Effect ofOcimum sanctum (Tulsi) and vitamin E on biochemical parameters and retinopathy in streptozotocin induced diabetic rats

Aldose Reductase as a Key Target in the Prevention and Treatment of Diabetic Retinopathy: A Comprehensive Review

The escalating global prevalence of diabetes mellitus (DM) over the past two decades has led to a persistent high incidence of diabetic retinopathy (DR), necessitating screening for early symptoms and proper treatment. Effective management of DR aims to decrease vision impairment by controlling modifiable risk factors including hypertension, obesity, and dyslipidemia. Moreover, systemic medications and plant-based therapy show promise in advancing DR treatment. One of the key mechanisms related to DR pathogenesis is the polyol pathway, through which aldose reductase (AR) catalyzes the conversion of glucose to sorbitol within various tissues, including the retina, lens, ciliary body and iris. Elevated glucose levels activate AR, leading to osmotic stress, advanced glycation end-product formation, and oxidative damage. This further implies chronic inflammation, vascular permeability, and angiogenesis. Our comprehensive narrative review describes the therapeutic potential of aldose reductase inhibitors in treating DR, where both synthetic and natural inhibitors have been studied in recent decades. Our synthesis aims to guide future research and clinical interventions in DR management.

PhytoSelectDBT: A database for the molecular models of anti-diabetic targets docked with bioactive peptides from selected ethno-medicinal plants

It is of interest to assess the effectiveness of bioactive peptides derived from 41 ethno-medicinal plants, classify them according to their anti-diabetic protein targets (DPP-IV, alpha-amylase, alpha-glucosidase, GRK2, GSK3B, GLP-1R, and AdipoR1), and create a web tool named PhytoSelectDBT by using the top seven peptides per target. If one of the target-based medicinal plant suggestions made by PhytoSelectDBT is unsuccessful, alternative target-based possibilities are presented by PhytoSelectDBT for treating the condition and any other related complications. The results provide a useful resource for the management of type 2 diabetes and emphasize the significance of utilising ethnomedical knowledge for the identification of potent anti-diabetic plants and their peptides. We used molecular docking to investigate interactions between anti-diabetic targets (DPP-IV, alpha-amylase, alpha-glucosidase, GRK2, GSK3B, GLP-1R, and AdipoR1) and projected bioactive peptides from 41 ethnomedicinal plants. All bioactive peptides were cross-checked against several databases to determine their allergenicity, toxicity, and cross-reactivity. The presence of B and T cell epitopes was also examined in all simulated digested bioactive peptides for reference. This data is archived at the PhytoselectDBT database.

Natural Compounds as Source of Aldose Reductase (AR) Inhibitors for the Treatment of Diabetic Complications: A Mini Review

BACKGROUND

Aldol reductase (AR) is the polyol pathway's main enzyme that portrays a crucial part in developing 'complications of diabetes' involving cataract, retinopathy, nephropathy, and neuropathy. These diabetic abnormalities are triggered tremendously via aggregation of sorbitol formation (catalyzed by AR) in the polyol pathway. Consequently, it represents an admirable therapeutic target and vast research was done for the discovery of novel molecules as potential AR inhibitors for diabetic complications.

OBJECTIVE

This review article has been planned to discuss an outline of diabetic complications, AR and its role in diabetic complications, natural compounds reported as AR inhibitors, and benefits of natural/plant derived AR inhibitors for the management of diabetic abnormalities.

RESULTS

The goal of AR inhibition remedy is to stabilize the increased flux of blood glucose and sorbitol via the 'polyol pathway' in the affected tissues. A variety of synthetic inhibitors of AR have been established such as tolrestat and sorbinil, but both of these face limitations including low permeability and health problems. Pharmaceutical industries and other scientists were also undertaking work to develop newer, active, and 'safe' AR inhibitors from natural sources. Therefore, several naturally found molecules were documented to possess a potent inhibitory action on AR activity.

CONCLUSION

Natural inhibitors of AR appeared as harmless pharmacological agents for controlling diabetic complications. The detailed literature throughout this article shows the significance of herbal extracts and phytochemicals as prospective useful AR inhibitors in treating diabetic complications.

Recent advances in intraocular and novel drug delivery systems for the treatment of diabetic retinopathy

Introduction: Diabetic retinopathy (DR) is associated with damage to the retinal blood vessels that lead eventually to vision loss. The existing treatments of DR are invasive, expensive, and cumbersome. To overcome challenges associated with existing therapies, various intraocular sustained release and novel drug delivery systems (NDDS) have been explored.Areas covered: The review discusses recently developed intraocular devices for sustained release of drugs as well as novel noninvasive drug delivery systems that have met a varying degree of success in local delivery of drugs to retinal circulation.Expert opinion: The intraocular devices have got very good success in providing sustained release of drugs in patients. The development of NDDS and their application through the ocular route has certainly provided an edge to treat DR over existing therapies such as anti-VEGF administration but their success rate is quite low. Moreover, most of them have proved to be effective only in animal models. In addition, the extent of targeting the drug to the retina still remains variable and unpredictable. The toxicity aspect of the NDDS has generally been neglected. In order to have successful commercialization of nanotechnology-based innovations well-designed clinical research studies need to be conducted to evaluate their clinical superiority over that of the existing formulations.

Current Advances in Pharmacotherapy and Technology for Diabetic Retinopathy: A Systematic Review

Diabetic retinopathy (DR) is classically defined by its vascular lesions and damage in the neurons of the retina. The cellular and clinical elements of DR have many features of chronic inflammation. Understanding the individual cell-specific inflammatory changes in the retina may lead to novel therapeutic approaches to prevent vision loss. The systematic use of available pharmacotherapy has been reported as a useful adjunct tool to laser photocoagulation, a gold standard therapy for DR. Direct injections or intravitreal anti-inflammatory and antiangiogenesis agents are widely used pharmacotherapy to effectively treat DR and diabetic macular edema (DME). However, their effectiveness is short term, and the delivery system is often associated with adverse effects, such as cataract and increased intraocular pressure. Further, systemic agents (particularly hypoglycemic, hypolipidemic, and antihypertensive agents) and plants-based drugs have also provided promising treatment in the progression of DR. Recently, advancements in pluripotent stem cells technology enable restoration of retinal functionalities after transplantation of these cells into animals with retinal degeneration. This review paper summarizes the developments in the current and potential pharmacotherapy and therapeutic technology of DR. Literature search was done on online databases, PubMed, Google Scholar, clinitrials.gov, and browsing through individual ophthalmology journals and leading pharmaceutical company websites.

Effect of thiamine pyrophosphate on retinopathy induced by hyperglycemia in rats: A biochemical and pathological evaluation

Purpose:

Information is lacking on the protective effects of thiamine pyrophosphate (TPP) against hyperglycemia-induced retinopathy in rats. This study investigated the biochemical and histopathological aspects of the effect of TPP on hyperglycemia-induced retinopathy induced by alloxan in rats.

Materials and Methods:

The rats were separated into a diabetic TPP-administered group (DTPG), a diabetes control group (DCG) and a healthy group (HG). While the DTPG was given TPP, the DCG and HG were administered distilled water as a solvent at the same concentrations. This procedure was repeated daily for 3 months. At the end of this period, all of the rats were euthanized under thiopental sodium anesthesia, and biochemical and histopathological analyses of the ocular retinal tissues were performed. The results of the DTPG were compared with those of the DCG and HG.

Results:

TPP prevented hyperglycemia by increasing the amount of malondialdehyde and decreasing endogen antioxidants, including total glutathione, glutathione reductase, glutathione S-transferase and superoxide dismutase. In addition, the amounts of the DNA oxidation product 8-hydroxyguanine were significantly lower in the retinas of the DTPG compared to the DCG. In the retinas of the DCG, there was a marked increase in vascular structures and congestion, in addition to edema. In contrast, little vascularization and edema were observed in the DTPG, and there was no congestion. The results suggest that TPP significantly reduced the degree of hyperglycemia-induced retinopathy.

Conclusions:

The results of this study indicate that TPP may be useful for prophylaxis against diabetic retinopathy.

Clinical biomarkers and molecular basis for optimized treatment of diabetic retinopathy: current status and future prospects

Diabetic retinopathy is a highly specific microvascular complication of diabetes and a leading cause of blindness worldwide. It is triggered by hyperglycemia which causes increased oxidative stress leading to an adaptive inflammatory assault to the neuroretinal tissue and microvasculature. Prolonged hyperglycemia causes increased polyol pathway flux, increased formation of advanced glycation end-products, abnormal activation of signaling cascades such as activation of protein kinase C (PKC) pathway, increased hexosamine pathway flux, and peripheral nerve damage. All these changes lead to increased oxidative stress and inflammatory assault to the retina resulting in structural and functional changes. In addition, neuroretinal alterations affect diabetes progression. The most effective way to manage diabetic retinopathy is by primary prevention such as hyperglycemia control. While the current mainstay for the management of severe and proliferative diabetic retinopathy is laser photocoagulation, its role is diminishing with the development of newer drugs including corticosteroids, antioxidants, and antiangiogenic and anti-VEGF agents which work as an adjunct to laser therapy or independently. The current pharmacotherapy of diabetic retinopathy is incomplete as a sole treatment option in view of limited efficacy and short-term effect. There is a definite clinical need to develop new pharmacological therapies for diabetic retinopathy, particularly ones which would be effective through the oral route and help recover lost vision. The increasing understanding of the mechanisms of diabetic retinopathy and its biomarkers is likely to help generate better and more effective medications.

Compound Danshen Dripping Pill for Treating Early Diabetic Retinopathy: A Randomized, Double-Dummy, Double-Blind Study

This randomized, double-dummy, double-blind study was to observe the therapeutic effects of compound Danshen dripping pill (CDDP) in treating early diabetic retinopathy (DR). All the 57 type 2 diabetes cases in nonproliferative diabetic retinopathy (NPDR) stage were divided into two groups randomly: 28 cases treated with CDDP as the treated group and 29 cases treated with calcium dobesilate as the control group. The best corrected visual acuity (BCVA) in the treated group was significantly improved after treatment when compared to that before treatment (P < 0.05). Mean defect (MD) of visual field, hemorrhage area of the fundus, microaneurysm number, fluorescent leakage area, and capillary nonperfusion area evaluated by visual field, fundus photography, and fundus fluorescein angiography in the treated group had the same results as BCVA. However, there was no statistical difference in each index between the two groups. No obvious adverse events with clinical significance occurred. Our present study showed that CDDP has a similar improvement and safety to calcium dobesilate for NPDR. In future DR treatments, CDDP may function as the auxiliary drug.

Plants used in the management of diabetic complications

Diabetes is a disease, which has assumed vital public health importance because of the complications associated with it. Various mechanisms including polyol pathway along with a complex integrating paradigm have been implicated in glucose-mediated complications. Though polyol pathway was established as a major mechanism, precise pathogenesis of these complications is not yet completely elucidated. Thus research focus was shifted towards key enzyme, aldose reductase in the pathway. Even though various compounds with aldose reductase inhibitory activity were synthesised, a very few compounds are under clinical use. However, studies on these compounds were always under conflicting results and an attempt has been made to review various natural substances with aldose reductase inhibitory activity and their role in management of diabetic complications.

Double-blind, placebo-controlled clinical evaluation of an Ayurvedic formulation (GlucoCare capsules) in non-insulin dependent diabetes mellitus

Diabetes mellitus describes a metabolic disorder of multiple etiologies characterized by insulin resistance, relative insulin deficiency and hyperglycemia with disturbances of carbohydrate, fat and protein metabolism. The goal for treatment of diabetes is to prevent its acute manifestations and long-term microvascular and macrovascular complications. The present study was conducted to evaluate the efficacy and safety of an Ayurvedic formulation (GlucoCare Capsules) in non-insulin dependent diabetes mellitus. Fifty NIDDM patients of pitta-kapha prakriti attending the outpatient department of the Government Ayurvedic Medical College, Guwahati, Assam, India were included in the study, and randomly divided into 2 groups, GlucoCare and placebo. All received either GlucoCare or placebo in a dose of 2 capsules twice daily, before meals for 3 months. All 50 patients completed the study - no drop outs, withdrawals or patients lost to follow up. The GlucoCare group showed significant improvement in symptoms from the 2(nd) month till the end of the study. GlucoCare was well tolerated by all patients throughout the treatment period with no evidence of adverse effects. The study indicates clinical efficacy of GlucoCare Capsules in the management of NIDDM in those belonging to pitta-kapha prakriti. The formulation is well tolerated and appears safe in the dosage used.

Oxidative stress induced by lead and antioxidant potential of certain adaptogens in poultry

Effect of lead was studied for its action on antioxidant defense in broilers. A total of 225 one-day-old male broiler chicks (Vencobb strain) were divided randomly into 15 groups consisting of 15 chicks in each group. Group 1 was maintained on basal diet, group 2 on polyherbal formulation (PHF; stressroak), group 3 on shilajit, group 4 on amla, and group 5 on vitamin E + selenium (Se). Group 6 was maintained on lead for 42 days (6 weeks) and group 7 on lead for 28 days and subsequently on basal diet without lead for the remaining two weeks. Groups 8, 9, 10, and 11 were given lead along with PHF, shilajit, amla, and vitamin E + Se, respectively throughout the experiment for 6 weeks. Groups 12, 13, 14, and 15 were given lead containing diet for the first four weeks (28 days) and subsequently treated with PHF, shilajit, amla, and vitamin E + Se, respectively for the remaining two weeks. Antioxidant status of the birds was analyzed by assaying blood samples for glutathione (GSH) peroxidase, GSH reductase, and catalase at the end of fourth and sixth weeks, whereas Thiobarbituric acid reacting substances (TBARS) and GSH concentrations were estimated in liver homogenate at the end of the sixth week. The antioxidant defense parameters were significantly altered in toxic control groups indicating the possible oxidative damage caused by lead, whereas the parameters were normal in control groups 1 to 5 and other groups that were given the drugs in test, indicating their good ameliorating activity in oxidative stress.

Cadmium-induced Oxidative Stress and Evaluation of Embilica Officinalis and Stressroak in Broilers

Cadmium (Cd) toxicity was studied in broilers, and efficacy of Emblica officinalis (500 ppm in feed), vitamin E (300 ppm in feed), and stressroak (1 g/kg feed) were evaluated for prophylactic and therapeutic management of Cd toxicity. One-day-old male broiler chicks were randomly divided into eight groups consisting of 10 chicks in each. Groups 1 and 2 were maintained as plain control and Cd (100 ppm in feed) toxic control (for six weeks). Groups 3, 4, and 5 were maintained on a combination of Cd (100 ppm in feed) and Emblica officinalis, vitamin E, and stressroak for six weeks. Groups 6, 7, and 8 were maintained with Cd for the first four weeks and on Emblica officinalis, vitamin E, and stressroak during the subsequent two weeks without Cd. Body weights, feed consumed, Feed conversion ratio (FCR), and glulathione (GSH) were significantly (P<0.05) decreased, whereas the activities of antioxidant enzymes (catalase and Superoxide dismutase (SOD)) and concentration of Thiobarbituric acid reacting substances (TBARS) were significantly (P<0.05) increased in toxic control group. After treatment with Emblica officinalis, vitamin E, and stressroak in groups 6, 7, and 8 during last two weeks and discontinuation of Cd, the parameters revealed improvement. From this study, it is concluded that Cd induces toxicity by oxidative stress, and supplementing Emblica officinalis, vitamin E, and stressroak in feed is useful in preventing and treating the toxicity.

Therapy with methanolic extract of Pterocarpus marsupium Roxb and Ocimum sanctum Linn reverses dyslipidemia and oxidative stress in alloxan induced type I diabetic rat model

Methanolic extracts of Pterocarpus marsupium Roxb (P. marsupium) and Ocimum sanctum Linn (O. sanctum) were prepared separately and then administered to both non-diabetic and alloxan induced diabetic adult female Wistar rats as a mixture of both at a dosage of 500mg/kg body weight, and its effect was checked on serum and tissue lipids together with corticosterone, estrogen and progesterone profile. Further, tissue load of metabolites (cholesterol), enzymatic and non-enzymatic antioxidant status together with lipid peroxidation levels and serum markers of hepatic and renal damage were also assessed. Results of the present study strongly support the possibility of this herbal combination in humans to meet the objective of achieving a holistic amelioration and cure of diabetes as, the herbal extract mixture of P. marsupium and O. sanctum has succeeded in not only rectifying dyslipidemia but also in restoring the endogenous antioxidant levels to the pre diabetic status. Herbal preparations are ideal candidates of choice and in this context, the present combination of P. marsupium and O. sanctum provides compelling evidence for a holistic efficacy in amelioration of associated diabetic manifestations/dysregulations.