB induced time-dependent changes in in vivo electrocardiograms, particularly prolonging the QT interval after 28 days of administration. Isolated left ventricular cardiomyocytes exposed to TEB exhibited lengthened action potentials and reduced transient outward potassium current. TEB also increased reactive oxygen species (ROS) production in these cardiomyocytes, a phenomenon reversed by N-acetylcysteine (NAC). Furthermore, TEB-treated animals, when subjected to an in vivo dobutamine (Dob) and caffeine (Caf) challenge, displayed heightened susceptibility to severe arrhythmias, a phenotype prevented by NAC. In conclusion, TEB at the no observed adverse effect level (NOAEL) dose adversely affects heart electrical function, increases arrhythmic susceptibility, partially through ROS overproduction, and this phenotype is reversible by scavenging ROS with NAC.
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Affiliation(s)
- Jorge Lucas Teixeira-Fonseca
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo, Brazil
| | - Diego Santos Souza
- Laboratory of Heart Biophysics, Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil
| | | | - Leisiane Pereira Marques
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo, Brazil
| | - Aimée Obolari Durço
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo, Brazil; Laboratory of Heart Biophysics, Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Polyana Leal da Silva
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo, Brazil
| | - Julliane V Joviano-Santos
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Investigações NeuroCardíacas, Ciências Médicas de Minas Gerais (LINC CMMG), Belo Horizonte, Minas Gerais, Brazil
| | - Artur Santos-Miranda
- Department of Physiology and Biophysics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Danilo Roman-Campos
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo, Brazil.
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Durço AO, Souza DS, Rhana P, Costa AD, Marques LP, Santos LABO, de Souza Araujo AA, de Aragão Batista MV, Roman-Campos D, Santos MRVD. d-Limonene complexed with cyclodextrin attenuates cardiac arrhythmias in an experimental model of doxorubicin-induced cardiotoxicity: Possible involvement of calcium/calmodulin-dependent protein kinase type II. Toxicol Appl Pharmacol 2023; 474:116609. [PMID: 37392997 DOI: 10.1016/j.taap.2023.116609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Arrhythmias are one manifestation of the cardiotoxicity that results from doxorubicin (Doxo) administration. Although cardiotoxicity is an anticipated outcome in anticancer therapies, there is still a lack of treatment options available for its effective management. This study sought to evaluate the possible cardioprotective effect of complex d-limonene (DL) plus hydroxypropyl-β-cyclodextrin (HβDL) during treatment with Doxo, focusing on the arrhythmic feature. METHODS Cardiotoxicity was induced in Swiss mice with Doxo 20 mg/kg, with 10 mg/kg of HβDL being administered 30 min before the Doxo. Plasma CK-MB and LDH levels were analyzed. Cellular excitability and susceptibility to cardiac and cardiomyocyte arrhythmias were evaluated using in vivo (pharmacological cardiac stress) and in vitro (burst pacing) ECG protocols. Ca2+ dynamics were also investigated. The expression of CaMKII and its activation by phosphorylation and oxidation were evaluated by western blot, and molecular docking was used to analyze the possible interaction between DL and CaMKII. RESULTS Electrocardiograms showed that administration of 10 mg/kg of HβDL prevented Doxo-induced widening of the QRS complex and QT interval. HβDL also prevented cardiomyocyte electrophysiological changes that trigger cellular arrhythmias, such as increases in action potential duration and variability; decreased the occurrence of delayed afterdepolarizations (DADs) and triggered activities (TAs), and reduced the incidence of arrhythmia in vivo. Ca2+ waves and CaMKII overactivation caused by phosphorylation and oxidation were also decreased. In the in silico study, DL showed potential inhibitory interaction with CaMKII. CONCLUSION Our results show that 10 mg/kg of βDL protects the heart against Doxo-induced cardiotoxicity arrhythmias, and that this is probably due to its inhibitory effect on CaMKII hyperactivation.
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Affiliation(s)
- Aimée Obolari Durço
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Diego Santos Souza
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil
| | - Paula Rhana
- Department of Physiology and Membrane Biology, University of California, Davis, USA
| | | | | | | | - Adriano Antunes de Souza Araujo
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil; Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | | | - Danilo Roman-Campos
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil
| | - Marcio Roberto Viana Dos Santos
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil; Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil.
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Wani AK, Akhtar N, Sharma A, El-Zahaby SA. Fighting Carcinogenesis with Plant Metabolites by Weakening Proliferative Signaling and Disabling Replicative Immortality Networks of Rapidly Dividing and Invading Cancerous Cells. Curr Drug Deliv 2023; 20:371-386. [PMID: 35422214 DOI: 10.2174/1567201819666220414085606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cancer, an uncontrolled multistage disease causing swift division of cells, is a leading disease with the highest mortality rate. Cellular heterogeneity, evading growth suppressors, resisting cell death, and replicative immortality drive the tumor progression by resisting the therapeutic action of existing anticancer drugs through a series of intrinsic and extrinsic cellular interactions. The innate cellular mechanisms also regulate the replication process as a fence against proliferative signaling, enabling replicative immortality through telomere dysfunction. AREA COVERED The conventional genotoxic drugs have several off-target and collateral side effects associated with them. Thus, the need for the therapies targeting cyclin-dependent kinases or P13K signaling pathway to expose cancer cells to immune destruction, deactivation of invasion and metastasis, and maintaining cellular energetics is imperative. Compounds with anticancer attributes isolated from plants and rich in alkaloids, terpenes, and polyphenols have proven to be less toxic and highly targetspecific, making them biologically significant. This has opened a gateway for the exploration of more novel plant molecules by signifying their role as anticancer agents in synergy and alone, making them more effective than the existing cytotoxic regimens. EXPERT OPINION In this context, the current review presented recent data on cancer cases around the globe, along with discussing the fundamentals of proliferative signaling and replicative immortality of cancer cells. Recent findings were also highlighted, including antiproliferative and antireplicative action of plant-derived compounds, besides explaining the need for improving drug delivery systems.
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Affiliation(s)
- Atif Khurshid Wani
- Department of Biotechnology, School of Bioengineering and Biosciences, Lovely Professional University, Punjab (144411), India
| | - Nahid Akhtar
- Department of Biotechnology, School of Bioengineering and Biosciences, Lovely Professional University, Punjab (144411), India
| | - Arun Sharma
- Department of Pharmacy, School of Pharmaceutical Sciences, Lovely Professional University, Punjab (144411), India
| | - Sally A El-Zahaby
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
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Rhana P, Barros GM, Santos VCDO, Costa AD, Santos DMD, Fernandes-Braga W, Durço AO, Santos MRV, Roman-Campos D, Vasconcelos CMLD, Cruz JS, Souza DS. S-limonene protects the heart in an experimental model of myocardial infarction induced by isoproterenol: Possible involvement of mitochondrial reactive oxygen species. Eur J Pharmacol 2022; 930:175134. [PMID: 35843301 DOI: 10.1016/j.ejphar.2022.175134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is associated with high mortality rates, despite the fact that there are therapies available. Importantly, excessive oxidative stress may contribute to ischemia/reperfusion injury leading to death related to MI. In this scenario, naturally occurring antioxidant compounds are an important source of possible therapeutic intervention. Thus, this study sought to elucidate the mechanisms of cardioprotection of s-limonene in an isoproterenol-induced MI animal model. METHODS Wistar rats were treated with 1 mg/kg s-limonene (SL) or 100 mg/kg N-acetylcysteine (NAC, positive control) once, 30 min after isoproterenol-induced MI (applied in two doses with a 24 h interval). The protective effects of SL in the heart were examined via the serum level of creatine kinase myocardial band (CK-MB), electrocardiographic profile, infarct size and histological parameters. Using isolated cardiomyocytes, we also assessed calcium transient amplitude, cytosolic and mitochondrial oxidative stress and the expression of proteins related to oxidative stress. RESULTS SL at a concentration of 1 mg/kg attenuated isoproterenol-induced MI injury, by preventing ST-segment elevation and QTc prolongation in the ECG. SL reduced the infarct size and collagen content in cardiac tissue. At the cellular level, SL prevented increased Ca2+, associated with attenuation of cytosolic and mitochondrial oxidative stress. These changes resulted in a reduction of the oxidized form of Ca2+ Calmodulin-Dependent Kinase II (CaMKII) and restored superoxide dismutase and glutathione peroxidase activity. CONCLUSION Our data show that s-limonene promotes cardioprotection against MI injury, probably through inhibition of increased Ca2+ and attenuation of oxidative stress via CaMKII.
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Affiliation(s)
- Paula Rhana
- Department of Physiology and Membrane Biology, University of California Davis, Davis, USA; Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Alexandre Dantas Costa
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Danillo Menezes Dos Santos
- Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil; Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Weslley Fernandes-Braga
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Aimée Obolari Durço
- Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil; Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Márcio Roberto Viana Santos
- Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil; Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Danilo Roman-Campos
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil
| | | | - Jader Santos Cruz
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Diego Santos Souza
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil.
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Marinho YY, P. Silva EA, Oliveira JY, Santos DM, Lima BS, Souza DS, Macedo FN, Santos AC, Araujo AA, Vasconcelos CM, Santos LA, Batista MV, Quintans JS, Quintans-Junior LJ, de Santana-Filho VJ, Barreto AS, Santos MR. Preparation, physicochemical characterization, docking and antiarrhythmic effect of d-limonene and d-limonene hydroxypropyl-β-cyclodextrin complex. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gonçalves MSS, Silva EAP, Santos DM, Santana IR, Souza DS, Araujo AM, Heimfarth L, Vasconcelos CML, Santos VCO, Santos MRV, de S S Barreto R, Quintans Júnior LJ, Barreto AS. Nerolidol attenuates isoproterenol-induced acute myocardial infarction in rats. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:353-363. [PMID: 35050389 DOI: 10.1007/s00210-022-02202-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
Cardiovascular diseases have high morbidity and mortality rates, and their treatment is not effective in reducing the damage caused by myocardial infarction (MI). This study aimed to investigate whether nerolidol (NRD), a sesquiterpene alcohol, could attenuate MI in an isoproterenol-treated rat model. MI was induced by the administration of two doses of isoproterenol (ISO, 100 mg/kg, i.p.) with an interval of 24 h between doses.The animals were divided into four groups: control (CTR) (vehicle - NaCl 0.9% + Tween 80 0.2%), MI (ISO + vehicle), MI + NRD (50 mg/kg) and MI + NRD (100 mg/kg). An electrocardiogram was performed, and contractile parameters, cardiac enzymes, infarction size, and antioxidant parameters in the heart were measured to evaluate the effects of NRD. The ISO group showed a significant rise in ST segment, QTc, and heart rate associated with a reduction in left ventricular developed pressure (LVDP), + dP/dt, and -dP/dt. In addition, there were increases in levels of creatine kinase (CK), creatine kinase-myocardial band (CK-MB), lactate dehydrogenase (LDH), and thiobarbituric acid (TBARS); reductions in superoxide dismutase (SOD) and catalase (CAT) activities; and an increase in the infarction size. Interestingly, NRD significantly attenuated almost all the parameters of ISO-induced MI mentioned above. Our results suggest that nerolidol attenuates MI caused by ISO by a marked reduction in myocardial infarct size and suppression of oxidative stress. CK total, creatine kinase total; CK-MB, creatine kinase myocardial band; LDH, lactate dehydrogenase; SOD, superoxide dismutase; CAT, catalase. CTR (vehicle group), MI (100 mg/kg of isoproterenol), ISO + NRD 50 (50 mg/kg of nerolidol), and ISO + NRD 100 (100 mg/kg of nerolidol).
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Affiliation(s)
- Meire S S Gonçalves
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil.,Biotechnology Graduate Program (PROBIO), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Eric Aian P Silva
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil
| | - Danillo M Santos
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil
| | - Izabel R Santana
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil
| | - Diego S Souza
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil
| | - Andreza M Araujo
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil
| | - Luana Heimfarth
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil
| | - Carla M L Vasconcelos
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil.
| | - Vinícius C O Santos
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil
| | - Márcio R V Santos
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil
| | - Rosana de S S Barreto
- Department of Health Education, Federal University of Sergipe, Marcelo Deda Avenue, Centro, Lagarto, Sergipe, 49400-000, Brazil
| | - Lucindo J Quintans Júnior
- Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, SN, Rosa Elze, São Cristóvão, Sergipe, Brazil
| | - André S Barreto
- Biotechnology Graduate Program (PROBIO), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil. .,Department of Health Education, Federal University of Sergipe, Marcelo Deda Avenue, Centro, Lagarto, Sergipe, 49400-000, Brazil.
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7
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Pereira EWM, Heimfarth L, Santos TK, Passos FRS, Siqueira-Lima P, Scotti L, Scotti MT, Almeida JRGDS, Campos AR, Coutinho HDM, Martin P, Quintans-Júnior LJ, Quintans JSS. Limonene, a citrus monoterpene, non-complexed and complexed with hydroxypropyl-β-cyclodextrin attenuates acute and chronic orofacial nociception in rodents: Evidence for involvement of the PKA and PKC pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 96:153893. [PMID: 35026511 DOI: 10.1016/j.phymed.2021.153893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/05/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Chronic orofacial pain is a serious public health problem with a prevalence of 7-11% in the population. This disorder has different etiologies and characteristics that make pharmacological treatment difficult. Natural products have been shown to be a promising source of treatments for the management of chronic pain, as an example the terpenes. PURPOSE The aim of this study was to evaluate the anti-nociceptive and anti-inflammatory effects of one of these terpenes, d-limonene (LIM - a common monoterpene found in citrus fruits) alone and complexed with hydroxypropyl-β-cyclodextrin (LIM/HPβCD) in preclinical animal models. METHODS Orofacial pain was induced by the administration of hypertonic saline on the corneal surface, the injection of formalin into the temporomandibular joint (TMJ), or chronic constriction injury of the infraorbital nerve (CCI-IoN). The study used male Wistar rats and Swiss mice treated with LIM (50 mg/kg), LIM/HPβCD (50 mg/kg), vehicle (control), gabapentin or morphine, and eyes wiping (induced by hypertonic saline), face rubbing (formalin-induced in TMJ) or mechanical hyperalgesia (provoked by CCI-IoN) were assessed. Additionally, ELISA was used to measure TNF-α, and western blot analysis to assess levels of PKAcα, NFκB, p38MAPK and phosphorylated PKC substrates. Serum levels of aspartate aminotransferase (AST) and alanine transferase (ALT) were also evaluated. RESULTS LIM and LIM/HPβCD significantly reduced (p < 0.001) corneal nociception and formalin-induced TMJ nociception. In addition, both substances attenuated (p < 0.001) mechanical hyperalgesia in the CCI-IoN model. The antinociceptive effect induced by LIM and HPβCD/LIM was associated with decreased TNF-α levels, downregulation of the NFκB and p38MAPK signalling pathways and reduced PKC substrate phosphorylation and PKA immunocontent. Moreover, the results demonstrated that complexation with HPβCD was able to decrease the therapeutic dose of LIM. CONCLUSION LIM was found to be a promising molecule for the treatment of orofacial pain due to its capacity to modulate some important mediators essential to the establishment of pain, and HPβCD can be a key tool to improve the profile of LIM.
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Affiliation(s)
- Erik W M Pereira
- Department of Physiology, Laboratory of Neuroscience and Pharmacological Assays (LANEF), Federal University of Sergipe, São Cristóvão, SE, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil
| | - Luana Heimfarth
- Department of Physiology, Laboratory of Neuroscience and Pharmacological Assays (LANEF), Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Tiffany Kb Santos
- Department of Physiology, Laboratory of Neuroscience and Pharmacological Assays (LANEF), Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Fabiolla R S Passos
- Department of Physiology, Laboratory of Neuroscience and Pharmacological Assays (LANEF), Federal University of Sergipe, São Cristóvão, SE, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil
| | | | | | | | | | - Adriana R Campos
- Experimental Biology Centre (NUBEX). University of Fortaleza, Fortaleza, CE, Brazil
| | | | - Patrick Martin
- Univ Artois, UniLaSalle, Unité Transformations & Agroressources, Béthune, France
| | - Lucindo J Quintans-Júnior
- Department of Physiology, Laboratory of Neuroscience and Pharmacological Assays (LANEF), Federal University of Sergipe, São Cristóvão, SE, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil
| | - Jullyana S S Quintans
- Department of Physiology, Laboratory of Neuroscience and Pharmacological Assays (LANEF), Federal University of Sergipe, São Cristóvão, SE, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil
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Vašková J, De Martino L, Caputo L, De Feo V. Two representatives of lamiaceae essential oils and their main components cause changes in glutathione related enzymatic activities. Nat Prod Res 2022; 36:680-686. [DOI: 10.1080/14786419.2020.1797728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Janka Vašková
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University of Košice, Košice, Slovak Republic
| | - Laura De Martino
- Department of Pharmacy, University of Salerno, Fisciano (Salerno), Italy
| | - Lucia Caputo
- Department of Pharmacy, University of Salerno, Fisciano (Salerno), Italy
| | - Vincenzo De Feo
- Department of Pharmacy, University of Salerno, Fisciano (Salerno), Italy
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Chen D, Wu Y, Chen Y, Chen Q, Ye X, Xu S, Luo S. Exploration of the molecular targets and mechanisms of suxiao xintong dropping pills for myocardial infarction by network pharmacology method. Biosci Rep 2021; 41:BSR20204211. [PMID: 34286341 PMCID: PMC8350434 DOI: 10.1042/bsr20204211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Suxiao Xintong dropping pills (SXXTDP), a traditional Chinese medicine, is widely applied for treating myocardial infarction (MI). However, its therapy mechanisms are still unclear. Therefore, this research is designed to explore the molecular mechanisms of SXXTDP in treating MI. METHODS The active ingredients of SXXTDP and their corresponding genes of the active ingredients were retrieved from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database. MI-related genes were identified via analyzing the expression profiling data (accession number: GSE97320). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed to study the shared genes of drug and disease. Through protein-protein interaction (PPI) network and the Cytoscape plugin cytoHubba, the hub genes were screened out. The compounds and hub targets binding were simulated through molecular docking method. RESULTS We obtained 21 active compounds and 253 corresponding target genes from TCMSP database. 1833 MI-related genes were identified according to P<0.05 and |log2FC| ≥ 0.5. 27 overlapping genes between drug and disease were acquired. GO analysis indicated that overlapping genes were mainly enriched in MAP kinase activity and antioxidant activity. KEGG analysis indicated that overlapping genes were mainly enriched in IL-17 signaling pathway and TNF signaling pathway. We obtained 10 hub genes via cytoHubba plugin. Six of the 10 hub genes, including PTGS2, MAPK14, MMP9, MAPK1, NFKBIA, and CASP8, were acted on molecular docking verification with their corresponding compounds of SXXTDP. CONCLUSION SXXTDP may exert cardioprotection effect through regulating multiple targets and multiple pathways in MI.
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Affiliation(s)
- Daqiu Chen
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping 353000, Fujian Province, China
| | - Yanqing Wu
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping 353000, Fujian Province, China
| | - Yixing Chen
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping 353000, Fujian Province, China
| | - Qiaoxing Chen
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping 353000, Fujian Province, China
| | - Xianhua Ye
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping 353000, Fujian Province, China
| | - Shanghua Xu
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping 353000, Fujian Province, China
| | - Shunxiang Luo
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping 353000, Fujian Province, China
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10
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Silva EAP, Santos DM, de Carvalho FO, Menezes IAC, Barreto AS, Souza DS, Quintans-Júnior LJ, Santos MRV. Monoterpenes and their derivatives as agents for cardiovascular disease management: A systematic review and meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 88:153451. [PMID: 33483251 DOI: 10.1016/j.phymed.2020.153451] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/16/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Monoterpenes are one of the most studied plant's secondary metabolites, they are found abundantly in essential oils of aromatic plants. They also have a great range of pharmacological properties, such as antihypertensive, bradycardic, antiarrhythmic and hypotensive. In the face of the burden caused by cardiovascular disease (CVDs) worldwide, studies using monoterpenes to assess their cardiovascular effects have increased over the years. PURPOSE This systematic review aimed to summarize the use of monoterpenes in animal models of any CVDs. METHODS PubMed, SCOPUS, LILACS and Web of Science databases were used to search for articles that used monoterpenes, in any type of administration, to treat or prevent CVDs in animal models. The PRISMA guidelines were followed. Two independent researchers extracted main characteristics of studies, methods and outcomes. Data obtained were analyzed qualitatively and quantitatively. RESULTS At the ending of the search process, 33 articles were selected for the systematic review. Of these, 17 articles were included in the meta-analysis. A total of 16 different monoterpenes were found for the treatment of hypertension, myocardial infarction, pulmonary hypertension, cardiac hypertrophy and arrhythmia. The main actions include hypotension, bradycardia, vasodilatation, antiarrhythmic, and antioxidant and antiapoptotic properties. From our data, it can be suggested that monoterpenes may be a significant source for new drug development. However, there is still a need to apply these knowledge into clinical research and a long path to pursue before putting them in the market. CONCLUSION The variability of cardiovascular effects demonstrated by the monoterpenes highlighted them as a promising candidates for treatment or prevention of CVDs. Nevertheless, studies that investigate their biological sites of action needs to be further encouraged.
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Affiliation(s)
- Eric Aian P Silva
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Biotechnology Graduate Program - Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil
| | - Danillo M Santos
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Health Sciences Graduate Program, Universidade Federal de Sergipe, Rua Claudio Batista S/N, Sanatorio, Aracaju-SE, 49.060-100, Brazil
| | - Fernanda Oliveira de Carvalho
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Health Sciences Graduate Program, Universidade Federal de Sergipe, Rua Claudio Batista S/N, Sanatorio, Aracaju-SE, 49.060-100, Brazil
| | - Igor A Cortes Menezes
- Hospital de Clínicas, Universidade Federal do Paraná, Rua General Carneiro, 181, Curitiba-PR, 80060-900, Brazil
| | - André S Barreto
- Department of Health Education, Universidade Federal de Sergipe, Av. Governador Marcelo Deda, 13, Centro, Lagarto-SE, CEP 49400-000, Brazil
| | - Diego S Souza
- Department of Anesthesiology, University of Arizona, Tucson, AZ, USA
| | - Lucindo J Quintans-Júnior
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Health Sciences Graduate Program, Universidade Federal de Sergipe, Rua Claudio Batista S/N, Sanatorio, Aracaju-SE, 49.060-100, Brazil
| | - Márcio R V Santos
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Health Sciences Graduate Program, Universidade Federal de Sergipe, Rua Claudio Batista S/N, Sanatorio, Aracaju-SE, 49.060-100, Brazil; Biotechnology Graduate Program - Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil.
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11
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Quintero WL, Moreno EM, Pinto SML, Sanabria SM, Stashenko E, García LT. Immunomodulatory, trypanocide, and antioxidant properties of essential oil fractions of Lippia alba (Verbenaceae). BMC Complement Med Ther 2021; 21:187. [PMID: 34215249 PMCID: PMC8254251 DOI: 10.1186/s12906-021-03347-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Parasite persistence, exacerbated and sustained immune response, and continuous oxidative stress have been described to contribute to the development of the cardiac manifestations in Chronic Chagas Disease. Nevertheless, there are no efficient therapies to resolve the Trypanosoma cruzi infection and prevent the disease progression. Interestingly, trypanocide, antioxidant, and immunodulatory properties have been reported separately for some major terpenes, as citral (neral plus geranial), limonene, and caryophyllene oxide, presents in essential oils (EO) extracted from two chemotypes (Citral and Carvone) of Lippia alba. The aim of this study was to obtain L. alba essential oil fractions enriched with the aforementioned bioactive terpenes and to evaluate the impact of these therapies on trypanocide, oxidative stress, mitochondrial bioenergetics, genotoxicity, and inflammatory markers on T. cruzi-infected macrophages. METHODS T. cruzi-infected J774A.1 macrophage were treated with limonene-enriched (ACT1) and citral/caryophyllene oxide-enriched (ACT2) essential oils fractions derived from Carvone and Citral-L. alba chemotypes, respectively. RESULTS ACT1 (IC50 = 45 ± 1.7 μg/mL) and ACT2 (IC50 = 80 ± 1.9 μg/mL) exhibit similar trypanocidal effects to Benznidazole (BZN) (IC50 = 48 ± 2.5 μg/mL), against amastigotes. Synergistic antiparasitic activity was observed when ACT1 was combined with BZN (∑FIC = 0.52 ± 0.13 μg/mL) or ACT2 (∑FIC = 0.46 ± 1.7 μg/mL). ACT1 also decreased the oxidative stress, mitochondrial metabolism, and genotoxicity of the therapies. The ACT1 + ACT2 and ACT1 + BZN experimental treatments reduced the pro-inflammatory cytokines (IFN-γ, IL-2, and TNF-α) and increased the anti-inflammatory cytokines (IL-4 and IL-10). CONCLUSION Due to its highly trypanocidal and immunomodulatory properties, ACT1 (whether alone or in combination with BZN or ACT2) represents a promising L. alba essential oil fraction for further studies in drug development towards the Chagas disease control.
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Affiliation(s)
- Wendy Lorena Quintero
- Infectious Disease Research Program, Universidad de Santander, Bucaramanga, Santander Colombia 680006
| | - Erika Marcela Moreno
- Infectious Disease Research Program, Universidad de Santander, Bucaramanga, Santander Colombia 680006
| | - Sandra Milena Leal Pinto
- Infectious Disease Research Program, Universidad de Santander, Bucaramanga, Santander Colombia 680006
| | | | - Elena Stashenko
- National Research Center for the Agroindustrialization of Aromatic and Medicinal Tropical Species (CENIVAM), Universidad Industrial de Santander, Bucaramanga, Colombia 680002
| | - Liliana Torcoroma García
- Infectious Disease Research Program, Universidad de Santander, Bucaramanga, Santander Colombia 680006
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12
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Nagoor Meeran M, Seenipandi A, Javed H, Sharma C, Hashiesh HM, Goyal SN, Jha NK, Ojha S. Can limonene be a possible candidate for evaluation as an agent or adjuvant against infection, immunity, and inflammation in COVID-19? Heliyon 2021; 7:e05703. [PMID: 33490659 PMCID: PMC7810623 DOI: 10.1016/j.heliyon.2020.e05703] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 09/16/2020] [Accepted: 12/08/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease (COVID-19) caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an ongoing pandemic and presents a public health emergency. It has affected millions of people and continues to affect more, despite the tremendous social preventive measures. The therapeutic strategy relies on suppressing infectivity and inflammation, along with immune modulation. The identification of candidate drugs effective for COVID-19 is crucial, thus many natural products including phytochemicals are also being proposed for repurposing and evaluated for their potential in COVID-19. Among numerous phytochemicals, limonene (LMN), a dietary terpene of natural origin has been recently showed to target viral proteins in the in-silico studies. LMN is one of the main compounds identified in many citrus plants, available and accessible in diets and well-studied for its therapeutic benefits. Due to dietary nature, relative safety and efficacy along with favorable physicochemical properties, LMN has been suggested to be a fascinating candidate for further investigation in COVID-19. LMN showed to modulate numerous signaling pathways and inhibits inflammatory mediators, including cytokines, chemokines, adhesion molecules, prostanoids, and eicosanoids. We hypothesized that given the pathogenesis of COVID-19 involving infection, inflammation, and immunity, LMN may have potential to limit the severity and progression of the disease owing to its immunomodulatory, anti-inflammatory, and antiviral properties. The present article discusses the possibilities of LMN in SARS-CoV-2 infections based on its immunomodulatory, anti-inflammatory, and antiviral properties. Though, the suggestion on the possible use of LMN in COVID-19 remains inconclusive until the in-silico effects confirmed in the experimental studies and further proof of the concept studies. The candidature of LMN in COVID-19 treatment somewhat appear speculative but cannot be overlooked provided favorable physiochemical and druggable properties. The safety and efficacy of LMN are necessary to be established in preclinical and clinical studies before making suggestions for use in humans.
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Affiliation(s)
- M.F. Nagoor Meeran
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, PO Box - 17666, United Arab Emirates University, Al Ain, United Arab Emirates
| | - A. Seenipandi
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, PO Box - 17666, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hayate Javed
- Department of Anatomy, College of Medicine and Health Sciences, PO Box - 17666, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine and Health Sciences, PO Box - 17666, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hebaallah Mamdouh Hashiesh
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, PO Box - 17666, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sameer N. Goyal
- Shri Vile Parle Kelvani Mandal's Institute of Pharmacy, Dhule 424001, Maharashtra, India
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering & Technology, Sharda University, Knowledge Park III, Greater Noida, Uttar Pradesh 201310, India
| | - Shreesh Ojha
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, PO Box - 17666, United Arab Emirates University, Al Ain, United Arab Emirates
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Santos MMB, Filho LFS, De Souza JB, Filho JERDM, Mesquita TRR, Santos MS, De Vasconcelos CML, Lauton-Santos S, De Oliveira ED. Topical application of (S)-(-)-limonene is as effective as phonophoresis for improving oxidative parameters of injured skeletal muscle in rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2020; 393:2293-2300. [PMID: 32653977 DOI: 10.1007/s00210-020-01941-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
The aim of this study is to investigate the effects of limonene, alone or associated with therapeutic ultrasound, on oxidative stress following skeletal muscle injury. Thirty male Wistar rats were divided into 5 groups: CTR-control, MI-muscle injury without treatment, TPU-therapeutic pulsed ultrasound alone, TPU + LIM-phonophoresis with 5% limonene, and LIM-5% limonene applied topically. Muscle injury was induced by a mechanical abrupt impact over gastrocnemius muscle. The animals were treated in the following intervals: 2, 12, 24, 48, 72, and 96 h after injury. Blood and gastrocnemius samples were collected 98 h after lesion for data analysis. Creatine kinase (CK) and lactate dehydrogenase (LDH) activity, lipid peroxidation (TBARS) levels, catalase (CAT), and superoxide dismutase (SOD) activity were assessed. CK (p = 0.01), SOD activity (p < 0.01), and TBARS levels (p < 0.01) were increased after injury. There was no effect on LDH levels in any group. Phonophoresis (TABRS p < 0.01; SOD p = 0.01), TPU alone (TBARS p < 0.01; SOD p = 0.01), and LIM alone (TBARS p < 0.01; SOD p < 0.01) reduced TBARS levels and SOD activity after muscle injury. There was no change for CAT activity after injury. Only phonophoresis reduced CK activity after injury (p < 0.01). There was no difference between phonophoresis, TPU alone and LIM alone groups for TBARS, SOD, CAT, and LDH. Limonene alone and TPU alone were effective in reducing oxidative stress parameters after skeletal muscle injury. Only phonophoresis decreased CK activity. Skeletal muscle injury increases reactive oxidative species (ROS) levels and muscle proteins activity as creatine kinase (CK) and lactate dehydrogenase (LDH). Five percent limonene, alone or associated with therapeutic pulsed ultrasound, exhibited reduction of CK, superoxide dismutase (SOD) and catalase (CAT) activity, and lipid peroxidation markers (TBARS). Graphical abstract.
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Affiliation(s)
- Marta Maria Barbosa Santos
- Department of Physical Therapy, Center of Biological and Health Sciences, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil
| | - Luís Fernando Sousa Filho
- Department of Physical Therapy, Center of Biological and Health Sciences, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
- Graduate Program in Physical Education, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Jéssica Batista De Souza
- Department of Physical Therapy, Center of Biological and Health Sciences, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil
| | | | - Thássio Ricardo Ribeiro Mesquita
- Department of Physiology, Center of Biological and Health Sciences, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil
| | - Michel Santana Santos
- Department of Physical Therapy, Center of Biological and Health Sciences, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil
| | - Carla Maria Lins De Vasconcelos
- Department of Physiology, Center of Biological and Health Sciences, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil
| | - Sandra Lauton-Santos
- Department of Physiology, Center of Biological and Health Sciences, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil
| | - Evaleide Diniz De Oliveira
- Department of Physical Therapy, Center of Biological and Health Sciences, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil
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Souza DS, Barreto TDO, Menezes-Filho JERD, Heimfarth L, Rhana P, Rabelo TK, Santana MNS, Durço AO, Conceição MRDL, Quintans-Júnior LJ, Guimarães AG, Cruz JS, Vasconcelos CMLD. Myocardial hypertrophy is prevented by farnesol through oxidative stress and ERK1/2 signaling pathways. Eur J Pharmacol 2020; 887:173583. [DOI: 10.1016/j.ejphar.2020.173583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022]
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15
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Antonelli M, Donelli D, Barbieri G, Valussi M, Maggini V, Firenzuoli F. Forest Volatile Organic Compounds and Their Effects on Human Health: A State-of-the-Art Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186506. [PMID: 32906736 PMCID: PMC7559006 DOI: 10.3390/ijerph17186506] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022]
Abstract
The aim of this research work is to analyze the chemistry and diversity of forest VOCs (volatile organic compounds) and to outline their evidence-based effects on health. This research work was designed as a narrative overview of the scientific literature. Inhaling forest VOCs like limonene and pinene can result in useful antioxidant and anti-inflammatory effects on the airways, and the pharmacological activity of some terpenes absorbed through inhalation may be also beneficial to promote brain functions by decreasing mental fatigue, inducing relaxation, and improving cognitive performance and mood. The tree composition can markedly influence the concentration of specific VOCs in the forest air, which also exhibits cyclic diurnal variations. Moreover, beneficial psychological and physiological effects of visiting a forest cannot be solely attributed to VOC inhalation but are due to a global and integrated stimulation of the five senses, induced by all specific characteristics of the natural environment, with the visual component probably playing a fundamental role in the overall effect. Globally, these findings can have useful implications for individual wellbeing, public health, and landscape design. Further clinical and environmental studies are advised, since the majority of the existing evidence is derived from laboratory findings.
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Affiliation(s)
- Michele Antonelli
- Terme di Monticelli, 43022 Monticelli Terme PR, Italy
- Institute of Public Health, University of Parma, 43125 Parma PR, Italy
- Correspondence:
| | - Davide Donelli
- CERFIT, Careggi University Hospital, 50139 Firenze FI, Italy; (D.D.); (V.M.); (F.F.)
- AUSL-IRCCS Reggio Emilia, 42122 Reggio Emilia RE, Italy
| | - Grazia Barbieri
- Binini Partners S.r.l. Engineering and Architecture, 42121 Reggio Emilia RE, Italy;
| | - Marco Valussi
- European Herbal and Traditional Medicine Practitioners Association (EHTPA), Norwich NR3 1HG, UK;
| | - Valentina Maggini
- CERFIT, Careggi University Hospital, 50139 Firenze FI, Italy; (D.D.); (V.M.); (F.F.)
| | - Fabio Firenzuoli
- CERFIT, Careggi University Hospital, 50139 Firenze FI, Italy; (D.D.); (V.M.); (F.F.)
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