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Contents lists available at ScienceDirect Journal of Ethnopharmacology journal homepage: www.elsevier.com/locate/jep Phyllanthus niruri leaves aqueous extract improves kidney functions, ameliorates kidney oxidative stress, inammation, brosis and apoptosis and enhances kidney cell proliferation in adult male rats with diabetes mellitus Nelli Giribabu a, , Kamarulzaman Karim a , Eswar Kumar Kilari b , Naguib Salleh a, a Dept of Physiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia b Pharmacology Division, A.U. College of Pharmaceutical Sciences, Andhra University, Visakhapatnam 530003, Andhra Pradesh, India ARTICLE INFO Keywords: Phylanthus niruri Renal function Renal oxidative stress Inammation Fibrosis Apoptosis Proliferation ABSTRACT Ethnopharmacological relevance: Phylanthus niruri has been used to treat ailments related to the urogenital organs. In this study, this herb was hypothesized to help to ameliorate kidney disease in diabetes mellitus (DM). Aims: To investigate P. niruri leaves aqueous extract (PN) eects on kidney functions, histopathological changes and levels of oxidative stress, inammation, brosis, apoptosis and proliferation in DM. Methods: PN was orally administered to streptozotocin-nicotinamide-induced male diabetic rats for 28 days. At the end of the treatment, fasting blood glucose (FBG) and kidney functions were measured. Kidney somatic index, histopathological changes and levels of RAGE, Nrf2, oxidative stress markers (TBARS, SOD, CAT and GPx), inammatory markers (NFkβ-p65, Ikk-β, TNF-α, IL-1β and IL-6), apoptosis markers (caspase-3, caspase- 9 and Bax), brosis markers (TGF-β1, VEGF and FGF-1) and proliferative markers (PCNA and Ki-67) were determined by biochemical assays, qPCR, Western blotting, immunohistochemistry or immunouorescence. Results: Administration of PN helps to maintain near normal FBG, creatinine clearance (CCr), blood urea nitrogen (BUN), BUN/Cr ratio, serum electrolytes, uric acid and urine protein levels in DM. Decreased RAGE, TBARS and increased Nrf2, SOD-1, CAT and GPx-1 were observed in PN-treated diabetic rat kidneys. Expression of inammatory, brosis and apoptosis markers in the kidney reduced but expression of proliferative markers increased following PN treatment. Lesser histopathological changes were observed in the kidney of PN-treated diabetic rats. Conclusion: PN helps to preserve near normal kidney function and prevents histopathological changes via ameliorating oxidative stress, inammation, brosis and apoptosis while enhancing proliferation of the kidney in DM. 1. Introduction Diabetic nephropathy (DN) is one of the serious complications of DM (Tziomalos and Athyros, 2015). In DN, kidney damage is histologically characterized by thickening of the glomerular basement membrane, mesangial matrix expansion, macrophage inltration, loss of podocytes and degeneration of tubular epithelium (Roshan and Stanton, 2013). Recently, attention has been given to oxidative stress as the main factor contributing to DN (Arora and Singh, 2014). Both increased in the production of pro-oxidants and decreased in the action of antioxidants have been reported to be involved in the pathogenesis of DN (Bondeva and Wolf, 2014). In DM, hyperglycemia was reported to trigger oxidative stress, inammation, brosis and apoptosis in the kidney (Xu et al., 2005). Hyperglycemia was also found to enhance formation of advanced glycation end (AGE) and its receptor, RAGE (Singh et al., 2014). In DN, glomerular damage results in protein leakage into the urine which is associated with elevation of blood urea and creatinine levels. Progression of DN ultimately results in end-stage renal failure (ESRF) (Hadjadj et al., 2016). Phyllanthus niruri is herb belonging to Euphorbiaceae family and is widely used in traditional medicine among the people of the South and Southeast Asia. This plant has been used in the treatment of bronchitis, anemia, leprosy and asthma (Karuna et al., 2009). P. niruri has also been used in Chinese traditional medicine to treat liver injury (Wang, 2000). This herb is found to display hepatoprotective, hypoli- pidaemic, anti-inammatory and antihyperuricaemic eects (Lee et al., http://dx.doi.org/10.1016/j.jep.2017.05.002 Received 25 September 2016; Received in revised form 1 May 2017; Accepted 2 May 2017 Corresponding authors. E-mail addresses: [email protected] (N. Giribabu), [email protected] (N. Salleh). Journal of Ethnopharmacology 205 (2017) 123–137 Available online 05 May 2017 0378-8741/ © 2017 Elsevier B.V. All rights reserved. MARK

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Page 1: Journal of Ethnopharmacology - Nutramedixpdfs.nutramedix.ec/Chanca Piedra Kidney Function... · 2019-09-20 · Journal of Ethnopharmacology journal homepage: ... used in the treatment

Contents lists available at ScienceDirect

Journal of Ethnopharmacology

journal homepage: www.elsevier.com/locate/jep

Phyllanthus niruri leaves aqueous extract improves kidney functions,ameliorates kidney oxidative stress, inflammation, fibrosis and apoptosisand enhances kidney cell proliferation in adult male rats with diabetesmellitus

Nelli Giribabua,⁎, Kamarulzaman Karima, Eswar Kumar Kilarib, Naguib Salleha,⁎

a Dept of Physiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysiab Pharmacology Division, A.U. College of Pharmaceutical Sciences, Andhra University, Visakhapatnam 530003, Andhra Pradesh, India

A R T I C L E I N F O

Keywords:Phylanthus niruriRenal functionRenal oxidative stressInflammationFibrosisApoptosisProliferation

A B S T R A C T

Ethnopharmacological relevance: Phylanthus niruri has been used to treat ailments related to the urogenitalorgans. In this study, this herb was hypothesized to help to ameliorate kidney disease in diabetes mellitus (DM).Aims: To investigate P. niruri leaves aqueous extract (PN) effects on kidney functions, histopathologicalchanges and levels of oxidative stress, inflammation, fibrosis, apoptosis and proliferation in DM.Methods: PN was orally administered to streptozotocin-nicotinamide-induced male diabetic rats for 28 days. Atthe end of the treatment, fasting blood glucose (FBG) and kidney functions were measured. Kidney somaticindex, histopathological changes and levels of RAGE, Nrf2, oxidative stress markers (TBARS, SOD, CAT andGPx), inflammatory markers (NFkβ-p65, Ikk-β, TNF-α, IL-1β and IL-6), apoptosis markers (caspase-3, caspase-9 and Bax), fibrosis markers (TGF-β1, VEGF and FGF-1) and proliferative markers (PCNA and Ki-67) weredetermined by biochemical assays, qPCR, Western blotting, immunohistochemistry or immunofluorescence.Results: Administration of PN helps to maintain near normal FBG, creatinine clearance (CCr), blood ureanitrogen (BUN), BUN/Cr ratio, serum electrolytes, uric acid and urine protein levels in DM. Decreased RAGE,TBARS and increased Nrf2, SOD-1, CAT and GPx-1 were observed in PN-treated diabetic rat kidneys.Expression of inflammatory, fibrosis and apoptosis markers in the kidney reduced but expression ofproliferative markers increased following PN treatment. Lesser histopathological changes were observed inthe kidney of PN-treated diabetic rats.Conclusion: PN helps to preserve near normal kidney function and prevents histopathological changes viaameliorating oxidative stress, inflammation, fibrosis and apoptosis while enhancing proliferation of the kidneyin DM.

1. Introduction

Diabetic nephropathy (DN) is one of the serious complications ofDM (Tziomalos and Athyros, 2015). In DN, kidney damage ishistologically characterized by thickening of the glomerular basementmembrane, mesangial matrix expansion, macrophage infiltration, lossof podocytes and degeneration of tubular epithelium (Roshan andStanton, 2013). Recently, attention has been given to oxidative stressas the main factor contributing to DN (Arora and Singh, 2014). Bothincreased in the production of pro-oxidants and decreased in the actionof antioxidants have been reported to be involved in the pathogenesisof DN (Bondeva and Wolf, 2014). In DM, hyperglycemia was reportedto trigger oxidative stress, inflammation, fibrosis and apoptosis in the

kidney (Xu et al., 2005). Hyperglycemia was also found to enhanceformation of advanced glycation end (AGE) and its receptor, RAGE(Singh et al., 2014). In DN, glomerular damage results in proteinleakage into the urine which is associated with elevation of blood ureaand creatinine levels. Progression of DN ultimately results in end-stagerenal failure (ESRF) (Hadjadj et al., 2016).

Phyllanthus niruri is herb belonging to Euphorbiaceae family andis widely used in traditional medicine among the people of the Southand Southeast Asia. This plant has been used in the treatment ofbronchitis, anemia, leprosy and asthma (Karuna et al., 2009). P. nirurihas also been used in Chinese traditional medicine to treat liver injury(Wang, 2000). This herb is found to display hepatoprotective, hypoli-pidaemic, anti-inflammatory and antihyperuricaemic effects (Lee et al.,

http://dx.doi.org/10.1016/j.jep.2017.05.002Received 25 September 2016; Received in revised form 1 May 2017; Accepted 2 May 2017

⁎ Corresponding authors.E-mail addresses: [email protected] (N. Giribabu), [email protected] (N. Salleh).

Journal of Ethnopharmacology 205 (2017) 123–137

Available online 05 May 20170378-8741/ © 2017 Elsevier B.V. All rights reserved.

MARK

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2016). Recently, P. niruri has been found to exhibit anti-diabeticeffects (Mediani et al., 2016). It is found to possess antioxidantactivities in-vivo and in-vitro (Giribabu et al., 2014). P. niruri is widelyused in the treatment of urinary tract calculi in different parts of theworld. In Brazil, this plant is known as ‘Chanca Piedra’ or ‘stonebreaker’ and is considered as a remedy for renal and ureteric calculi(Calixto et al., 1998). In Indian Ayurvedic medicine, P. niruri is used totreat renal calculi (Narendra et al., 2012). In Malaysia, P. niruri, locallyknown as ‘dukong anak’ is used to treat kidney disorders includingkidney and ureteric calculi (Burkill et al., 1966). Evidences indicatethat this plant protects the kidney against stone formation via inhibit-ing growth of urate crystals (Freitas et al., 2002). Besides, P. niruri isalso found able to modify composition of kidney stone (Barros et al.,2003) via making it more fragile and easily dissolved (Barros et al.,2006). P. niruri is also reported able to induce urethral relaxation aswell as reduces excretion of cystalization promoter such as calcium inthe urine (Boim et al., 2010). This herb is also proven to be effective inthe treatment of hemorrhagic cystitis (Boeira et al., 2011).

Despite of this herb being used in the treatment of stone-relatedurinary tract disorders, currently there is lack of evidence on its role inameliorating kidney disease in DM. The notion that P. niruri could helpto reduce DN progression was supported by an observation that otherPhylanthus species i.e. P. amarus was found to protect the kidneysagainst damage due to acetaminophen-induced toxicity in rats(Adeneye and Benebo, 2008b). Therefore, in this study, it washypothesized that PN was able to protect the kidney against DM-induced nephropathy. This study was aimed to investigate effects of PNon kidney function, kidney histopathological changes and kidneyoxidative, inflammatory, fibrosis and apoptosis in DM. Ability of PNto induce kidney cell proliferation in DM was also identified. The leaveswas used in view that it is the part of the plant that is most commonlyconsumed for cooking, as a decoction and as a mixture with beveragesexample tea (Bagalkotkar et al., 2006; Lee et al., 2016).

2. Materials and methods

2.1. Plant and extraction

The fresh leaves of P. niruri were collected from Visakhapatnam,Andhra Pradesh, India. Taxonomic identification was made by botanistand the plant was deposited in a herbarium. The leaves were washedunder running tap water and air dried under shade. Dried leaves(800 g) were steeped in cold sterile distilled water (1 L) for three daysand aqueous extract was filtrated by using No. 1 Whatmann Milliporefilter paper (0.45 µm Ref HAWP04700, Bedford, MA, USA). Theextract was lyophilized by using a freeze-drying system (Telstar,Barcelona, Spain), yielding 4.46% (w/w) freeze-dried material, whichwas stored in a cool, dry place until use.

2.2. GC-MS

Identification of the bioactive compounds in PN was performed byusing a Trace GC ultra-gas chromatograph, coupled to Quantum XLSmass spectrometer (Thermo Scientific, FL, USA). Compounds wereseparated by using TG-5MS capillary column (5% phenyl and 95%methyl polysiloxane, 30 m×0.25 mm i.d. ×0.25 µm film thickness). 1 µlPN was injected into CT splitless mode at injector temperature of260 °C. GC oven temperature was set at 110 °C, increased by 10 °C/min to 200 °C, then 5 °C/min to 280 °C, ending with 9 min isothermal,at 280 °C. Carrier gas (Helium) flow was at 1 ml/min. Mass spectrawere taken at 70 eV; a scan interval of 0.5 s and fragments from 45 to450 Da. The solvent delay was 0–2 min and total GC-MS running timewas 48 min. Identification was done by comparing the mass spectrawith NIST library. The name, molecular weight and structure of thecomponents in the tested materials were then identified.

2.3. Animals

Healthy adult male Wistar rats weighing 180–220 g were procuredfrom National Institute of Nutrition, Hyderabad, India. Animals weremaintained at room temperature of 25 ± 2 °C, 12/12 h light/dark cycle.Animals were given standard commercial rat chow diet (GodrejAgrovet, Mumbai, India) and tap water ad libitum. Experimentalprocedures were in accordance with ARRIVE guidelines (Animals inResearch: Reporting In-Vivo Experiments) and European CommunityGuidelines/ EEC Directive, 1986. All experimental protocols wereapproved by Institutional Animal Care and Use Committee, AndhraUniversity, with ethics number: AU-IAEC/12/2016/009. Acute toxicitystudy was conducted according to Organization For EconomicCooperation and Development (OECD) revised up-and-down proce-dure for acute toxicity testing (OECD 425) (OECD, 2001). No signs oftoxicity were observed in the tested animals up to dose of 2000 mg/kg/day.

2.4. Induction of DM in experimental animals

After 12 h of fasting, animals were given single injection ofnicotinamide (NA) (dissolved in normal saline), intraperitoneally(i.p), at dose of 110 mg/kg. 15 min later, streptozotocin (STZ)(Sigma, St. Louis, MO) at 55 mg/kg (in 0.1 M sodium citrate buffer,pH 4.5) was also injected i.p. (Giribabu et al., 2016). STZ-NA injectedanimals were given 5% glucose for 24 h to prevent drug-inducedhypoglycemia. Control rats were injected with similar volume of citratebuffer. After 72 h, animals with FBG levels above 300 mg/dl werechosen for the experiment. Treatment was commenced on the fourthday after STZ-NA injection which was considered as day 1. PN wasadministered at a dose of 200 and 400 mg/kg/day orally in a form ofsuspension in 1% sodium carboxy methyl cellulose (Na-CMC) indistilled water by using oral gavage tube daily for 28 days. The dosageselection of PN was based on the previous reported doses (Adeneye andBenebo, 2008a; Giribabu et al., 2014; Okoli et al., 2010).

2.5. Experimental Designs

Experimental animals were divided into five (5) groups, each groupconsist of six rats, as below:

Group I: (NC) Normal control rats - receiving 1% Na-CMC vehicleonly.

Group II: (D) Diabetic control rats- receiving 1% Na-CMC vehicleonly.

Group III- (D+200PN) Diabetic rats treated with P. niruri leavesaqueous extract at 200 mg/kg body weight.

Group IV- (D+400PN) Diabetic rats treated with P. niruri leavesaqueous extract at 400 mg/kg body weight.

Group V- (G) Diabetic rats treated with glibenclamide (standard) at600 µg/kg body weight (Adam et al., 2016b).

2.6. Assessment of body weight and FBG levels

Body weight at day 0 and day 28th. was determined by using a digitalweight balance (Sartorius Balance, AX224, Fisher-Scientific, UK). At theend of the experimental period (day 28), animals were placed individuallyin metabolic cages for 12 h. Urine was collected to measure biochemicalparameters. Then blood was collected from retro-orbital plexus and FBGlevels were measured by using a semi-auto analyzer (Screen Master 3000,Tulip, Goa, India). Measurement was based on glucose oxidase (GOD) andperoxidase (POD) methods, using commercially available kits (Spandiagnostic Ltd., Surat, India). At the end of the treatment, rats wereanaesthetized by i.p. injection of pentobarbitone sodium (60 mg/kg) andsacrificed by cervical dislocation. Kidneys were dissected out immediatelyand weighted on an electronic balance. Tissue somatic index was deter-mined by using this formula:

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Weight of kidney in grams/weight of body in grams x 100.Blood was collected via direct heart puncture, directly into cen-

trifuge tubes and serum was separated via centrifugation (ThermoScientific, Model 75005286, USA), at 2000×g for 15 min. Serum wasused for biochemical analyses or stored at −80 °C for future use.

2.7. Estimation of creatinine (Cr) clearance

Estimation of serum and urine Cr was made by alkaline picratemethod using a commercially available kit (Span diagnostic Ltd., Surat,India). Cr clearance was calculated by using this formula:

urinary Cr(mg/dl) × urine volume(ml)serum Cr(mg/dl)

× [1000][body weight(g)]

× [1][1440(min)]

Cr clearance was expressed as ml/min/kg body weight.

2.8. Estimation of BUN, BUN/Cr ratio, urea and uric acid levels

Urea and uric acid levels in serum were estimated by usingcommercially available kits (Span diagnostic Ltd., Surat, India). Thevalues were expressed as milligrams per deciliter of serum. BUN wasobtained by using the following formula:

Urea [mmol/L] = BUN [mg/dL] × 10 [dL/L] /14×2 [mg N/mmolurea].

2.9. Estimation of urine protein, sodium (Na+) and potassium (K+)concentrations

Urine protein concentrations were determined by using bicincho-ninic acid (BCA) assay (Thermo Scientific, Rockford, IL) with BSA usedas standard and the results were expressed in mg/dl. Na+ and K+ levelsin the serum were estimated by using commercially available kits (BioSystems S.A. Costa Brava 30, Barcelona, Spain) and values wereexpressed as mEq/l.

2.10. Preparation of kidney cytosolic extracts

Excised kidneys were rinsed in ice-cold normal saline. Kidney wasminced and homogenized in ice-cold, 0.25 M sucrose solution by usingtissue homogenizer, with Teflon pestle (Heidolph Silent Crusher M,Germany), at 4 °C to give 20% homogenate (w/v). Homogenates werethen centrifuged (10 min at 8500×g, 4 °C) and supernatant was storedat −80 °C for biochemical and molecular analyses.

2.11. Estimation of lipid peroxidation

Lipid peroxidation in kidney homogenate was measured by esti-mating the amount of thiobarbituric acid reactive substances (TBARS),by using a commercial kit (Cayman Chemical Item Number 10009055).

2.12. Measurement of TNF-α and IL-6 levels in kidney homogenatesby ELISA

TNF-α and IL-6 levels in kidney homogenates were measured byusing ELISA kit (Cayman chemicals, Ann Arbor, MI, USA), accordingto the manufacturer's guidelines. Cytokines levels were determinedfrom a standard curve and were expressed in ng/mg protein.

2.13. Nuclear extraction and NF-kB p65 activity measurement inkidney homogenates

Nuclear extractions were prepared from kidney homogenates byusing nuclear extract kit (Cat#40010, Active Motif, Carlsbad, CA, USA),following the manufacturer's protocol. NFκB p65 DNA binding activitywas determined by using TransAM® NFκB p65 protein assay kit (#CatNo. 40096, Active Motif, Carlsbad, CA, USA) following the method as

previously described (Aziz et al., 2017). The results were expressed asNF-kB p65 concentration per unit of optical density.

2.14. Histopathological studies

Kidneys were immediately fixed in 10% buffered formalin followingharvesting, then embedded in paraffin and manually cut into 5 µm-thick sections by using a microtome (Histo-line laboratories, ARM-3600, Viabrembo, Milan, Italy). Sections were then dewax in twochanges of xylene, hydrated in two changes of 100% ethanol, followedby 95% and 80% ethanol and finally rinsed with H2O. Sections werethen stained with hematoxylin and eosin (H& E). The stained sectionswere dehydrated with 80% ethanol followed by 95% ethanol, placed intwo changes of 100% ethanol and cleansed with two changes of xylene.Histopathological changes were viewed by using a phase contrastmicroscope (Nikon H600L, Nikon DS camera control Unit DS-U2,Version 4.4), with an attached photograph machine (Nikon H600L,Japan).

2.15. Morphometric analysis

Morphometric analysis of the renal corpuscle and glomeruli wereperformed by using Image J software (Image J 1.39f, NIH-Bethesda,MD, USA). From each group, six histological sections were examined atdifferent magnifications to obtain average (1) diameter of renalcorpuscles, (2) diameter of glomerulus, (3) glomerular cross sectionalarea and (4) diameter of Bowman's capsule from 50 corpuscles underlow power field (10×). Mean glomerular volume (VG) was calculated asfollows:

XGV = area 1. 381. 01

1.5

GV=1.5×1.38/1.01, where 1.38 represents the shape coefficient,and 1.01 represents size distribution coefficient.

2.16. Distribution of protein by immunoperoxidase andimmunofluorescence

For immunohistochemistry, sections were deparaffinized by im-mersing in xylene for 20 min, and then dropped in ethanol atdecreasing concentrations as above, 5 min each. Antigen retrievalwas performed by incubating the sections in 0.01 M citrate buffer,pH 6.0 for 10 min at 100 °C. Subsequently 3% H2O2 in PBS was used toneutralize the endogenous peroxidase. Sections were blocked in 5%BSA for non-specific binding, prior to incubation with RAGE, Nrf2,TNF-α, IL-6, Casp-3, TGF-β1, FGF-1, Ki-67 primary polyclonal anti-bodies (sc-8230; sc-722; sc-1351; sc-1266; sc-1225; sc-146; sc-1884;and sc-15402; Santa Cruz, CA, USA respectively), at a dilution of 1:500in 5% BSA at room temperature for 1 h. After three times rinsing withPBS, sections were incubated with appropriate biotinylated secondaryantibody (Santa Cruz, CA, USA) for 30 min at room temperature, thenexposed to avidin and biotinylated HRP complex in PBS for another30 min (ImmunoCruz™ ABC Staining). The site of antibody bindingwas visualized by using 3,3′-Diaminobenzidine (DAB) staining, whichgave dark-brown precipitates. Sections were counterstained withhematoxylin for nuclear staining. Immunoperoxidase changes wereviewed under a phase contrast microscope. Ki-67 positive cells (brown)together with total number of cells were counted in 6 random visualfields under 40 x magnifications, and results were expressed as apercentage of Ki-67 positive cells relative to total number of countedcells.

For immunofluorescence, sections were blocked with appropriatenormal serum (Santa Cruz, CA, USA) prior to incubation with Ikk-β,IL-1β, Casp-9, Bax and VEGF polyclonal primary antibodies (sc-34674;sc-7884; sc-7885; sc-526; sc-507; Santa Cruz, CA, USA), at a dilutionof 1:100 in PBS with 1.5% normal blocking serum at room temperature

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for 1 h. After three times rinsing with PBS, sections were incubatedwith IgG–fluorochrome-conjugated secondary antibody (Santa Cruz,CA, USA), at a dilution of 1:250 in PBS with 1.5% normal blockingserum at room temperature for 45 min. The slides were rinsed threetimes with PBS and were mounted with Ultracruz mounting medium(Santa Cruz, CA, USA), counterstained with DAPI to visualize thenuclei.

2.17. mRNA quantification by Real-time PCR (qPCR)

Kidney were kept in RNALater solution (Ambion, Austin, TX, USA)prior to RNA extraction. Tissues were homogenized in liquid nitrogenusing mortar and pestle, Total RNA was freshly isolated by usingRNeasy plus Mini Kit (Qiagen, Valencia, CA, USA). Purity andconcentration of RNA was assessed by 260/280 UV absorption ratios(Gene Quant 1300, GE Healthcare UK Limited, Buckinghamshire, UK).Two steps Real-time PCR was used to evaluate gene expression.Reverse transcription into cDNA was performed by using high capacityRNA-to-cDNA Kit (Applied Biosystems, Foster City, CA, USA). Targetgenes were amplified using standard real-time PCR kit (AppliedBiosystems, Foster City, CA, USA). In real-time PCR, amplificationwas performed using QuantiNova SYBR Green PCR Kit (Qiagen,Valencia, CA, USA) on Applied Biosystems StepOne Plus Real-TimePCR Systems. RNA fold changes were calculated according to com-parative Ct (2−ΔΔCt) method. Primers used for amplification of therespective gene used in this study were as follows: RAGE (Ager) (5′-AGGGTCACAGAAACCGGTGAT-3′ and 5′-GGCCTCCCAGGATCCCTAAG-3′), IKK-β (5′- CCTGTGCAGTGGCACTCTAA-3′ and 5′-GTTCCGTTCAAGTCCTCGCT-3′), Bax (5′-CACCAAGAAGCTGAGCGAGT-3′and 5′-CACATCAGCAATCATCCTCTGC-3′), VEGF (5′-GACCACATTCACTGTGAGCCTT-3′ and 5′-CTGCGGATCTTGGACAAACA-3′), TGF-β1(5′-CTGCTGACCCCCACTGATAC-3′ and 5′-AGCCCTGTATTCCGTCTCCT-3′); FGF-2 (5′-TTCTTCCTGCGCATCCATCC-3′ and 5′-GCTGTAGTTTGACGTGTGGG-3′), PCNA (5′-GAAGGCTTCGACACATACCG-3′ and 5′-TTTTGGACATGCTGGTGAGGT-3′), Gapdh (5′-GCATCTTCTTGTGCAGTGCC-3′ and 5′-TACGGCCAAATCCGTTCACA-3′). The pri-mers were designed by NCBI Primer-BLAST tool (http://www.ncbi.nlm.nih.gov/tools/primer-blast/) and synthesized by Integrated DNATechnologies.

2.18. Western blotting

Peri-renal fats were removed and kidneys were rinsed with 0.1%phosphate buffered solution. Tissues were then snapped frozen inliquid nitrogen and stored at −80 °C prior to protein extraction. Totalamount of protein was extracted from 40 mg (wet weight) tissue. Afterextraction of total protein with PRO-PREP solution (INtRONBiotechnology, South Korea), equal amount of protein from each tissuelysate were mixed with loading dye, boiled for 5 min and separated bySDS-PAGE 10%. Protein was then transferred onto PVDF membrane(BIO-RAD, Hercules, CA, USA) and blocked with 5% BSA for 90 min atroom temperature. The membranes were then exposed to goat poly-clonal primary polyclonal SOD-1 (sc-271014), CAT (sc-50508), GPx-1(sc-22145), IL-1β (sc-7884), Casp-3 (sc-1225), Casp-9 (sc-7885),PCNA (sc-9857), GAPDH (sc-25778), Vinculin (sc-5573) (Santa Cruz,CA, USA) diluted at 1:1000 in phosphate buffered saline (PBS)containing 1% bovine serum albumin (BSA) and Tween 20 for 90 mins.

Blots were washed 3 times, 5 min each, and finally incubated withappropriate horseradish peroxidase (HRP) conjugated secondary anti-body (Santa Cruz Biotech Inc, CA, USA) at a dilution of 1:2000, for 1 h.The membranes were washed and subjected to Opti-4CN™ SubstrateKit (Bio-Rad, USA) to visualize the protein bands. Photos of the blotswere captured by using a gel documentation system (Biospectrum,UVP). Density of each band was determined by using Image J software(1.39, NIH-Bethesda, MD, USA). The ratio of each target band/GAPDHor vinculin was calculated and was considered as the expression level ofthe target proteins.

2.19. Statistical analysisStudent's t-test was used to compare between different samples. p

< 0.05 was considered as significant. Results were expressed as mean± standard deviation (S.D.). Post‐hoc statistical power analysis wasperformed and values obtained were > 0.8 which indicate adequatesample size.

3. Results

3.1. Effects of PN on body weight and FBG levels

The body weight of diabetic rats declined steadily following STZinjection (Table 1). In PN or glibenclamide-treated diabetic rats, body

Table 1Effects of PN on metabolic parameters in different experimental groups.

Parameters Normal Diabetic Diabetic

200 mg/kg P. niruri 400 mg/kg P. niruri 600 µg/kg glibenclamide

Body weight at 0th day 195.34 ± 8.55 212.54 ± 11.24 216.25 ± 9.42 205.55 ± 8.53 208.36 ± 11.46Body weight at 28th day 210.42 ± 9.46 157.47* ± 10.45 176.34*† ± 9.63 195.65*† ± 9.32 187.46*† ± 11.63Blood glucose levels at 0th day (mg/dl) 88.75 ± 9.5 358.64* ± 14.53 347.56*† ± 16.79 349.65*† ± 13.25 354.68*† ± 18.46Blood glucose levels at 28th day (mg/dl) 90.68 ± 9.21 346.43* ± 15.53 208.75*† ± 15.85 152.37*† ± 17.43 146.28*† ± 12.59Kidney tissue somatic index (%) 0.64 ± 0.07 0.52* ± 0.05 0.55*† ± 0.06 0.59*† ± 0.08 0.62*† ± 0.08Serum creatinine (mg/dl) 0.62 ± 0.06 1.76* ± 0.08 1.05*† ± 0.07 0.87*† ± 0.08 0.75*† ± 0.06Urine creatinine (mg/dl) 57.26 ± 2.89 18.35* ± 1.92 25.68*† ± 1.54 32.72*† ± 2.36 38.65*† ± 2.71Urine output (ml) 8.52 ± 0.76 38.72* ± 0.59 26.28*† ± 0.48 21.83*† ± 0.86 18.97*† ± 0.67CCr (ml/min/kg bw) 2.50 ± 0.06 1.75* ± 0.02 2.13*† ± 0.03 2.33*† ± 0.03 2.47*† ± 0.02Serum Urea (mg/dl) 27.78 ± 1.24 41.62* ± 1.62 35.92*† ± 1.42 31.53*† ± 1.55 27.84*† ± 0.89Serum BUN (mg/dl) 12.97 ± 0.24 19.43* ± 0.50 16.77*† ± 0.41 14.72*† ± 0.40 13.00*† ± 0.40BUN/Cr ratio 20.9 ± 0.07 11.03* ± 0.05 15.97*† ± 0.06 16.91*† ± 0.08 17.33*† ± 0.06Serum uric acid (mg/dl) 3.47 ± 0.23 6.56* ± 0.37 5.03*† ± 0.32 4.46*† ± 0.43 4.22*† ± 0.48Urine protein (mg/dl) 17.34 ± 0.58 32.16* ± 0.62 22.18*† ± 0.45 19.25*† ± 0.93 19.11*† ± 0.85Na+(mEq/l) 142.16 ± 3.03 164.06* ± 5.13 158.54*† ± 3.53 141.52† ± 3.53 139.66† ± 2.18K+ (mEq/l) 6.04 ± 0.86 8.25* ± 0.94 7.36*† ± 1.07 6.57† ± 1.77 5.43† ± 1.41

The value represents means ± S.D. for 6 rats per group. *p < 0.01 compared to non-diabetic rats, †p < 0.01 as compared to non-treated diabetic rats.

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weight was markedly higher than un-treated diabetic rats (p < 0.05).Serum FBG levels in diabetic rats at day 0 was markedly higher than innon-diabetic rats where no significant changes were noted in theformer after 28 days. However, treatment of diabetic rats with PN orglibenclamide for 28 days resulted in significant lowering of FBG levels

(p < 0.01).

3.2. Effects of PN on kidney functions

In un-treated diabetic rats, weight of the kidneys was significantly

Fig. 1. (A): Effects of PN on kidney histopathology, (B) high magnification image showing glomerular appearance. (A) Sections of normal, non-diabetic rats kidney showing glomerularand renal tubular histology. Shrink glomeruli could be seen in the kidney section from diabetic rats. Kidney sections from PN and glibenclamide-treated diabetic rats showed lessmorphological changes with slightly shrink glomeruli (H & E 400×).(B) High number of mesangial cells and low number of podocytes were observed in diabetic rats’ kidneys. PNtreatment caused low number of mesangial cells and high number of podocytes (1000X). GR- Glomeruli, M - Mesangial cell, P - Podocyte, GCL- Glomerular capillary lumina. Scale bar=50 µm.

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decreased however serum Cr, uric acid, BUN, CCr, Na+, K+, urineoutput and urine protein were significantly increased as compared tonon-diabetic rats (p < 0.05) (Table 1). Treatment of diabetic rats withPN or glibenclamide for 28 days ameliorated reduction of kidneyweight while maintaining near normal serum Cr, urea, uric acid, BUN,CCr, serum Na+, K+, urine output and urine protein levels. In diabeticrats, urine Cr, CCr and BUN/Cr ratio decreased, and these decreasewere ameliorated following treatment with PN or glibenclamide.

3.3. Effects of PN on histopathological changes in the kidney

In non-diabetic rats, kidney appeared normal as featured by normalappearance of proximal and distal convoluted tubules (PCT and DCT),renal corpuscles and glomerulus (G) (Fig. 1A). However, in diabeticrats, kidneys showed abnormal features such as atrophied glomeruliand necrosis of the tubules. These abnormal changes were amelioratedin diabetic rats treated with PN or glibenclamide.

Higher magnification images showed higher number of mesangialcells with lower number of podocytes in diabetic rat glomeruli whencompared to non-diabetic rat glomeruli (Fig. 1B). In PN or glibencla-mide-treated diabetic rats, lower number of mesangial cells but highernumber of podocytes were observed in the kidney when compared tonon-treated diabetic rats.

The average diameter of renal corpuscles, glomerulus, Bowmancapsules, glomerular cross sectional area and glomerular volume indiabetic rats were significantly lower when compared with non-diabeticrats (p < 0.01) (Table 2). 28 days treatment of diabetic rats with PN orglibenclamide resulted in significantly higher average diameter of renalcorpuscles, glomerulus, Bowman capsule, glomerular cross sectionalarea and glomerular volume (p < 0.01).

3.4. Effects of PN on kidney oxidative stress

In diabetic rats, RAGE protein was abundantly expressed in thetubular regions of the kidney (Fig. 2A). Treatment of diabetic rats withPN or glibenclamide resulted in a relatively lesser RAGE expression inkidney tubules. Significantly higher Rage mRNA levels were noted indiabetic rat kidney as compared to non-diabetic rat kidney (p < 0.05)(Fig. 2B). In diabetic rat kidney, Rage mRNA levels were significantlyreduced following PN or glibenclamide treatment (p < 0.05).

In diabetic rats, nuclear factor-erythroid-2-related factor 2 (Nrf2)was found to be distributed in the nuclei of kidney cells (Fig. 2C and D).However, in diabetic rats receiving PN or glibenclamide, even higherNrf2 nuclei distribution was observed (p < 0.05).

TBARS was found to be significantly increased in the kidney ofdiabetic rats when compared to kidneys of non-diabetic rats (p < 0.05)(Fig. 2E). Treatment of diabetic rats with PN or glibenclamide resultedin significantly lesser TBARS level in kidneys. SOD-1, CAT and GPx-1expressions in diabetic rat kidney were significantly decreased whencompared to non-diabetic rat kidneys (p < 0.05) (Fig. 2F). Treatment ofdiabetic rats with PN or glibenclamide resulted in significantly higherSOD-1, CAT and GPx-1 expression in the kidney.

3.5. Effects of PN on kidney inflammation

NFκB p65 DNA binding activity in diabetic rat kidneys wassignificantly higher as compared to non-diabetic rat kidneys (p <0.05) (Fig. 3A). Treatment of diabetic rats with PN or glibenclamideresulted in lower NFκB p65 level in the kidney. Ikk-β mRNA levelswere significantly higher in the kidney of diabetic rats when comparedto non-diabetic rats (p < 0.05) (Fig. 3B). In diabetic rats, treatmentwith PN or glibenclamide resulted in Ikk-β mRNA levels in the kidneyto decrease (p < 0.05). Immunofluorescence staining showed Ikk-βprotein was predominantly distributed in the tubular and glomerularregions of the kidneys at a relatively higher levels in diabetic rats thannon-diabetic rats (Fig. 3C). Treatment with PN or glibenclamideresulted in Ikk-β levels in the kidney of diabetic rats to reduce.

TNF-α levels were significantly higher in the kidney of diabetic ratsas compared to non-diabetic rats (p < 0.05) (Fig. 3D). Diabetic ratstreated with PN or glibenclamide had lower TNF-α levels in kidneys (p< 0.05). Immunohistochemistry images indicated that TNF-α werehighly distributed in the tubular regions of the kidney of diabetic rats.However, a relatively lower distribution of TNF-α was observed inkidney tubules of diabetic rats following treatment with PN orglibenclamide (Fig. 3E).

Immunohistochemistry images showed IL-6 was highly distributedin the tubules and glomerulus of diabetic rat kidneys (Fig. 4A). Diabeticrats treated with PN or glibenclamide had a relatively lower IL-6distribution in the kidney tubules and glomeruli.

IL-6 levels in diabetic rat kidneys were significantly higher whencompared to non-diabetic rat kidneys (Fig. 4B). In diabetic rats, PN orglibenclamide treatment resulted in IL-6 levels in kidneys to decrease.Higher expression of IL-1β was observed in kidneys of diabetic ratswhen compared to non-diabetic rats with PN or glibenclamide treat-ment reversed these changes (Fig. 4C). Immunofluorescence imagesshowed a relatively higher IL-1β distribution in the glomeruli andtubular regions of kidney of diabetic rats (Fig. 4D). Treatment ofdiabetic rats with PN or glibenclamide resulted in IL-1β distribution inthe glomeruli and tubules to decrease.

3.6. Effects of PN on kidney apoptosis

Immunofluorescence images show high distribution of Bax in theglomeruli and tubules of diabetic rat kidneys (Fig. 5A). In diabetic ratsreceiving PN or glibenclamide treatments, a relatively lower distribu-tion of this protein was observed in the glomeruli and tubules. BaxmRNA levels were highest in diabetic rat kidney and its levels werereduced following treatment with PN or glibenclamide (Fig. 5B).Immunohistochemistry images showed high distribution of caspase-3in tubules of diabetic rat kidneys with administration of PN orglibenclamide resulted in distribution of this protein to be relativelydecreased (Fig. 5C). In the meantime, immunofluorescence imagesshowed high distribution of caspase-9 in the renal corpuscles andtubules of diabetic rat kidneys where treatment with PN or glibencla-mide caused distribution of caspase-9 to be relatively decreased(Fig. 5D). Caspase-3 and Caspase-9 protein expression levels were

Table 2Effects of PN on morphometric analysis of renal corpuscles in different experimental groups.

Parameters Normal Diabetic Diabetic

200 mg/kg P. niruri 400 mg/kg P. niruri 600 µg/kg glibenclamide

Diameter of renal corpuscles (µm) 87.24 ± 4.61 62.34 ± 5.42* 75.78 ± 4.57*† 81.95 ± 3.46*† 84.86 ± 4.58*†

Diameter of glomerulus (µm) 136.12 ± 5.06 98.85 ± 6.15* 112.14 ± 7.39*† 124.78 ± 6.11*† 128.45 ± 6.28*†

Glomerular cross sectional area (µm2) 12526 ± 289.34 9758 ± 0.05* 10953 ± 0.06*† 11746 ± 0.09*† 11972 ± 0.08*†

Glomerular volume (mm3) 1915.46 ± 56.55 1317.03 ± 97.07* 1566.22 ± 89.73*† 1739.36 ± 67.35*† 1789.8 ± 72.82*†

Diameter of Bowman's capsule (µm) 17.86 ± 1.65 11.67 ± 1.82* 14.58 ± 1.24*† 15.74 ± 1.91*† 15.87 ± 1.94*†

The value represents means ± S.D. for 6 rats per group. *p < 0.01 compared to non-diabetic rats, †p < 0.01 as compared to non-treated diabetic rats.

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highest in diabetic rat kidneys (p < 0.05) (Fig. 5E). In diabetic rats,treatment with PN or glibenclamide resulted in caspase-3 and caspase-9 protein expression levels in the kidney to decrease (p < 0.05).

3.7. Effects of PN on kidney fibrosis

Immunofluorescence images showed high distribution of VEGF inthe glomerulus and tubules of diabetic rat kidneys (Fig. 6A).Distribution of VEGF in the glomeruli and tubules was markedlydecreased when diabetic rats were given either PN or glibenclamide.The levels of Vegf mRNA were highest in the kidney of diabetic rats(Fig. 6B). However, following PN or glibenclamide treatment, VegfmRNA levels markedly decreased. TGF-β1 was highly expressed in thetubules of diabetic rat kidneys (Fig. 6C). Tgf-β mRNA levels were alsohighest in diabetic rat kidneys (Fig. 6D). In these rats, treatment with

PN or glibenclamide resulted in significant reduction in Tgf-β mRNAlevels. Immunohistochemistry images showed FGF-1 was highly dis-tributed in the tubules of diabetic rat kidneys (Fig. 6E). However,following treatment of diabetic rats with PN or glibenclamide, dis-tribution of FGF-1 in tubules reduced. FgfmRNA levels were highest inthe kidney of diabetic rats and were markedly reduced following PN orglibenclamide treatments (Fig. 6F).

3.8. Effects of PN on kidney proliferation

Immunohistochemistry images showed low distribution of Ki-67 inthe kidney of diabetic rats (Fig. 7A and B). Ki-67 could be seen to belocalized in the nuclei. In diabetic rats, distribution of Ki-67 wasrelatively higher following treatment with PN or glibenclamide.Expression levels of PCNA protein in diabetic rat kidneys was

Fig. 2. (A): Immunoperoxidase images showing distribution of RAGE (B) Rage mRNA levels (C) Immunoperoxidase images showing distribution of Nrf2 (D) Quantification of Nrf2expression level. Data were represented as number of positively-stained cells/image (E) TBARS levels (F) Western blotting images of SOD-1, CAT and GPx-1. *p < 0.05 compared to NC,†p < 0.05 compared to D. Data were expressed as mean ± S.E.M from 6 animals per treatment. Scale bar =50 µm.

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significantly lesser when compared to the kidney of non-diabetic rats(Fig. 7C). In diabetic rats, treatment with PN or glibenclamide resultedin significantly higher PCNA expression in the kidney. Similarly, PcnamRNA levels were lowest in the kidney of diabetic rats. In diabetic ratswhich received PN or glibenclamide treatments, Pcna mRNA levelswere significantly increased (Fig. 7D).

3.9. Identification of the compounds in PN by GC-MS

Analyses of GC-MS chromatogram showed the presence of 12 peakswhich represent 12 major compounds in the extract (Fig. 8A and B).The retention time (RT), molecular formula and molecular weight

(MW) of these compounds are shown in Table 3. The major compoundsp-resent are phenol, 4-(2-phenylethyl) (Rt 15.106); tyrosine (Rt16.880), tyrosine (Rt 7.126), n-hexadecanoic acid (Rt 33.588); 9,12-octadecadienoic acid (Z,Z) (Rt 36.775); trans-13-octadecenoic acid (Rt36.907); tetratetracontane (Rt 43.006); octacosane (Rt 44.540); tetra-tetracontane (Rt 46.010); octacosane (Rt 47.441); 6,7-epoxypregn-4-ene-9,11,18-triol-3,20-dione, 11,18-diacetate (Rt 48.688).

4. Discussion

This study has shown that administration of PN to diabetic rats wasable to prevent deterioration of kidney functions via ameliorating

Fig. 3. (A): NF-Kβ p65 DNA binding activity (B) Ikk-β mRNA (C) Immunofluorescence images showing distribution of Ikk-β (D) TNF-α levels (E) Immunoperoxidase images showingdistribution of TNF-α. *p < 0.05 compared to NC, †p < 0.05 compared to D. Data were expressed as mean ± S.E.M from 6 animals. Scale bar represents 50 µm.

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histopathological changes in the kidney particularly in the renalcorpuscles and tubules. These effects could be due to the reducedlevels of oxidative stress, inflammation, fibrosis and apoptosis. Diabeticrats was found to have elevated FBG levels which was significantlyameliorated following treatment with PN, in a dose-dependent manner.The anti-hyperglycemic effects of P. niruri was also reported in alloxan-induced diabetic rats (Okoli et al., 2011). Our findings indicated thattreatment of diabetic rats with PN was able to ameliorate the decreasedin kidney somatic index which could be due to decrease in protein and/or glycogen degradation.

Administration of PN to diabetic rats was found able to improvetherenal function as indicated by decreased in the urine output, mostprobably due to near normal FBG levels. Ability of PN to ameliorateincreased in plasma electrolytes i.e. Na+ and K+ levels in diabeticcondition could be due to its ability to decrease the urine output, thusameliorating dehydration. In the meantime, near normal K+ levels in

diabetic rats as observed following PN treatment could be due to abilityof the plant extract to maintain near normal plasma insulin level that isessential for the regulation of plasma K+(Zierler et al., 1966).

Administration of PN to diabetic rats was found able to decrease theserum uric acid levels, but the underlying mechanisms are unknown.There has been a report which indicate that P. niruri leaves methanolicextract was able to lower the serum uric acid levels in hyperuricemicrats (Murugaiyah and Chan, 2006). An increased in serum Cr andblood urea levels in diabetic rats indicated the decreased renalfunction, the findings consistent with others (Perrone et al., 1992). Inthe meantime, elevated urea levels indicated the possibility of renalfailure (Nissenson, 1998) while decreased in BUN/Cr ratio indicatedthat the failure most likely due to intrinsic damage to the kidney (Irwinand Rippe, 2008; Lavizzo-Mourey et al., 1988). Preservation of nearnormal serum Cr, urea, BUN and decreased in BUN/Cr ratio suggestedthat PN was able to preserve near normal kidney functions in DM.

Fig. 4. (A): Immunoperoxidase images showing distribution of IL-6. (B) IL-6 levels (C) Western blot image showing IL-1β protein expression (D) Immunofluorescence images showingdistribution of IL-1β. *p < 0.05 compared to NC, †p < 0.05 compared to D. Data were expressed as mean ± S.E.M from 6 animals per treatment. Scale bar =50 µm.

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Deterioration of kidney functions as observed in diabetic rats wasconsistent with the histopathological changes in the kidneys as featuredby glomerular atrophy and reduced surface area of the Bowmancapsule. These changes would likely contribute towards decreased inGFR. Administration of PN to diabetic rats reduced the loss ofpodocytes, in which decreased in podocytes is a characteristic of DN(Steffes et al., 1992). In DM, podocyte loss is associated withglomerulosclerosis (GS) (Sayyed et al., 2009). In this study, reducednumber of renal corpuscles in diabetic rat kidneys indicated renalatrophy, which would result in decreased kidney ultrafiltration (Joneset al., 1979). Additionally, variations of the size of renal corpuscles indiabetic rats indicate compensatory hypertrophy which could help tosustain the normal GFR. Following administration of PN, reducedinter-glomeruli size variations and increased in glomerular diameter,glomerular cross-sectional area and glomerular volume in diabetic rats

indicate amelioration of renal atrophy following administration of theextract. Additionally, reduced urine protein concentration following PNadministration indicated reduced glomerular basement membranedamage, the features that characterized DM-induced intrinsic kidneydisease (Lahdenkari et al., 2004).

In this study, ability of PN to partially alleviate deterioration ofrenal function could be due to amelioration of oxidative stress,inflammation, apoptosis and fibrosis in the kidney and improvementof the kidney cell proliferation. The increased in oxidative stress indiabetic rat kidney was evidenced from increased levels of RAGE andlipid peroxidation (LPO), the latter is a reflection of tissue oxidativedamage in addition to decreased in SOD, CAT and GPx anti-oxidativeenzymes. Administration of PN ameliorated DM-induced oxidativestress. In addition, in DN, tissue damage was also due to increase inperoxide and NO free radicals levels (Onozato et al., 2002).

Fig. 5. (A): Immunofluorescence images showing distribution of Bax (B) Bax mRNA levels (C) Immunoperoxidase images showing distribution of caspase-3. (D) Immunofluorescenceimages showing distribution of caspase-9 (E) Western blot image showing caspase-3 and 9 expression. *p < 0.05 compared to NC, †p < 0.05 compared to D. Data were expressed asmean ± S.E.M from 6 animals per treatment. Scale bar =50 µm.

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In DM, levels of Nrf2, a well-known cytoprotective factor werefound to increase, where this factor could help to protect the kidney viaorchestrating the antioxidant responses to oxidative stress. ElevatedROS levels prevent degradation of Nrf2 and activate the formed Nrf2 totranslocate into the nucleus, after which it activates the antioxidantresponse elements (AREs)-regulated genes, leading to downstreamtranscription of antioxidantive enzymes (Kim and Vaziri, 2010; Ruizet al., 2013). PN administration to diabetic rats increased Nrf2expression where this could help to up-regulate ARE-regulated genescausing increased in antioxidant enzymes’ levels. Lack of increased inNrf2 in non-diabetic rats was expected as there were no pathology thattriggers increased in Nrf2 levels. Our findings were consistent withprevious studies which indicate that natural products activate Nrf2 aswell as scavenges free radicals via activating its downstream targets in

many disease conditions (Xu et al., 2016; Li et al., 2016; Panduranganet al., 2015; Park et al., 2016). Increased in Nrf2 expression in diabeticrats following PN administration would increase cytoprotection andthis was supported by studies which reported that aqueous andmethanolic extracts of P. niruri leaves displayed in- vitro free radicalscavenging activities (Harish and Shivanandappa, 2006; Sabir andRocha, 2008). Besides, P. niruri leaves extracts were also found toprevent toxins (Manjrekar et al., 2008) and drug-induced oxidativestress in the liver in rats (Chatterjee and Sil, 2006; Sarkar and Sil,2007).

In this study it was found that the levels of inflammation were highin diabetic rat kidney as indicated by increased levels of NF-kβ, Ikkβ,TNF-α and ILs (IL-1β and IL-6). These findings were consistent with areport which indicate that TNF-α levels in the kidney were markedly

Fig. 6. (A): Immunofluorescence images showing distribution of VEGF (B) VegfmRNA levels (C) Immunoperoxidase images showing distribution of TGF-β1 (D) Tgf-βmRNA levels (E)Immunoperoxidase images showing distribution of FGF-1 (F) Fgf mRNA levels. *p < 0.05 compared to NC, †p < 0.05 compared to D. Data were expressed as mean ± S.E.M from 6animals per treatment. Scale bar represents 50 µm.

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increased in DM (McCarthy et al., 1998). Inflammation was found to betriggered by hyperglycemia and oxidative stress (Adam et al., 2016a;Ojha et al., 2014). Activation of Nrf-2 as well as translocation of Nrf2into the nucleus due to increase in LPO and free radicals levels couldtrigger NF-kβ activation, inducing transcription of genes that encodesthe inflammatory proteins (Roslan et al., 2017; Zhong et al., 2016).Ability of PN to reduce inflammation in the kidney could either be dueto direct or indirect effects via decreased in oxidative stress andhyperglycemia.

In this study, it was found that fibrosis levels in the kidney weremarkedly increased in DM and were ameliorated following PN admin-istration as reflected by decreased in TGF-β1, VEGF and FGF1 levels.Previous reports indicated that DN is associated with high fibrosislevels (Ha and Kim, 1999). High glucose levels were able to stimulatesynthesis of collagen and matrix glycoproteins in the mesangial cellsand interfered with the degradation of glycosylated proteins (Abrass,1995). Meanwhile, increased in TGF-β1 expression could result inmesangial matrix expansion (Kagami et al., 1994) and decreased inpodocytes number in DM (Wolf and Ziyadeh, 2007). Decreased in thepopulation of mesangial cells in diabetic rat kidneys following PN

administration could be due to amelioration in fibrosis.The levels of apoptosis in kidneys which were high in DM were

markedly reduced following PN administration as reflected by reducedlevels of Bax, caspase-3 and caspase-9. In the meantime, reduced cellproliferation in the kidneys in DM as reflected by reduced levels ofPCNA and Ki-67 were ameliorated following PN administration. Levelsof apoptosis were reportedly high in DM (Verzola et al., 2007).Hyperglycemia, inflammation and oxidative stress could trigger in-creased in Bax levels, which activates the apoptosis signaling pathwayencompassing of caspase-3 and caspase-9 (Song et al., 2014).

Some of the bioactive compounds in PN could account for theseobserved biological effects. n-Hexadecanoic acid (palmitic acid) hasbeen shown to exhibit antioxidant (Sutha et al., 2012) and anti-inflammatory effects via inhibition of phospholipase A(2), an enzymethat is involved in controlling inflammation (Aparna et al., 2012). 9,12-Octadecadienoic acid (Z,Z) (Linoleic acid), one of the polyunsaturatedfatty acid, has been reported able to prevent DM and attenuateoxidative stress in diabetic condition (Suresh and Das, 2003).Linoleic acid has been shown able to prevent experimentally-inducedDN as a result of exposure to high glucose levels (Pitel et al., 2007).

Fig. 7. (A): Immunoperoxidase images showing distribution of Ki-67 (B) Quantification of Ki-67 expression. Data were represented as number of positively stained cells/image. (C)Western blot showing PCNA expression. (D) Pcna mRNA levels. *p < 0.05 compared to NC, †p < 0.05 compared to D. Data were expressed as mean ± S.E.M from 6 animals pertraetment. Scale bar represents 50 µm.

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Besides, linoleic acid (Z,Z) has been found to possess anti-inflamma-tory activities (Jones, 2002).

In conclusions, the present study has provided scientific cues tosupport the use of PN in ameliorating progression of nephropathy inDM. By having these effects, PN is useful to decrease DN progression to

chronic renal failure, effects which might be contributed by its bioactivecompounds. However, effects of individual compounds need to befurther explored. These findings threfore justify the claims that thisherb is useful in treating genito-urinary disorders and pave the way forits use as an agent to treat DN.

Fig. 8. (A): Chromatogram showing peaks with retention time (x-axis [Retention time; y-axis [% intensity/% abundance). (B) GCMS analysis of the major compounds in PN.

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Conflict of interest statement

Authors declare no existing conflict of interest.

Acknowledgement

This study was funded by University of Malaya Research Grant(RPO11/13HTM), University of Malaya, Kuala Lumpur, Malaysia.

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Table 3The active principles of PN and their retention time (RT), molecular formula andmolecular weight (MW).

S. No RT (min) Name of the compound Molecularformula

MolecularWeight

1 15.106 Phenol, 4-(2-phenylethyl) C14H14O 1982 16.880 Tyrosine C9H11NO3 1813 17.126 Tyrosine C9H11NO3 1814 33.588 n-Hexadecanoic acid C16H32O2 2565 36.775 9,12-Octadecadienoic acid

(Z,Z)C18H32O2 280

6 36.907 trans−13-Octadecenoic acid C19H36O2 2827 43.006 Tetratetracontane C44H90 6198 44.540 Octacosane C28H58 3949 46.010 Tetratetracontane C44H90 61910 47.441 Octacosane C28H58 39411 48.688 6,7-Epoxypregn−4-ene

−9,11,18-triol−3,20-dione,11,18-diacetate

C25H32O8 460

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