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扁桃斑鸠菊及非洲印楝叶的提取物对链脲佐菌素致糖尿病大鼠肝脏形态学及肝毒性标志物的影响(英文)



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DOI:10.3736/jcim20111215
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Akinola OB,Omotoso GO,Akinola OS,Dosumu OO,
Adewoye ET.Effects of combined leaf extract of Vernonia
amygdalina and Azadirachta indica on hepatic morphology
and hepatotoxicity markers in streptozotocin-induced diabetic
rats.J Chin Integr Med.2011;9(12):1373-1379.
Akinola OB,Omotoso GO,Akinola OS,Dosumu OO,
Adewoye ET.扁桃斑鸠菊及非洲印楝叶的提取物对链脲佐
菌素致糖尿病大鼠肝脏形态学及肝毒性标志物的影响.中
西医结合学报.2011;9(12):1373-1379.
Received July 5,2011;accepted September 28,2011;published
online December 15,2011.
Ful-text LinkOut at PubMed.Journal title in PubMed:
Zhong Xi Yi Jie He Xue Bao.
Correspondence:Oluwole Busayo Akinola,PhD;Tel:+234-
7032268248;E-mail:akinolub@unilorin.edu.ng,woleakinola
@yahoo.com
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Original Experimental Research 实验论著
Effects of combined leaf extract of Vernonia amygdalina
and Azadirachta indica on hepatic morphology and
hepatotoxicity markers in streptozotocin-induced diabetic rats
Oluwole Busayo Akinola1,Gabriel Olaiya Omotoso1,Oluwafunmike Sharon Akinola1,Olufunke
Olubusola Dosumu2,Esther Tomi Adewoye1
1.Department of Anatomy,Faculty of Basic Medical Sciences,Colege of Health Sciences,University of
Ilorin,Ilorin,Nigeria
2.Department of Anatomy,Colege of Medicine,University of Lagos,Lagos,Nigeria
Objectives:In this work,we studied liver morphology,markers of hepatic oxidative stress and
some liver enzymes in diabetic rats treated with the combined leaf extract(CLE)of Vernonia
amygdalina(bitter leaf)and Azadirachta indica(neem).
Methods:Diabetes was induced in fasted male Wistar rats with intraperitoneal injection of
streptozotocin(STZ).Oral CLE(500 mg/kg body weight)and metformin(150 mg/kg body
weight)were administered to diferent groups of diabetic rats for eight weeks.Blood glucose
and change in body weight were estimated weekly.Al animals were sacrificed under anaesthesia
after eight weeks.Hepatic sections were stained with periodic acid-Schif.Liver samples were
homogenized and assayed for contents of malondialdehyde(MDA)and glutathione peroxidase
(GPx),while the plasma was assayed for contents of alanine aminotransferase(ALT)and
aspartate aminotransferase(AST).
Results:Metformin and CLE treatment produced normoglycaemia in the diabetic rats in the
course of the treatment period.Significant increases in body weight were observed in the
treatment groups compared with the diabetic control rats(P<0.05).In the control and
treatment groups,light microscopic study showed intact hepatic histology.Plasma ALT and
AST were not significantly diferent from the control values in the CLE-treated rats.In addition,
from week four onwards,blood glucose concentrations in the CLE-treated rats were not
diferent from the normal control(P>0.05).Besides,hepatic MDA(P<0.05)significantly
decreased in the CLE-treated rats compared with the normal control.
Conclusion:These findings suggest that CLE ameliorates hyperglycemia and hepatic oxidative
stress when administered to diabetic rats as a chronic regimen,and there was no morphologic
or biochemical evidence of liver damage at the dose tested.
Keywords:diabetes melitus,experimental;Vernonia;Azadirachta;plant extracts;hepatotoxicity;
oxidative stress;rats
·3731·中西医结合学报2011年12月第9卷第12期 Journal of Chinese Integrative Medicine,December 2011,Vol.9,No.12
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 In diabetes melitus,insulin deficiency and insulin
resistance result in chronic hyperglycemia,with
the risk of microvascular and macrovascular com-
plications that are associated with long-term poorly
controled blood glucose.These diabetes-induced
complications include atherosclerosis,cardiopathy,
nephropathy and retinopathy.
 The liver plays crucial roles in glucose and drug
metabolism.Its cels(hepatocytes,Kupffer cels,
etc.)are constantly exposed to numerous chemical
insults via the gastrointestinal route,with the risk
of hepatic toxicity.Because many complementary
and alternative medicines(CAMs)are taken oraly,
their thorough laboratory and clinical screening is
vital to patients’safety.Savvidou et al[1]reported
hepatic toxicity in patients taking an hypoglycaemic
preparation from Teucriumpolium.The toxicity
led to the discontinuation of the clinical use of
this herbal preparation.Moreover,in animal
studies,Freire et al[2]reported liver toxicity in
mice treated with an antiparasitic preparation
from the extract of Ruta graveolens.
 Similarly,antidiabetic drugs such as phenformin
and troglitazone were withdrawn from the American
markets in 1977 and 2000,respectively.This was
due to their toxic effects on the liver[3].In 2010,
rosiglitazone(Avandia)was also withdrawn from
the American markets because of reported myocardial
infarction in treated patients.These findings
underscore the benefits of standardised screening
of existing and potential conventional and herbal
antidiabetic medications prior to clinical use.
 Presently,data on antidiabetic medicinal plants
are accumulating,and CAMs are receiving unprece-
dented attention as veritable means of disease
management.Previous animal studies in our laboratory
reported the efficacy of Vernonia amygdalina
(bitter leaf)[4]and Azadirachta indica (neem)[5]
as antihyperglycaemic therapies. Similarly,
Ebong et al
[6]reported the hypoglycaemic activity
of the combined leaf extract(CLE)of neem and
bitter leaf in aloxan-induced diabetic rats.Thus,
owing to the prospect of producing potent antidiabetic
remedy from the combined leaf extract of neem
and bitter leaf,additional work on the biosafety
of the CLE is needed.
 In the present study,we reported the effects of
the CLE of neem and bitter leaf on hepatic histology.
We also studied the effects of the extract on some
liver enzymes and oxidative stress markers in a
streptozotocin(STZ)model of diabetic rats.
1 Materials and methods
1.1 Chemicals Al chemicals used were of analytical
grades.STZ,ethanol,citric acid,sodium citrate,
disodium hydrogen phosphate and monosodium
phosphate were procured from Sigma (MO,
USA).Xylene was procured from Carlo Erba
(Milan,Italy),and paraffin wax was from Bio-
Optica(Milan,Italy).Periodic acid and Schiff
reagent were from Sigma(MO,USA).Reagents
for Bouin’s fluid(picric acid,formaldehyde and
glacial acetic acid)were from Carlo Erba(Milan,
Italy).Al other chemicals used were either supplied
with the assay kits or procured localy,and they
were of analytical grades.
1.2 Plant materials  Mature fresh leaves of
neem(Azadirachta indica)were colected in the
premises of the University of Ilorin(Mini Campus),
Nigeria.Mature fresh leaves of bitter leaf(Vernonia
amygdalina)were obtained from a botanical garden
in Ilorin,Nigeria.Both plants were colected in
October 2009,and were authenticated at the
herbarium of the University of Ilorin,where they
were compared to the herbarium specimens(voucher
numbers:neem(542);bitter leaf(10)).
 The leaves were separately shade-dried and
pulverized.Ethanolic extraction was done for
each dry leaf material using 70% ethanol(in a
percolator)at room temperature (23 ℃).The
extracts were evaporated to dryness in a water
bath at 45 ℃.A compound herbal extract was
thereafter prepared at a weight ratio of 5∶4
(neem∶bitter leaf).This ratio of the combined
neem and bitter leaf extract was selected because
it is within the range reported to produce normo-
·4731· 中西医结合学报2011年12月第9卷第12期 Journal of Chinese Integrative Medicine,December 2011,Vol.9,No.12
glycaemia in experimental diabetic Wistar rats[6].
1.3 Experimental animals  Male Wistar rats
(eight weeks old)were randomly assigned to one
of the folowing treatment groups:normal control
group,STZ diabetic control group,STZ plus
CLE group,STZ plus metformin group,and CLE
group.Each group consisted of eight animals.
Fasted rats were induced to hyperglycemia with
intraperitoneal injection of STZ (70 mg/kg body
weight),in sodium citrate buffer(0.1 mol/L,pH
4.5).Animals with fasting blood glucose 250 mg/dL
or more(96 h after STZ induction)were included
in the study.CLE was administered oraly at
500 mg/kg body weight per day
[6],while oral
metformin was administered at 150 mg/kg body
weight per day[7].Al rats were treated for eight
weeks.Animals were exposed to a 12-hour light/dark
photocycle.They were maintained on peletized
rat feed(Bendel Feed,Nigeria).Food and water
were served ad libitum.
1.4 Estimation of blood glucose and body weight 
Starting at day 0,blood glucose was estimated
weekly by the glucose oxidase method using the
One-Touch glucometer (Lifescan,CA,USA).
Besides,in each group,change in body weight of
the rats was estimated as folows:change in body
weight=(final body weight—initial body weight)×
100%/(initial body weight).
1.5 Termination of treatment After the last
dose of CLE or metformin,al animals were fasted
for 12 h and then placed under anaesthesia(diethyl
ether,Sigma,USA).Laparatomy was performed
and blood was colected from the inferior vena
cava into heparinised tubes.Blood was centrifuged
at 8 000×g.
 Liver samples were fixed in chiled Bouin’s fluid,
embedded in paraffin wax,and sectioned at 4μm
using a rotary microtome(Cambridge Instruments,
Germany).Liver sections were then stained by
the periodic acid-Schiff(PAS)method,as described
by Bancroft and Stevens
[8].Moreover,10%liver
homogenate was prepared from fresh liver tissue
samples using phosphate buffer(0.1 mol/L,pH7.4)
as the homogenizing buffer.
1.6 Estimation of plasma alanine aminotransferase
and aspartate aminotransferase Plasma alanine
aminotransferase (ALT)and aspartate amin-
otransferase(AST)were estimated by colourimetry.
ALT and AST levels were estimated by the method
of Reitman and Franke[9],using kits from Fortress
Diagnostics(Antrim,UK).Assessment of enzyme
levels was done as indicated in the kit manuals.
1.7 Estimation of malondialdehyde and glutathione
peroxidase  Hepatic malondialdehyde (MDA)
was estimated by the thiobarbituric acid test
[10].
Hepatic glutathione peroxidase(GPx)was esti-
mated by the method of Paglia and Valentine
[11]
using a kit from Randox Laboratories(Antrim,
UK).Total liver protein was determined by the
biuret method[12]using a kit from Randox Laboratories
(Antrim,UK).
1.8 Statistical analysis Data were presented as
mean±standard error of mean and analysed by
one-way analysis of variance,folowed by the
Waler-Duncan post-hoc test.Statistical signifi-
cance was accepted at P<0.05.
2 Results
2.1 Blood glucose and body weights Figure 1
shows the mean blood glucose concentrations of
each group of rats.Blood glucose in the untreated
diabetic group remained significantly higher than
the normal control group(P<0.05).Meanwhile,
metformin and CLE treatment produced normo-
glycaemia in the diabetic rats in the course of the
treatment period.The difference in body weight
of the rats was estimated and expressed as the
percentage change in body weight,as shown in
Figure 2.Significant increases were observed in
the treatment groups compared with the diabetic
control rats.
·5731·中西医结合学报2011年12月第9卷第12期 Journal of Chinese Integrative Medicine,December 2011,Vol.9,No.12
2.2 Plasma ALT and AST and hepatic MDA and
GPx levels As shown in Table 1,after 8 weeks,
metformin-treated diabetic rats had the higher
levels of plasma ALT and AST than the normal
control(P<0.05);hepatic MDA was not signifi-
cantly different from the normal control values in
al the treatment groups except the CLE-treated
rats,where significant decreases occurred(P<
0.05);hepatic GPx activity was higher in the
metformin-treated rats than that in the normal
control(P<0.05).
2.3 Hepatic histology Figure 3 shows the histologic
findings of PAS-stained liver sections.Hepatic
sections of the control and treatment groups were
PAS-negative.There were no striking differences
in the hepatic morphology of these groups after
8 weeks of treatment.Liver sections did not show
any necrotic changes,and inflammatory cels
were not observable.Hepatocytes retained their
cord-like organization,and adjoining cords of
hepatocytes were separated by intact sinusoids.
Table 1 Effects of treatment with CLE and metformin on liver enzymes and oxidative stress markers in STZ diabetic rats
(mean±SEM)
Group  n  Plasma ALT(IU/L)Plasma AST(IU/L) Hepatic MDA(μmol/mg protein) Hepatic GPx(U/mg protein)
Normal control  8  36.3±5.1  68.1±6.2  1 650±150  1.20±0.15
Diabetic control  8  37.0±3.2  88.3±7.1* 1 410±132  1.22±0.30
STZ plus metformin  8  45.2±4.8* 89.8±6.5* 1 305±98  1.60±0.41*
STZ plus CLE  8  28.6±3.1  30.1±2.8△  903±69*△ 0.62±0.05
CLE control  8  25.1±5.5  30.1±3.1△ 1 906±161△ 1.50±0.35*
  *P<0.05,vs normal control group;△P<0.05,vs diabetic control group.SEM:standard error of mean;STZ:streptozotocin;CLE:
combined leaf extract of Vernonia amygdalina and Azadirachta indica;ALT:alanine aminotransferase;AST:aspartate aminotransferase;
MDA:malondialdehyde;GPx:glutathione peroxidase.
Figure 3 Hepatic histology after eight weeks of treatment(Light microscopy,×400)
A:Normal control;B:Diabetic control;C:STZ plus CLE;D:STZ plus metformin;E:CLE alone.In each of the groups,hepatic sections are
periodic acid-Schiff-negative;besides,no notable differences exist in hepatic morphology of the control and treated rats.Thick white arrows
point to the Kupffer cels;thick black arrows point to the sinusoid;thin arrows point to the hepatocyte nucleus;C means the central vein.
STZ:streptozotocin;CLE:combined leaf extract of Vernonia amygdalina and Azadirachta indica.
3 Discussion
 In the present work,we studied the effects of
the CLE of neem and bitter leaf on blood glucose,
hepatic histology,liver enzymes and oxidative
stress markers in STZ-induced diabetic Wistar
rats.CLE ameliorated STZ-induced hyperglycemia
in the treated diabetic rats beginning at week4 of
treatment,when blood glucose levels of the CLE-
treated rats were not significantly different from
the control values.The work of Ebong et al
[6]
showed that oral treatment of aloxan-induced
hyperglycemic rats with CLE of neem and bitter
leaf(500 mg/kg body weight per day)resulted in
significant reduction in blood glucose at the end
of the 24-day treatment period.Meanwhile,in
the present study,hyperglycemia persisted in the
CLE-treated rats until the 4th week(28 d),when
normoglycaemia was established.This is also in
spite of the higher dose of CLE used in the present
study(500 mg/kg body weight).Earlier studies in
our laboratory showed that oral ethanolic leaf
extract of neem produced normoglycaemia as
early as week 1 of treatment when administered
·6731· 中西医结合学报2011年12月第9卷第12期 Journal of Chinese Integrative Medicine,December 2011,Vol.9,No.12
to STZ-induced diabetic rats at 500 mg/kg body
weight[5].Similarly,the work of Akinola et al[4]
showed that oral treatment of STZ-induced hy-
perglycaemic rats with ethanolic leaf extract of
bitter leaf(400 mg/kg body weight)ameliorated
hyperglycemia after 21 d of treatment.Moreover,
Osinubi et al[13]reported amelioration of hyper-
glycemia in an acute study of aloxan-induced
hyperglycemia in Sprague-Dawley rats treated
oraly with aqueous leaf extract of bitter leaf
(500 mg/kg body weight).Normoglycaemia was
established in this treated group 12 h after bitter
leaf dosing.These studies showed that the leaf
extracts of neem and bitter leaf possess antidia-
betic property when used separately.However,
their combined regimen as used in the present
study produced normoglycaemia in the treated
rats later than the separate leaf extracts.This
suggests that CLE does not have a remarkable
advantage on hyperglycemia in STZ-induced
diabetic rats,when compared with the individual
extract of neem and bitter leaf respectively.
 Moreover,in the control and treatment groups,
PAS-stained paraffin sections of the liver showed
normal morphology.This finding suggests that
CLE and metformin did not produce any morpho-
logic damage to the liver during the 8-week treat-
ment period.Although many herbal medications
are safe and are not hepatotoxic,a few animal
and human studies reported hepatic toxicity asso-
ciated with the ingestion of certain phytomedi-
cines.A study by Fu et al
[14]in rats showed that
Piper methysticum Forst(kava)produced severe
vascular and endothelial damage in the liver of
the exposed rats.In human studies,isolated cases
of phytotherapy-induced liver injury have been
reported.Hepatotoxicity of hydroxycut and herbalife,
which are weight-loss herbal supplements,was
reported by Chen et al
[15].Similarly,elevated liver
enzymes and hepatobiliary injury were reported in
apatient on a weight-loss medication containing
materials fromLycopodium serratumand Chelidonium
majus[16].These animal and human reports validate
the need for thorough screening of herbal medica-
tions,to forestal hepatic and other organ injuries.In
addition,several conventional drugs are also known
hepatotoxins.A recent review by Chau
[17]explicitly
summarized these conventional hepatotoxic drugs.
 In the control and CLE-treated diabetic rats,
serological analysis showed that plasma AST and
ALT were not significantly different.In contrast,
plasma levels of these liver enzymes(ALT and
AST)were significantly higher in the metformin-
treated rats compared with the control.These
suggest deleterious effect of oral metformin in
these rats at a dose of 150 mg/kg body weight.
This relatively high dose of metformin is within
the range reported to be the effective dose for
reversing hyperglycemia in diabetic rats
[18].
Meanwhile,this dose(150 mg/kg)is much higher
than the human metformin dose range for type 2
diabetes and does not suggest toxicity of this drug
at the human dose range.
 However,a few studies reported the adverse
effects of oral metformin in diabetic patients.
Olivera-Gonzlez et al[19]reported severe liver
injury in a diabetic patient on oral metformin
therapy.Besides,one of the most commonly
reported side effects of oral metformin is lactic
acidosis[20].This suggests that oral metformin
does have potential adverse effects on the meta-
bolic functions of the liver.Metformin reportedly
precipitates lactic acidosis possibly by impairing
gluconeogenesis[21].Moreover,biguanide therapy
decreases the activity of pyruvate dehydrogenase
and the transport of mitochondrial reducing agents;
and these properties enhance anaerobic metabolism[22].
Thus,increased conversion of pyruvate to lactate
is associated with biguanide use,resulting in
increased lactic acid production,and lactic acidosis.
Results from the present and previous studies
therefore suggest that metformin doses should be
as low as possible.
 We also studied certain markers of oxidative
stress in the control and treated rats.Oxidative
stress is a confounding factor in diabetes,and it
may account for the pathogenesis of some diabetic
complications[23].In the CLE-treated diabetic
group,hepatic MDA levels were significantly
lower than those of the normal control group
(P<0.05),but there was no significant difference
in the hepatic levels of GPx between the CLE
group and the normal control group.These findings
suggest the absence of hepatic oxidative stress in
the CLE-treated rats.Earlier work in our laboratory
showed that oral treatment of diabetic rats with
the leaf extract of neem alone was associated with
exacerbation of hepatic oxidative stress[5].Thus,
with respect to its effects on hepatic oxidative stress,
CLE had better antioxidant protection on the liver
compared with the use of neem leaf extract alone.
 Furthermore,body weights of the treatment
groups were not significantly different from the
control group at the end of the treatment period.
In the untreated diabetic rats,significant reduction
(P<0.05)in body weight occurred compared
with the normal control rats.The lack of signifi-
cant difference between the body weights of rats
in the CLE-treated group and the normal control
group suggests improved disease(diabetes)man-
agement in the treated animals.
 The present study shows that CLE ameliorates
hyperglycemia and hepatic oxidative stress when
administered to diabetic rats as a chronic regimen,
and there is no morphologic or biochemical evidence
of liver damage at the dose tested.
4 Competing interests
 The authors declare that they have no competing
interests.
·7731·中西医结合学报2011年12月第9卷第12期 Journal of Chinese Integrative Medicine,December 2011,Vol.9,No.12
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·8731· 中西医结合学报2011年12月第9卷第12期 Journal of Chinese Integrative Medicine,December 2011,Vol.9,No.12
扁桃斑鸠菊及非洲印楝叶的提取物对链脲佐菌素
致糖尿病大鼠肝脏形态学及肝毒性标志物的影响
Oluwole Busayo Akinola1,Gabriel Olaiya Omotoso1,Oluwafunmike Sharon Akinola1,Olufunke Olubusola
Dosumu2,Esther Tomi Adewoye1
1.Department of Anatomy,Faculty of Basic Medical Sciences,Colege of Health Sciences,University of Ilorin,Ilorin,Nigeria
2.Department of Anatomy,Colege of Medicine,University of Lagos,Lagos,Nigeria
目的:研究扁桃斑鸠菊及非洲印楝叶的提取物对链脲佐菌素致糖尿病大鼠肝脏形态学、肝脏氧化性应激标
志物及部分肝脏酶类的影响。
方法:大鼠腹腔注射链脲佐菌素致糖尿病。不同治疗组大鼠分别口服扁桃斑鸠菊及非洲印楝叶的提取物
(500mg/kg)或二甲双胍(150mg/kg),疗程8周,每周测量大鼠的血糖水平及体质量变化。8周后麻醉处
死大鼠。取肝组织制成切片,希夫染色法染色,并测量肝匀浆中丙二醛和谷胱甘肽过氧化物酶的含量;下腔
静脉采血,分离血浆,检测血浆中丙氨酸氨基转移酶和天冬氨酸氨基转移酶的活性。
结果:二甲双胍及植物提取物均能显著改善糖尿病大鼠的血糖水平,且与糖尿病模型组相比,治疗组的体质
量明显增加(P<0.05)。光学显微镜下,各组大鼠的肝脏形态学无明显差别。植物提取物治疗组大鼠的血
浆丙氨酸氨基转移酶及天冬氨酸氨基转移酶的活性与正常对照组相比无明显变化(P>0.05),而丙二醛含
量明显下降(P<0.05)。
结论:扁桃斑鸠菊及非洲印楝叶的提取物对糖尿病大鼠有明显的降糖作用,而肝脏形态学及肝毒性标志物
没有明显变化。
关键词:糖尿病,实验性;斑鸠菊属;印楝属;植物提取物;肝脏毒性;氧化性应激;大鼠
·9731·中西医结合学报2011年12月第9卷第12期 Journal of Chinese Integrative Medicine,December 2011,Vol.9,No.12