Recent advances in the herbal treatment of non-alcoholic Fatty liver disease

Global publication trends and research hotspots of nonalcoholic fatty liver disease: a bibliometric analysis and systematic review

With the globally increasing prevalence, nonalcoholic fatty liver disease (NAFLD) becomes the predominant cause of chronic liver disease. A global look at the publication trends and the research hotspots of NAFLD are urgently needed to assess the situation of NAFLD research. The global scientific research in the Science Citation Index-Expanded covered articles relevant to NAFLD was retrieved and its bibliometric parameters and research hotspots of NAFLD were systematically evaluated. To sum up, 6356 articles were published in 994 different journals covering 93 SCI subject categories during 1986–2013, in which English was the most predominant language used. Starting from the late 1980s, the publication on NAFLD grew slowly and entered into a highly developing period in the 21st century, especially in the last decade. Besides hepatic steatosis, metabolic syndrome and its combination of symptoms such as obesity, insulin resistance are listed as the top frequent keywords. Bibliometric results suggest that the obviously rapid growth of the articles in recent years appears to be associated with the accelerating incidence of NAFLD and its cofactors such as metabolic syndrome. In addition, epidemiology focusing on comparing different regions and population is attracting ever-growing attention. Meantime, pathology plays an important role in NAFLD research.

Dietary supplements and pediatric non-alcoholic fatty liver disease: Present and the future

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. High prevalence of pediatric obesity and sedentary lifestyle has augmented the incidence of NAFLD in children. Obesity is associated with an increased risk of NAFLD through various mechanisms such as intensification of insulin resistance and increased levels of inflammatory markers. There is no approved medical intervention for treatment of pediatric NAFLD; the only proven strategy in management of pediatric NAFLD is lifestyle modification. Recently, the effects of nutritional supplements have been examined in the management of pediatric NAFLD. The purpose of this review is to summarize the studies evaluating the effects of nutritional supplements on pediatric NAFLD and explain the future direction in this field.

Effects of Soothing Liver and Invigorating Spleen Recipes on the IKKβ-NF-κB Signaling Pathway in Kupffer Cells of Nonalcoholic Steatohepatitis Rats

This study investigates the effect of soothing liver and invigorating spleen recipes on steatohepatitis examining the IKKβ-NF-κB signaling pathway in KCs of NASH rats. SD male rats were randomly divided into 8 groups, and the NASH model was induced by a high-fat diet (HFD). After 26 weeks, liver tissue was examined in H&E stained sections and liver function was monitored biochemically. KCs were isolated by Seglen's method, with some modifications. The mRNA and protein expression of the IKKβ-NF-κB signaling pathway components was examined by quantitative PCR and Western blotting. The results show that the high-fat diet induced NASH in the rats, and the soothing liver recipe and invigorating spleen recipe decreased the levels of TNF-α, IL-1, and IL-6 in KCs, as well as inhibiting the mRNA and protein expression of the IKKβ-NF-κB signaling pathway components. In conclusion, the experiment indicated the importance of the IKKβ-NF-κB signaling pathway in KCs for the anti-inflammatory effects of the soothing liver and invigorating spleen recipes.

Glycyrrhizin ameliorates metabolic syndrome-induced liver damage in experimental rat model

Glycyrrhizin, a major constituent of licorice (Glycyrrhiza glabra) root, has been reported to ameliorate insulin resistance, hyperglycemia, dyslipidemia, and obesity in rats with metabolic syndrome. Liver dysfunction is associated with this syndrome. The objective of this study is to investigate the effect of glycyrrhizin treatment on metabolic syndrome-induced liver damage. After induction of metabolic syndrome in rats by high fructose (60%) diet for 6 weeks, the rats were treated with glycyrrhizin (50 mg/kg body weight, single intra-peritoneal injection). After 2 weeks of treatment, rats were sacrificed to collect blood samples and liver tissues. Compared to normal, elevated activities of serum alanine transaminase, alkaline phosphatase and aspartate transaminase, increased levels of liver advanced glycation end products, reactive oxygen species, lipid peroxidation, protein carbonyl, protein kinase Cα, NADPH oxidase-2, and decreased glutathione cycle components established liver damage and oxidative stress in fructose-fed rats. Activation of nuclear factor κB, mitogen-activated protein kinase pathways as well as signals from mitochondria were found to be involved in liver cell apoptosis. Increased levels of cyclooxygenase-2, tumor necrosis factor, and interleukin-12 proteins suggested hepatic inflammation. Metabolic syndrome caused hepatic DNA damage and poly-ADP ribose polymerase cleavage. Fluorescence-activated cell sorting using annexin V/propidium iodide staining confirmed the apoptotic hepatic cell death. Histology of liver tissue also supported the experimental findings. Treatment with glycyrrhizin reduced oxidative stress, hepatic inflammation, and apoptotic cell death in fructose-fed rats. The results suggest that glycyrrhizin possesses therapeutic potential against hepatocellular damage in metabolic syndrome.

Resveratrol ameliorates high glucose-induced oxidative stress injury in human umbilical vein endothelial cells by activating AMPK

AIMS

To investigate the effects of resveratrol on high glucose (HG)-induced vascular injury, and to establish the mechanism(s) underlying these effects.

MAIN METHODS

Human umbilical vein endothelial cells (HUVECs) were treated with glucose, and then incubated with resveratrol in the presence or absence of Compound C, an AMP-activated protein kinase (AMPK) inhibitor. Cell viability was determined using the Cell Counting Kit-8 (CCK-8) method. Reactive oxygen species, malondialdehyde, and superoxide dismutase were detected by flow cytometry, thiobarbituric acid reaction, and the nitroblue tetrazolium method, respectively. Protein levels of total and phosphorylated AMPKα and acetyl-CoA carboxylase were detected by immunoblotting.

KEY FINDINGS

Resveratrol significantly ameliorated HG-induced decreases in cell viability and superoxide dismutase levels and increases in reactive oxygen species and MDA levels. Moreover, resveratrol significantly reversed HG-induced dephosphorylation of AMPKα and acetyl-CoA carboxylase. However, treatment with Compound C curtailed the beneficial effects of resveratrol on HG-treated HUVECs.

SIGNIFICANCE

Resveratrol ameliorates HG-induced injury in HUVECs by activation of AMPKα, leading to increased cellular reductive reactions and decreased oxidative stress. These results provide further evidence for resveratrol-mediated activation of AMPKα.

Effects of rosuvastatin and/or β-carotene on non-alcoholic fatty liver in rats

The prevalence of non-alcoholic fatty liver disease (NAFLD) has markedly increased, especially in patients exhibit one or more features of the metabolic syndrome. This study investigates the effect of rosuvastatin (RSV) and/or β-carotene (βC) in NAFLD-induced rats. Rats were classified into nine groups; normal (I), NAFLD-induced with high-fat diet (HFD; II), NAFLD switched to regular diet (RD; III), NAFLD-HFD or NAFLD-RD treated with RSV (IV, V), βC (VI, VII) or both RSV+βC (VIII, IX), respectively. After four weeks, rats were sacrificed to obtain serum samples and liver tissues. Liver histology, lipid profile, liver oxidative stress markers, and adipocytokines were measured. Liver sections of rats with NAFLD-HFD revealed steatosis, lose of hepatic architecture, inflammation and hepatocyte vacuolation with high percentage of cell fibrosis. Serum levels of ALT, AST, ALP, gamma glutamyl transferase (GGT) and lipid profile (triglycerides, cholesterol, LDL and VLDL) were significantly increased (P<0.05) compared with normal. Also, hepatic malondialdehyde level and serum leptin, tumor necrosis factor-alpha (TNF-α) and transforming growth factor-β1 (TGF-β1) were increased. Meanwhile, superoxide dismutase (SOD) activity, GSH content in liver, serum HDL and adiponectin were decreased (P<0.05) vs normal. These changes were observed to a lesser extent in NAFLD-RD group. Administration of RSV or/and βC almost improved all previously mentioned parameters. Moreover, hepatic steatosis was decreased and inflammation was markedly ameliorated with reduction of TNF-α and TGF-β. These results were more pronounced in the groups VIII and IX vs each drug alone. In conclusion RSV and βC could be beneficial for the treatment and prevention of NAFLD. Combined RSV with βC is more effective than RSV alone.

Influence of lipid-lowering decoction on biochemical indexes in rats with nonalcoholic fatty liver disease

AIM: To observe the effect of lipid-lowering decoction (LLD) on malondialdehyde (MDA), superoxide dismutase (SOD), and tumor necrosis factor-α (TNF-α) in rats with nonalcoholic fatty liver disease (NAFLD).

METHODS: Fifty-eight male SD rats were fed a high-fat diet (HFD) for 16 wk to induce NAFLD, and 13 male SD rats were fed a normal diet (ND). After successful induction of NAFLD, NAFLD rats were randomly divided into a model group, a Ganle group, and low-, medium-, and high-dose LLD groups. The LLD groups and Ganle group were given the corresponding drug. After 16 wk, the rats were sacrificed to obtain blood and liver tissue samples for analyzing the levels of liver chemical parameters, blood lipids, liver lipids, MDA, SOD, and TNF-α.

RESULTS: Compared with the model group, the levels of low-density lipoprotein (LDL), total cholesterol (TC), triglyceride (TG), free fatty acids (FFA), alanine transaminase (ALT), and aspartate transaminase (AST) were significantly decreased in the LLD groups, the content of MDA was significantly decreased in the LLD groups (P < 0.01 or P <0 .05), and the levels of TNF-α and SOD were significantly decreased in the high-dose LLD group (P < 0.01). Adipose degeneration was improved in all the three LLD groups, especially prominent in the high-LLD group.

CONCLUSION: LLD can adjust lipid metabolism, improve oxidative stress, and decrease serum TNF-α levels in rats with NAFLD.

Influence of lipid-lowering decoction on hepatic morphology and pathological changes in rats with nonalcoholic fatty liver disease

AIM: To observe the effect of lipid-lowering decoction (LLD) on morphological and pathological changes of liver tissue in rats with nonalcoholic fatty liver disease (NAFLD).

METHODS: Fifty-eight male SD rats were fed a high-fat diet (HFD) for 16 wk to induce NAFLD, and 13 male SD rats were fed a normal diet (ND) as normal controls. After successful induction of NAFLD, 50 NAFLD rats were randomly divided into a model group, low-, medium-, and high-dose LLD groups, and a Ganle group. The LLD groups and Ganle group were given LLD (9.2, 4.6, 2.3 g/kg) and Ganle, respectively. After 16 wk of treatment, liver tissue samples were taken for HE staining to observe the morphological and pathological changes, and NAFLD activity scores (NAS) were calculated based on changes in liver histology.

RESULTS: Compared with the normal group, accumulation of lipid droplets, massive inflammatory cell infiltration and hepatocyte swelling deformation were observed in the liver, and the grade of NAS increased significantly in the model group (5.53 ± 0.58 vs 0.38 ± 0.55, P < 0.01). After intervention with lipid-lowering decoction, there were less significant lipid droplets, inflammatory cell infiltration and hepatocyte swelling in the LLD groups. Furthermore, the grade of NAS decreased significantly in the medium-, high-dose LLD groups and Ganle group (1.05 ± 0.54 vs 5.53 ± 0.58, 0.86 ± 0.45 vs 5.53 ± 0.58, 0.95 ± 0.45 vs 5.53 ± 0.58, P < 0.01) as well as in the low-dose LLD group (2.25 ± 0.54 vs 5.53 ± 0.58, P < 0.05).

CONCLUSION: Lipid-lowering decoction can reduce the pathological injury of liver tissue in rats with NAFLD, thus exerting a protective effect against this disease.

Hepatoprotective effects of lignans extract from Herpetospermum caudigerum against CCl₄-induced acute liver injury in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Herpetospermum caudigerum (HCD) is traditionally used for the treatment of liver diseases, cholic diseases, and dyspepsia as a well-known Tibetan medicine in China. The present study was designed to investigate the hepatoprotective effect of HCD and ascertain its active ingredients and possible mechanism.

MATERIALS AND METHODS

Mice were orally administrated with different parts (seeds, testa and kernel) and fractions of HCD. The hepatoprotective activities of different parts (seeds, testa and kernel) and three fractions (petroleum ether fraction, ethyl acetate fraction and aqueous fraction) with different polarities of HCD and herpetrione (HPE) isolated from HCD were determined using a mouse model of CCl4-induced liver injury based on the analysis of serum ALT and AST activities and the changes of antioxidant parameters like malondialdehyde (MDA) content, glutathione (GSH) level, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities in the liver. Moreover, the chemical analysis of different parts and fractions of HCD was later analyzed by HPLC.

RESULTS

Our results showed that the ethyl acetate fraction and HPE significantly alleviated liver injury as indicated by the decreased levels of serum ALT and AST and reduce the pathological tissue damage induced by CCl4. Moreover, they decreased the MDA content and increased the levels of SOD, GSH and GSH-Px. Chemical analysis indicated that the ethyl acetate fraction were rich in HPE.

CONCLUSIONS

The lignans extract of Herpetospermum caudigerum is effective for the prevention of CCl4-induced hepatic damage in mice and HPE may be partially responsible for the pharmacological effect of hepatoprotection. The hepatoprotective effect may be related to its free radical scavenging effect, inhibiting lipid peroxidation and increasing antioxidant activity.

Effects of Mediterranean diet supplemented with silybin-vitamin E-phospholipid complex in overweight patients with non-alcoholic fatty liver disease

BACKGROUND

Non-alcoholic fatty liver disease is the most common liver disease worldwide.

AIM

The aim of this study is to compare the metabolic effects of the Mediterranean diet versus the diet associated with silybin, phosphatidylcholine and vitamin E complex in overweight patients with non-alcoholic fatty liver disease.

METHODS

Thirty Caucasian overweight patients were randomized into three groups of 10 (Groups A, B and C). A personalized Mediterranean diet was started in Group A and B patients. In association with the diet, Group B patients were given Realsil complex, daily, for 6 months. Group C patients refused any treatment.

RESULTS

We showed that the Mediterranean diet alone, or in association with the Realsil complex, led to the significant variation in BMI, waist circumference, total cholesterol and triglycerides. We also observed a statistically significant decrease in homeostasis model assessment technique in Group B patients.

Retinal structure and function preservation by polysaccharides of wolfberry in a mouse model of retinal degeneration

Retinitis pigmentosa (RP) is a heterogeneous group of inherited disorders caused by mutations in a variety of genes that are mostly expressed by rod cells, which results in initial death of rod photoreceptors followed by gradual death of cone photoreceptors. RP is currently untreatable and usually leads to partial or complete blindness. Here, we explored the potential neuroprotective effects of polysaccharides of wolfberry, which are long known to possess primary beneficial properties in the eyes, on photoreceptor apoptosis in the rd10 mouse model of RP. We found that these polysaccharides provided long-term morphological and functional preservation of photoreceptors and improved visual behaviors in rd10 mice. Moreover, we demonstrated that polysaccharides exerted neuroprotective effects through antioxidant, anti-inflammatory and anti-apoptotic mechanisms. Furthermore, we identified that polysaccharides modulated inflammation and apoptosis partly through inhibition of NF-κB and HIF-1α expressions, respectively. Overall, we demonstrated the synergistic protective effects of polysaccharides in preserving photoreceptors against degeneration in rd10 mice. Our study provides rationale and scientific support on using polysaccharides of wolfberry as one supplementary treatment of RP patients in the future.

Therapeutic potential of traditional chinese medicine on inflammatory diseases

Increased oxidative stress induces inflammation to several tissues/organs leading to cell death and long-term injury. Traditional Chinese Medicine (TCM) with antioxidant, anti-inflammatory, anti-apoptotic, and autophagic regulatory functions has been widely used as preventive or therapeutic strategy in modern medicine. Oxidative stress and inflammation have been widely reported to contribute to cigarette smoke-induced lung inflammation, hepatotoxicity, or sympathetic activation-induced liver inflammation, lipopolysaccharide-induced renal inflammation, and substance P-mediated neurogenic hyperactive bladder based on clinical findings. In this review, we introduce several evidences for TCM treatment including Monascus adlay (MA) produced by inoculating adlay (Cois lachrymal-jobi L. var. ma-yuen Stapf) with Monascus purpureus on lung injury, Amla (Emblica officinalis Gaertn. of Euphorbiaceae family) on hepatotoxin-induced liver inflammation, Virgate Wormwood Decoction (Yīn Chén Hāo tāng) and its active component genipin on sympathetic activation–induced liver inflammation, and green tea extract and its active components, catechins, or a modified TCM formula Five Stranguries Powder (Wǔ Lén Sǎn) plus Crataegi Fructus (Shān Zhā) on hyperactive bladder. The pathophysiologic and molecular mechanisms of TCM on ameliorating inflammatory diseases are discussed in the review.