urolithiasis
DESCRIPTION
The aim of this study was to measure the effects of the aqueous extract of leaves of Adansonia digitata (AAD) in vitro on calcium oxalate (CaOx) nucleation and aggregation [by spectrophotometric time course measurements of optical density at 620 nm (OD620)]. For measuring calcium oxalate crystallization inhibitor activity agar gel model, and in vivo on experimentally induced CaOx urolithiasis in male Wistar rats. CaOx urolithiasis in rats was induced by intraperitoneal (i.p.) injection of sodium oxalate (NaOx) (7 mg/100 g/day for 7 days). AAD was administered orally (200 mg/kg/day for 7 days). Urine volume, pH, body weight, kidney weight (wet and dry), serum and urine level of creatinine, urea, magnesium (Mg2+), calcium (Ca2+) were evaluated on day 7. In addition, histopathological changes in kidney and oxalate in urine and kidney were evaluated. The results revealed that AAD inhibited the rate of crystal nucleation (SN) and aggregation (SA) and showed inhibitory activity on CaOx crystallization. The histopathological examination of kidneys revealed that AAD significantly reduced the incidence of CaOx crystal deposition. In addition, AAD significantly increased urinary excretion of Mg2+ along with a decrease of oxalate excretion. In conclusion, the aqueous extract contains potent antiurolithiatic substances which warrant further evaluation.TRANSCRIPT
Pharmacological Evaluation of Antiurolithic Activity of Leaves of Adansonia digitata Linn.
1
SUBMITTED BYMr. Swaroop Singh
SUPERVISORProf. (Dr.) Neelam Balekar
College of Pharmacy, IPS Academy,
Rajendra nagar, A.B. Road, Indore-452012
2010-2011
1. INTRODUCTION
Urolithiasis denotes stones originating anywhere in the urinary tract, including the
kidney and bladder (Pearle & Nakada, 2009).
Overall male to female ratio of 2.4:1 increased from 1977 (1.86:1) to 2006 (2.7:1)
(Knoll et al., 2011).
Recurrence rate (10 to 20% within 1 to 2 years, 35% within 5 years, & 60% within
10 years) (Berner et al., 2011).
Types of kidney stones (Dipiro et al., 1997)
• Calcium stones (CaOx and CaP)- 80%
• Uric acid- 9%
• Struvite-10%
• Others- 1%
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Fig. 1. Stones in kidney
1.1. PATHOGENESIS
Urine is a complex fluid that contains a number of minerals, inhibitors and
promoters of crystallization.
Crystallization can not occurs whether promoters and inhibitors are present or
absent, if a state of supersaturation does not exist.
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Fig. 2. Scheme of the precess of stone formation (Tsujihata, 2005).
1.2. Possible series of events of the normal and pathological crystallization in urine (adopted from ‘Oxford Textbook of Clinical Nephrology’).
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Fig. 3. Normal crystallization in urine.
Fig. 4. Pathological crystallization in urine.
1.3. Risk factor associated with kidney stones
Low urine volume
Hypercalciuria (most common)
Hypocitraturia
Hyperoxaluria
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Primary defect in renal tubular
reabsorption of calcium
Renal hypercalciuria
Excretion of Calcium in urineIon activity product
Supersaturation Plasma level of calcium
Resorptive hypercalciuria
Production of vit. D3 in kidney
PTH Calcium transport from lumen of gut
Absorptive hypercalciuria
Fig.5. Types of hypercalciuria
2. MANAGEMENT OF KIDNEY STONES
Therapeutic approaches
Removal of stones (surgical management & MET)
Lowering supersaturation (fluid intake & dietary modification)
Prevent crystal retention in kidneys
Reduction of renal oxidative stress
2.1. SURGICAL MANAGEMENT (Pearle & Nakada, 2009)
1) ESWL
2) PCNL
3) URS (flexible ureteroscopy)
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Cont…
2.2. MEDICAL EXPULSIVE THERAPY (Pearle & Nakada , 2009)
A new clinical approach
Urethral smooth muscle relaxation
CCB & alpha-1 receptor blockers
2.3. FLUID INTAKE AND DIETARY MODIFICATION
High fluid intake in order to maintain a urine output of at least 2 L/day
Reduced supersaturation and dilutes promoters of CaOx crystallization
Restriction of animal protein diet
Restriction of Na intake (2-3gm)
No restriction of calcium
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Cont…
2.4. PHARMACOLOGICAL TREATMENT (Dipiro et al., 1997)
Diuretics
Alkali Potassium citrate, potassium magnesium citrate
Pyridoxine
2.5. LIMITATION
Persistent of stone fragments cause renal injury & an increase in stone recurrence
with ESWL & development of diabetes and hypertension on long term use
(Butterweck & Khan 2000).
Long term use of thiazide causes K depletion (hypokalemia), Fatigue, dizziness,
impotence & musculoskeletal symtoms.
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3. PLANT PROFILE
3.1. BIOLOGICAL SOURCE
Botanical name : Adansonia digitata L.
Family : Bombacaceae
3.2. PHARMACOLOGICAL ACTIVITIES OF LEAVES OF PLANT
Anti-ulcer activity (Karumani et al., 2008)
Antimicrobial activity (Oloyede et al., 2010)
Antioxidant activity (Vetuani et al., 2002)
Antiviral activity (Hudson et al., 2000 ; Ananil et al., 2000)
Diuretic activity (Kirubha et al., 2006)
Anti-inflammatory activity (Selvarani & Hudson, 2009)
Antisickling activity (Adesanya et al., 1988)
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3.3. TRADITIONAL USES OF LEAVES OF Adansonia digitata (Sibibe & Willians, 2002)
Insect bite & gunia worm sores & otitis
Diseases of the bladder and urinary tract
Antiasthmatic
Antipyretic
Fatigue
Dysentery
Opthalmia
Astrigent
Diaphoretic
Tonic
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Fig.6. Leaf of Adansonia digitata.
3.4. PHYTOCHEMICAL CONSTITUENT OF LEAVES OF PLANT
Excellent source of amino acids (Yazzie et al., 1994)
Carbohydrate , fat, protein and fibre (Caluwe., 2010)
Antioxidants such as catechins and adansonia flavonosides (Maranz et al., 2007;
SEPASAL database., 2007; Kunkel ., 1979)
Minerals (iron, zinc, calcium, magnesium, manganese, copper, phosphorus &
sodium) (Glew et al., 1997)
Provitamin A along with thiamine, riboflavin &niacin (Caluweet al., 2010)
Mucilage (Woolfe et al., 1977)
Alkaloids & Steroids (Oloyede et al., 2010)
Tannis (Oloyede et al., 2010)
Cardio active glycosides (Oloyede et al., 2010)
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4. OBJECTIVE
The objective of present study to assess the effectiveness of leaves of Adansonia
digitata L., a medicinal plant used to treat kidney and bladder disease as
traditionally, as a prophylactic agent against CaOx stones by in vitro and in vivo
study.
The present study shall undertake
• Collection of plant material from local area.
• Identification and authentication of the plant from Botanical survey of India.
• Preparation of suitable extracts of selected plant material.
• Evaluation of the extract for antiurolithic activity by in vitro and in vivo study.
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4.1. RATIONALE
No satisfactory drug to use in clinical therapy for the prevention or the recurrence
of stones.
Traditional claim of the plant(Sidibe & Willians, 2002; Caius, 2003).
Absence of literatures on the systematic investigation of antiurolithic activity.
Data from In vitro and In vivo & clinical trials reveal that phytotherapeutic agent
could be useful in the management of urolithiasis. In this regards many plant have
been used to treat stones like Dolichous biflorus, Berginia ligulata, Tribulus
terrestris, Orthosiphon grandiflorus, Phylanthus niruri (Butterweck & khan, 2000).
Diuretic activity (Kirubha et al., 2006) & antioxidant activity (Vetuani et al., 2002).
Antiurolithic activity of L-arginine amino acid (Pragasam et al., 2005).
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5. PLAN OF WORK
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PLAN OF WORK
Phytochemical and pharmacognostic investigations
Collection of plant
Authentication of plant material
Preparation of aqueous extract of leaves
In vitro studyA gel model for measuring crystallization inhibitor activityNucleation and aggregation assay
Detailed pharmacological investigations of antiurilithic activity
In vivo studySodium oxalate induced urolithiasis model in male rats
Minor project Major project
Fig.7. Plan of work
6. EXPERIMENTAL WORKS AND RESULTS
6.1. PLANT MATERIALS AND EXTRACTION PROCEDURE
Leaves of Adansonia digitata were collected from MHOW, Indore & authentication of
plant was done in BSI, Pune (a voucher specimen number BSI/WC/Tech./2011/900A).
Aqueous extract was prepared by decoction method (temperature 90-95ºC) and was dried
at 37ºC. Yild was found 15.8 % (Pauly, 2001).
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6.2. AGAR GEL MODEL (Schneider et al., 1983)
Fig.8. Diagram of punch-hole pattern (all dimensions in mm) of agar gel model
6.2.1. Protocols For Agar Gel Model
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Group First method Second method
Modifier (70 µL) Modifier (conc. in agar gel)
Control Distilled water Distilled water
Standard Magnesium chloride (100mM) Magnesium chloride (100mM)
Trisodium citrate (100mM) Trisodium citrate (100mM)
Test HA extract (1mg/mL) HA extract (1mg/mL)
HA extract (10mg/mL) HA extract (10mg/mL)
Table 1:Protocols for agar gel model.
6.2.2. Results of Agar Gel Model
College of Pharmacy, IPS Academy 17Fig.9. Pattern of streak of caox cyrstal in agar gel
Crystallization streak’s Pattern
of CaOx crystal produced by
starter solution of 0.3 M CaCl2
and ammonium oxalate in agar
gel with addition of
a. distilled water.
b. 200 mM of MgCl2.
c. 1 mg/mL AAD.
d. 10 mg/mL of AAD.
e. 25 mg/mL of AAD.
f. distilled water.
g. 200 mM of MgCl2.
h. 100 mM of MgCl2.
i. 1 mg/mL of AAD.
j. 10 mg/mL of AAD; n=6
6.3. NUCLEATION AND AGGREGATION ASSAY (Kulaksizoglu et al., 2008 & Hennequin et al.,1993)
The nucleation and aggregation of CaOx were studied at pH 5.7 using
turbidimetric measurment at 620 nm of suspensions produced by mixing calcium
chloride and sodium oxalate (4 mM & 0.5 mM respectively).
Stock solutions (pH 7.5)
• Calcium chloride (8 mM, containing 200 mM NaCl & 10 Mm sodium acetate).
• Sodium oxalate (1 mM, ontaining 200 mM NaCl & 10 Mm sodium acetate).
• Trisodium citrate (0.30 mM) & test solutions (0.2, 2.0 & 20.0) in calcium chloride
stock solution.
All experiments with modifiers of CaOx crystallization were performed at assay
conc. of 4 mM CaCl2, 0.5 mM Na2C2O4, 200 mM NaCl, 10 mM sodium acatate,
0.1, 1.0, 10.0 mg/mL of extract, pH 5.7.
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0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
SN Equilibrium SA
Time (min)
OD
(62
0 nm
)
Fig. 10. Time Course Measurements of OD at 620 nm At Standard Condition of CaOx Crystallization
6.3.1. Results of Nucleation and Aggregation Assay.
Parameters Control StdTest
0.1mg/mL 1.0 mg/mL 10.0 mg/mL
tmax (min)7.96 ± 0.31 12.47 ± 0.54 12.38 ± 0.79 13.22 ± 0.38* 23.68 ± 1.69***
SN (×10-2)1.05 ± 0.04 0.36 ± 0.03** 0.52 ± 0.08 0.41 ± 0.02* 0.23 ± 0.04***
% Inhibition of SN - 65.12 ± 3.70 57.71 ± 5.40 60.42 ± 2.20 77.93 ± 4.10
SA (×10-3)1.24 ± 0.05 0.64 ± 0.06** 0.70 ± 0.02 0.57 ± 0.05*** 0.63 ± 0.05*
% Inhibition of SA - 48.42 ± 5.54 43.41 ± 2.04 53.03 ± 4.95 49.19 ± 4.08
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Table 2: Effect of extract on calcium oxalate crystallization.
*P < 0.05,** P < 0.01,***P < 0.001 vs control (Kruskal-Wallis variance analysis); n=6-9, ± SEM
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Table 3: Treatment Schedule
6.4. ANIMAL MODEL OF SODIUM OXALATE INDUCED UROLITHIATIC IN MALE RATS (Gupta et al., 2006; Khan et al., 1981., Ramesh et al., 2010)
Groups Treatment (daily for7 days)
Normal control 0.9% saline (1 mL/100g, orally & i.p.)
Urolithiactic group NaOx (7 mg/100g, i.p.) + 0.9% saline orally (1 mL/100g)
Standard groupNaOx (7 mg/100g, i.p.) + potassium citrate monohydrate (0.25g/100g, orally)
Treated group NaOx (7 mg/100g, i.p.) + aqueous extract (200mg/kg, orally)
Urine volume, pH, body weight, kidney weight (wet and dry), serum and urine level of creatinine, urea, magnesium, and calcium were evaluated on day 7. In addition, histopathological changes in kidney and oxalate in urine and kidney were evaluated.
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Table 4: Effect of ADD on serum chemistry in control and experimental animals
6.4.2. Results of Sodium Oxalate Induced Urolithiasis
Parameters
(mg/dl)Control
Urolithiactic
Control
PCi treated/
Standard group
ADD Treated
group
Ca++ 10.44 ± 2.36 11.99 ± 0.065 10.26 ± 2.68 12.68 ± 4.96
Mg++ 2.48 ± 0.21 1.63 ± 0.21*** 2.76 ± 0.19### 2.90 ± 0.090###
Urea 8.19 ± 1.03 27.36 ± 5.59*** 14.21 ± 4.75### 11.78 ± 1.69###
Creatinine 0.59 ± 0.19 2.13 ± 0.77** 0.89 ± 0.13### 0.85 ± 0.07##
Data are expressed as mean ± SD of 5 animals per group; * p< 0.05, ** p< 0.01, *** p< 0.001
versus control group; # p< 0.05, ## p< 0.01, ### p< 0.001 versus urolithiatic control; one-way
analysis of variance, ANOVA followed by Newman–Keuls test for multiple comparisons
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Table 5: Effect of AAD on urinary chemistry in control and experimental animals
Parameters Control group Urolithiactic
control
PCi treated/
standard group
ADD treated
group
Vol. (ml/100 g) 6.34 ± 4.11 4.51 ± 0.48 7.78 ± 1.32 6.02 ± 2.06
pH 8.78 ± 0.24 7.30 ± 0.84* 8.97 ± 0.97# 8.85 ± 0.22#
Ca++ (mg/dl) 28.96 ± 4.99 8.31 ± 1.40*** 4.84 ± 3.47*** 3.35 ± 0.89***
Mg++ (mg/dl) 2.50 ± 0.13 2.09 ± 0.10 2.80 ± 0.17# 3.35 ± 0.43###
Ox (µg/dl) 23.94 ± 0.84 29.48 ± 1.15*** 23.83 ± 0.86### 24.35 ± 0.46###
Urea (mg/dl) 1686 ± 667.7 543.3 ± 174.8* 1529.7 ± 261.5# 1830.1 ± 248.1#
Creatinine
(mg/dl)
57.04 ± 15.05 16.92 ±1.43** 55.27 ±9.44## 41.50 ±4.67#
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Table 6: Effect of AAD on kidney weight and chemistry in control and experimental animals
Parameters Control Urolithiactic
Control
PCi treated/
Standard group
ADD Treated
group
Wet Weight (mg/100 g) 385.00 ± 17.65 674.60 ± 62.87*** 474.70 ± 75.02### 527.80 ± 36.19###
Dry Weight (mg/100 g) 104.90 ± 9.46 127.80 ± 9.79** 95.09 ± 12.73## 100.60 ± 13.47##
Width (mm) 7.40 ± 0.89 11.80 ± 0.83*** 9.00 ± 0.70### 9.80 ± 0.83##
length (mm) 13.80 ± 1.30 19.00 ± 0.70** 14.00 ± 3.08## 14.80 ± 2.77##
Ox (µg/100 mg) 3.642 ± 0.22 6.12 ± 1.96* 4.41 ± 0.57# 3.59 ± 0.45#
Ca++ (mg/100 mg) 0.49 ± 0.22 1.34 ± 0.48** 0.75 ± 0.16# 0.76 ± 0.13#
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Fig .11. Light microscopic of H & E stained kidney section
Renal tissue of a. Control group’s rats showing normal kidney parenchyma with glomerulus, peroximal and distal convoluted tubules with normal brush-broder and intact glomeruli (×100). b. Control group’s rats showing no sign of crystallization (×400) . c Urolithiatic rats showing focal areas of necrosis, infiltration of inflammatory cells and atrophy glomerulus (×100). d. Urolithiatic rats showing deposition of numerous crystals and presence of casts and extensive haemorrhages in collecting tubules (×400). e. Urolithiatic rats showing deposition of salt of calcium, extensive atrophy of tubular lumen as well as dialated tubules (×400). f. Urolithiatic rats showing extensive haemorrhages and infiltration of inflammatory cells (×400). g. PCi treated rats showed moderate haemorrhage and absence of CaOx crystals (×100). h. PCi treated rats showing regeneration of tubules with large hyperchromic nuclei (×400). i. AAD treated animals showing highly regenerating tubules with normal brush-broder and absence of CaOx crystals (×100). j. AAD treated animals showing no deposition of crystals with rare tissue injury (×400).
7. CONCLUSIONS
7.1. CONCLUSIONS
Extract of leaves of Adansonia digitata could act as antilithic agent , by inhibiting
nucleation and aggregation of calcium oxalate crystals.
High binding of extract with oxalate could prevent dietary absorption of oxalate
form intestine.
In conclusion, based on our present results it seems that AAD contains several
active compounds which in a multifunctional/synergistic approach act as
antiurolithic. The mechanism underlying this effect is mediated possibly through an
antioxidant, antimicrobial, and/or anti-inflammatory activities contained in ADD
and presence of inhibitors of CaOx crystallization like magnesium and acidic amino
acids. In vitro and in vivo experiments confirm that AAD could be beneficial in the
management of CaOx stone disease.
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