Lemon juice as an alternative therapy in hypertension in Turkey

Antihypertensive and Vasorelaxant Effects of Citric Acid and Lemon Juice in Spontaneously Hypertensive Rats: In Vivo and Ex Vivo Studies

Hypertension is a key risk factor for heart, brain, and kidney disease development. Fruit consumption has been associated with a decrease in blood pressure. Lemon juice, which contains antihypertensive compounds, may exert antihypertensive effects. However, no research has verified the antihypertensive effects of citric acid, the most abundant ingredient in lemon juice. In the present study, we demonstrated the antihypertensive effects of citric acid and lemon juice by performing single oral administration tests and the aortic ring assay using spontaneously hypertensive rats (SHRs). Single oral doses of both agents markedly reduced the systolic and diastolic blood pressures in the SHRs. In addition, both these agents relaxed the thoracic aorta from the SHRs; however, these effects were notably attenuated by the removal of the aortic endothelium. Orally administered citric acid was rapidly absorbed and metabolized in vivo. Among the functional compounds in lemon juice, citric acid was identified as the primary antihypertensive component. Although more detailed studies are required to validate our findings, the novel functional attributes of citric acid can achieve the normalization of blood pressure when it is consumed via diet.

Utilization of Lemon Peel for the Production of Vinegar by a Combination of Alcoholic and Acetic Fermentations

Lemon peel is the major by-product of lemon juice processing and is currently underutilized. In this study, we explored the feasibility of using lemon peel as a raw material for making vinegar. Lemon peel was homogenized, treated with pectinase (30,000 U/g, 0.1%) at 50 °C for 4 h, and then filtered. The obtained lemon peel juice was first subjected to alcoholic fermentation by Saccharomyces cerevisiae var. FX10, and then acetic fermentation by an acid tolerant Acetobacter malorum, OQY-1, which was isolated from the lemon peels. The juice yield of the lemon peel was 62.5%. The alcoholic fermentation yielded a lemon peel wine with an alcoholic content of 5.16%, and the acetic acid fermentation produced a vinegar with a total acid content of 5.04 g/100 mL. A total of 36 volatile compounds were identified from the lemon vinegar, with some compounds such as esters and some alcohols that increased significantly during alcoholic fermentation while alcohols, terpenoids, and some esters decreased significantly during the fermentations. E-nose and E-tongue analyses coupled with principal component and discriminant factor analyses (PCA and DFA) were able to discriminate the samples at different fermentation stages. Overall, this work demonstrates the potential to transform lemon peel into a valuable product, thus reducing the waste of lemon processing and adding value to the industry.

Profile of hypertension in Turkey: from prevalence to patient awareness and compliance with therapy, and a focus on reasons of increase in hypertension among youths

Hypertension is one of the most common noncommunicable chronic diseases and is an important risk factor for vascular complications. The prevalence of hypertension is very high worldwide, and it is still increasing in low- and middle-income countries. Although some improvements were reported in high-income countries in recent years, there is still much to do to overcome hypertension and its complications. Identically, hypertension is a severe public health issue in Turkey. Approximately one third of the adult population has got hypertension but almost half is unaware of the disease. Children and youths are also affected by the burden of hypertension. Increased body mass index and obesity frequently accompany hypertension in children and adolescents. Major contributors to the disease burden appears to be consumption of high amounts of dietary sodium, lack of appropriate physical activity, increasing weight and obesity. In the last decades, an improvement at disease awareness has been achieved but blood-pressure control rates are still low in Turkey. Traditional and natural products, including lemon juice and garlic, are very popular among patients with concerns regarding medications' side effects. Patients' adherence to therapy differs between regions and increases in parallel with high education level. Decreasing daily salt intake has been shown to reduce the prevalence of hypertension substantially and to prevent cardiovascular and cerebrovascular deaths in a cost effective manner in projection studies. Finally, improving education of patients, which has positive effects on disease awareness, treatment adherence, and blood-pressure control rates, should be considered.

Application of graphene oxide in the adsorption and extraction of bioactive compounds from lemon peel

The bioactive compounds like rutin, naringin, and gallic acid have been separated from lemon peel by graphene oxide (GO). The different influences such as pH values and separation conditions were investigated. Moreover, the samples were characterized by Fourier transform infrared spectroscopy, thermogravimetric analysis, scanning electron microscopy, UV-Vis spectroscopy, and high-performance liquid chromatography. The findings of high-performance liquid chromatography revealed that the adsorbed proportion of rutin by GO was more than naringin and gallic acid so that 66.7% of rutin, 34% of naringin, and 19% of gallic acid from the extract were remarkably adsorbed and separated. Besides, adsorption percentage of these materials by GO was considered 74.8% after five cycles of adsorption-desorption process. On the other hand, we carried out batch experiments in order to study the adsorption mechanism of rutin on the GO since rutin was the highest quantity of bioactive substance in lemon peel. Pseudo-second-order kinetic model and Langmuir isotherm were the best models for describing adsorption process of rutin by GO. Adsorption capacity of rutin by GO was obtained about 21.08 mgg-1. In addition, the physical adsorption of rutin by GO was confirmed by Dubinin-Radushkevich isotherm. This research confirmed that this method for separation of flavonoids is simple and less cost.

Limonin Attenuates LPS-Induced Hepatotoxicity by Inhibiting Pyroptosis via NLRP3/Gasdermin D Signaling Pathway

Lipopolysaccharide (LPS)-induced liver injury is the main factor in acute liver failure. The current study aims to investigate the protection of limonin, an antioxidant compound from citrus fruit, against LPS-induced liver toxicity and elucidate the potential mechanisms. We found that limonin elevated cell viability and reduced LDH release in LPS-treated HepG2 cells. Limonin also inhibited LPS-induced pyroptosis by inhibiting membrane rupture, reducing ROS generation, and decreasing gasdermin D activation. Moreover, limonin inhibited the formation of a NOD-like receptor protein 3 (NLRP3)/Apoptosis-associated speck-like protein containing a CARD (ASC) complex by reducing the related protein expression and the colocalization cytosolic of NLRP3 and caspase-1 and then suppressed IL-1β maturation. Ultimately, we established LPS-induced hepatotoxicity in vivo by using C57BL/6 mice administrated LPS (10 mg/kg) intraperitoneally and limonin (50 and 100 mg/kg) orally. We found that limonin dereased the serum ALT and AST activity and LDH release and increased the hepatic GSH amount in LPS-treated mice. Additionally, the liver histological evaluation revealed that limonin protects against LPS-induced liver damage. We further demonstrated that limonin ameliorated LPS-induced hepatotoxicity by inhibiting pyroptosis via the NLRP3/gasdermin D signaling pathway. In summary, this study uncovered the mechanism whereby limonin mitigated LPS-induced hepatotoxicity and documented that limonin might be a promising candidate drug for LPS-induced hepatotoxicity.

Limonin ameliorates acetaminophen-induced hepatotoxicity by activating Nrf2 antioxidative pathway and inhibiting NF-κB inflammatory response via upregulating Sirt1

BACKGROUND

Limonin, a bioactive compound from citrus plants, exerts antioxidant activities, however its therapeutic potential in acetaminophen (APAP)-induced hepatotoxicity remains unclear.

PURPOSE

Our study aims to investigate the protective effect of limonin on APAP-induced hepatotoxicity and illuminate the underlying mechanisms.

STUDY

design In vitro, we chose L-02 cells to establish in vitro APAP-induced liver injury model. L-02 cells were treated with APAP (7.5 mM) for 24 h after pre-incubation with limonin (10, 25, 50 μM) or NAC (250 μM) for 2 h. In vivo, we used C57BL/6 mice as an in vivo APAP-induced liver injury model. C57BL/6 mice with pre-treatment of limonin (40, 80 mg/kg) or NAC (150 mg/kg) for 1 h, were given with a single dose of APAP (300 mg/kg).

METHODS

After pre-incubation with limonin (10, 25, 50 μM) for 2 h, L-02 cells were treated with APAP (7.5 mM) for 24 h.The experiments in vitro included MTT assay, Annexin V/PI staining, measurement of reactive oxygen species (ROS), quantitative real-time PCR analysis, Western blot analysis, immunofluorescence microscopy and analysis of LDH activity. Transfection of Nrf2 or Sirt1 siRNA was also conducted in vitro. In vivo, C57BL/6 mice with pre-treatment of limonin (40, 80 mg/kg) or NAC (150 mg/kg) for 1 h, were given with a single dose of APAP (300 mg/kg). Mice were sacrificed at 4, 12 h after APAP poisoning, and analysis of ALT and AST in serum, GSH level in liver tissues, liver histological observation and immunohistochemistry were performed.

RESULTS

Limonin increased the cell viability and alleviated APAP-induced apoptosis in hepatocytes. Limonin also inhibited APAP-induced mitochondrial-mediated apoptosis by decreasing the ratio of Bax/Bcl-2, recovery of mitochondrial membrane potential (MMP), inhibiting ROS production and cleavage of caspase-3 in L-02 cells. Moreover, limonin induced activation of Nrf2 and increased protein expression and mRNA levels of its downstream targets, including HO-1, NQO1 and GCLC/GCLM. The inhibition of limonin on apoptosis and promotion on Nrf2 antioxidative pathway were lessened after the application of Nrf2 siRNA. In addition, limonin inhibited NF-κB transcriptional activation, NF-κB-regulated genes and protein expression of inflammatory related proteins iNOS and COX2. Furthermore, limonin increased the protein expression of Sirt1. Sirt1 siRNA transfection confirmed that limonin activated Nrf2 antioxidative pathway and inhibited NF-κB inflammatory response by upregulating Sirt1. Finally, we established APAP-induced liver injury in vivo and demonstrated that limonin alleviated APAP-induced hepatotoxicity by activating Nrf2 antioxidative signals and inhibiting NF-κB inflammatory response via upregulating Sirt1.

CONCLUSION

In summary, this study documented that limonin mitigated APAP-induced hepatotoxicity by activating Nrf2 antioxidative pathway and inhibiting NF-κB inflammatory response via upregulating Sirt1, and demonstrated that limonin had therapeutic promise in APAP-induced liver injury.

Debittering of lemon juice using surface molecularly imprinted polymers and the utilization of limonin

In this work, surface molecularly imprinted polymers (SMIPs) were prepared as a specific sorbent to remove the limonin from the lemon juice for the first time, and then the MIPs containing limonin were directly made into a water-soluble gel to treat inflammation of mice. The resulting polymers were characterized by scanning electron microscopy, transmission electron microscopy and Fourier transform infrared spectrometer spectra. And the polymerization conditions and adsorption performances of the resultant nanomaterials were further investigated in detail. Results showed that the MIPs have higher adsorption capacity (27.72 mg/g) compared with surface molecularly non-imprinted polymers (NIPs) (8.12 mg/g). The selectivity experiment indicated that the polymers had excellent selective recognition for limonin and the selectivity factors were calculated as 2.75 and 1.83 for nomilin and obakunone, respectively. The MIPs were successfully used as adsorbent for selectively removing limonin from lemon juice and the MIPs extracted almost all the limonin from lemon juice according to the HPLC results. Furthermore, the MIPs with limonin were processed into water-soluble gel, which can be used to reduce the inflammation and enhance wound healing of model mice.

Quantitative ethnomedicinal survey of medicinal plants given for cardiometabolic diseases by the non-institutionally trained siddha practitioners of Tiruvallur district, Tamil Nadu, India

ETHNOBOTANICAL RELEVANCE

The burden of cardiometabolic diseases such as dyslipidemia, hyperglycemia, hypertension, visceral obesity and atherosclerotic cardiovascular diseases and the use of traditional medicine for the management of such diseases are high in India; hence there is a need to document and analyze such therapies.

AIM OF THE STUDY

This study documented and analyzed the medicinal plants prescribed for cardiometabolic diseases by the non-institutionally trained siddha practitioners of Tiruvallur district of Tamil Nadu, India.

METHODOLOGY

The field survey was conducted between December 2014 to November 2015. Successive free listing assisted with field-walks was used to interview the informants. After assessing the sampling sufficiency using rarefaction curve analysis, indices such as Informant Consensus Factor (Fic) and Index of Agreement on Remedies (IAR) were calculated for the data. The indicators of informant's medicinal plant knowledge such as Shannon's index, equitability index, etc., were regressed with the demographic profile of the informants.

RESULTS

For this study 70 non-institutionally trained Siddha medical practitioners were approached; the data from 36 practitioners who were treating cardiometabolic diseases were documented. This study recorded the use of 188 species which were used to prepare 368 formulations to treat illnesses categorized under cardiometabolic diseases. In this, 53.04% claims were singletons. Regression analysis showed that single species dominance was reduced and the diversity of medicinal plants was increased with the increase in the age and experience. Increase in the years of formal education increased the equitability in the uses. The plants such as Nelumbo nucifera Gaertn. (cardiovascular diseases), Allium sativum L. (dyslipidemia), Cuminum cyminum L. (hypertension), Macrotyloma uniflorum Verdc. (obesity) and Azadirachta indica A. Juss. (type 2 diabetes) were the highly cited medicinal plants.

CONCLUSION

This survey has identified the plants most commonly used by Siddha practitioners of Tiruvallur district, Tamil Nadu, India for cardiometabolic diseases. The prevalence of chronic, non-communicable metabolic illnesses such as type 2 diabetes, hypertension and obesity are increasing worldwide due to the rapid changes in the lifestyle. These ailments require a life-long care and in such instances, people tend to use complementary therapies in most cases, alongside with conventional therapies. In view of the high use of traditional therapies for treating cardiometabolic illnesses, this study supports the need for more research to evaluate the potential benefits of the treatments and to identify any safety concern.

Bioactive compounds and quality parameters of natural cloudy lemon juices

In this study, bioactive compounds (phenolic and carotenoid) and some quality parameters (color, browning index and hydroxymethylfurfural (HMF)) of natural cloudy lemon juice, pasteurized (90 °C/15 s) and storage stability of concentrated lemon juice (-25 °C/180 days) were carried out. Fifteen phenolic compounds were determined in the lemon juice and the most abounded phenolic compounds were hesperidin, eriocitrin, chlorogenic acid and neoeriocitrin. In generally, phenolic compound concentrations of lemon juice samples increased after the pasteurization treatment. Four carotenoid compounds (β-carotene, β-cryptoxanthin, lutein and zeaxanthin) were detected in natural cloudy lemon juice. Lutein and β-cryptoxanthin were the most abounded carotenoid compounds in the lemon juice. Color values of the lemon juices were not affected by processing and storage periods. HMF and browning index of the lemon juices increased with concentration and storage. According to the results, storing at -25 °C was considered as sufficient for acceptable quality limits of natural cloudy lemon juice.

Relationship between diabetes mellitus, hypertension and obesity, and health-related quality of life in Gaziantep, a central south-eastern city in Turkey

AIMS AND OBJECTIVES

The main goal of nursing care should be to increase health-related quality of life as well as improve the medical status of patients with chronic disease. For this reason, this study aims to evaluate and compare the health-related quality of life of patients with diabetes mellitus, hypertension and obesity in Gaziantep, a south-eastern city in Turkey.

BACKGROUND

Diabetes mellitus, hypertension and obesity are the most decisive factors in terms of adversely affecting health-related quality of life.

DESIGN

A cross-sectional, descriptive design was used.

METHOD

In this study, the research population included a total of 1601 diabetes mellitus, hypertension and obesity patients. To evaluate health-related quality of life of patients, Short Form-36 (SF-36) was used. Student's t-test, one-way anova and chi-square analyses were used for comparisons between groups.

RESULTS

In total, 18·1% of patients had combined obesity, hypertension and diabetes mellitus; 16·1% had hypertension and diabetes mellitus. Approximately 16·1% had only hypertension; 15·4% had obesity and hypertension; 13·3% had diabetes mellitus; 12·7% had obesity and diabetes mellitus; and 8·4% had obesity. The health-related quality of life physical component mean scores of patients with combined obesity and hypertension were lower than that of the other groups (p < 0·05). Health-related quality of life physical component mean scores were determined as 34·5 (SD 0·4), and mental component mean scores were determined as 43·9 (SD 4·4). Health-related quality of life physical component mean scores of moderately active patients were higher, while older age and lower educational and income levels had a negative effect on health-related quality of life (p < 0·05).

CONCLUSION

Diabetes, hypertension and obesity decrease patient health-related quality of life while physical activity increases it. The coexistence of obesity and hypertension, in particular, has a more negative effect on health-related quality of life.

RELEVANCE TO CLINICAL PRACTICE

Patients with hypertension, obesity and diabetes mellitus need professional support from nurse. Frequent health-related quality of life evaluation and support is required for chronic patients, especially for those who are older, have lower educational and income levels and those with more than one chronic disease.

Natural bioactive compounds of Citrus limon for food and health

Citrus genus is the most important fruit tree crop in the world and lemon is the third most important Citrus species. Several studies highlighted lemon as an important health-promoting fruit rich in phenolic compounds as well as vitamins, minerals, dietary fiber, essential oils and carotenoids. Lemon fruit has a strong commercial value for the fresh products market and food industry. Moreover, lemon productive networks generate high amounts of wastes and by-products that constitute an important source of bioactive compounds with potential for animal feed, manufactured foods, and health care. This review focuses on the phytochemistry and the analytical aspects of lemon compounds as well as on the importance for food industry and the relevance of Citrus limon for nutrition and health, bringing an overview of what is published on the bioactive compounds of this fruit.