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Sial NT, Malik A, Iqbal U, Rehman MFU. Arbutin attenuates CFA-induced arthritis by modulating expression levels of 5-LOX, NF‑κB, IL-17, PGE-2 and TNF-α. Inflammopharmacology 2024; 32:2377-2394. [PMID: 38748385 DOI: 10.1007/s10787-024-01480-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/07/2024] [Indexed: 08/06/2024]
Abstract
Arbutin, a naturally soluble glycosylated phenol has antioxidant, antimicrobial, antitumor and anti-inflammatory properties. The current exploration appraises the treatment of arthritis by use of Arbutin (25, 50 and 100 mg/kg) orally in CFA-induced rat arthritis model. Body weight changes, paw size, and joint diameter were recorded till the 28th day in the arthritic-induced rats. Hematological, biochemical, oxidative and inflammatory biomarkers were measured through the blood samples of anesthetized rats. Arbutin markedly decreased paw volume, PGE-2, anti-CCP and 5-LOX levels, however, maintained metabolic and hematological balance and prevented weight loss. Radiology and histology changes improved significantly in the ankle joints of rats. Moreover, Arbutin increased gene pointers such as IL-10 and IL-4 while significantly reducing the levels of CRP and WBCs, whereas Hb, platelets and RBCs count markedly raised in post-treatments. Antioxidant levels of SOD, CAT and GSH were improved and MDA level was reduced in treated groups. Rt-PCR investigation showed a significant reduction of the interleukin-1β, TNF-α, interleukin-6, cyclooxygenase-2, NF-κB and IL-17 and increased expression of gene pointers like IL-4, and IL-10 in treated groups. Assessment of molecular docking revealed a strong binding interaction of Arbutin against 5-LOX, IL-17, TNF-alpha and interleukin-6, cyclooxygenase-2, nuclear factor-κB, IL-4 and iNOS providing a strong association between experimental and theoretical results. As a result, Arbutin has significantly reduced CFA-induced arthritis by modulation of anti-inflammatory cytokines, i.e., IL-10 and IL-4, the pro-inflammatory cytokines panel such as NF-κB, TNF-alpha, IL-1β, IL-6, PGE-2, 5-LOX and COX-2 and oxidative biomarkers.
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Affiliation(s)
- Nabeela Tabassum Sial
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, 40100, Pakistan
- Department of Pharmacology, Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Jail Road, Lahore, 54000, Pakistan
| | - Abdul Malik
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, 40100, Pakistan.
| | - Urooj Iqbal
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, 40100, Pakistan
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2
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Al-Joufi FA, Uttra AM, Qasim S, Iqbal U, Sial NT, Alhumaid NM. Anti-arthritic and immunomodulatory efficacy of Micromeria biflora Benth extract and its fractions in rats by restoring oxidative stress, metalloproteinases, pro-inflammatory and anti-inflammatory cytokines network. Inflammopharmacology 2024; 32:2477-2491. [PMID: 38717557 DOI: 10.1007/s10787-024-01479-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/24/2024] [Indexed: 08/06/2024]
Abstract
Micromeria biflora (M.B) Benth has proven anti-inflammatory efficacy, thereby, the goal of the current investigation was to assess the anti-arthritic potential of M.B ethanolic extract and fractions as well as to investigate the likely mechanism of action. The effectiveness of M.B against acute arthritic manifestations was assessed using an arthritic model prompted by formaldehyde, whereas a chronic model was developed using an adjuvant called Complete Freund's in Sprague-Dawley rats. Weekly evaluations were conducted for parameters involving paw volume, body weight, and arthritic score; at the completion of the CFA model, hematological, biochemical and oxidative stress parameters as well as the level of various mediators (PGE2, IL-1β, TNFα, IL6, MMP2, 3, 9, VEGF, NF-ĸB, IL-10, and IL-4) were evaluated. The results demonstrated the plant's ability to treat arthritis by showing a significant decrease in paw volume, arthritic score, and histological characteristics. The levels of NF-ĸB, MMP2, 3, 9, IL6, IL1β, TNFα, and VEGF were all significantly reduced after treatment with plant extract and fractions. Plant extract and its fractions substantially preserved body weight loss, oxidative stress markers and levels of IL-4 and 1L-10. PGE2 levels were also shown to be reduced in the treatment groups, supporting the M.B immunomodulatory ability. Hematological and biochemical indicators were also normalized after M.B administration. Outcomes of the study validated the anti-arthritic and immunomodulatory attributes of M.B probably through modulating oxidative stress, inflammatory, pro-inflammatory and anti-inflammatory biomarkers.
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Affiliation(s)
- Fakhria A Al-Joufi
- Department of Pharmacology, College of Pharmacy, Jouf University, 72341, Aljouf, Saudi Arabia
| | - Ambreen Malik Uttra
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, Pakistan.
| | - Sumera Qasim
- Department of Pharmacology, College of Pharmacy, Jouf University, 72341, Aljouf, Saudi Arabia.
| | - Urooj Iqbal
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, Pakistan
| | - Nabeela Tabassum Sial
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, Pakistan
- Faculty of Pharmaceutical and Allied Health Sciences, Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Noura M Alhumaid
- College of Pharmacy, Jouf University, 72341, Aljouf, Saudi Arabia
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Jabbar Z, Irfan HM, Alamgeer, Ullah A, Mahmoud MH, Batiha GE, Ahsan H, Khan A, Kashtoh H. Trans-Chalcone (1-3-diphenyl-2-propen-1-one) as a Therapeutic Candidate in Joint Inflammation via Reduction of TNF-α, IL-1β, IL-6, and IL-17 in Rodents: An In Vivo Study by RT-PCR and ELISA analysis. ACS OMEGA 2024; 9:22123-22135. [PMID: 38799342 PMCID: PMC11112584 DOI: 10.1021/acsomega.4c00368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024]
Abstract
Autoimmune disorders include vast and distinct illnesses and are characterized by an immune system-mediated attack on the body's own tissues. Because of their ability to impact any portion of the body, their clinical symptoms are incredibly varied. The variations in symptoms are normally linked with the release and activation of vasoactive, chemotactic substances and cytokines. Cytokines perform a multitude of vital biological tasks, such as immune response control, inflammation, proliferation, and tissue repair. The reversal of inflammatory cytokines and leukocyte infiltration into the inflamed tissue by natural compounds provides an effective remedy for autoimmune diseases. Here, the oral administration of trans-chalcone (TC) for 28 days was tested with gradually increasing doses (30, 60, and 120 mg/kg) in complete Freund's adjuvant (CFA)-provoked joint tissue stiffness in rats. Paw edema, arthritic index, joint stiffness, thermal and flexion pain, C-reactive protein, and rheumatoid factor (RF) levels were determined to check the tested drug effectiveness in a chronic inflammatory model. Molecular docking studies revealed strong binding affinity with inflammatory cytokines and mediators such as TNF-α, IL-17, COX-2, and iNOS; further, they were quantified at the mRNA level by RT-PCR and ELISA analysis. Oral administration of TC significantly ameliorated paw edema, thymus and spleen indices, joint stiffness, thermal and flexion pain, C-reactive protein, RF, mobility, and stance of the treated animals. This therapeutic effectiveness was linked with a reduction in the mRNA expression of proinflammatory cytokines such as IL-1β, IL-6, and IL-17. The findings of the reported research confirmed the effectiveness of TC in ameliorating joint stiffness and flexion pain by prominently lowering the inflammatory cytokines.
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Affiliation(s)
- Zeeshan Jabbar
- College
of Pharmacy, University of Sargodha, 40100 Sargodha, Pakistan
| | - Hafiz M. Irfan
- College
of Pharmacy, University of Sargodha, 40100 Sargodha, Pakistan
| | - Alamgeer
- Punjab
University College of Pharmacy, University
of the Punjab, 54000 Lahore, Pakistan
| | - Aman Ullah
- Department
of Pharmacy, Saba Medical Centre, Abu Dhabi P.O. Box 20316, United Arab Emirates
| | - Mohamed H. Mahmoud
- Department
of Biochemistry, College of science, King
Saud University, 4545 Riyadh, Kingdom
of Saudi Arabia
| | - Gaber E. Batiha
- Department
of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511 AlBeheira, Egypt
| | - Haseeb Ahsan
- College
of Pharmacy, University of Sargodha, 40100 Sargodha, Pakistan
- Division
of Blood and Marrow Transplantation, Department of Pediatrics, School
of Medicine, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Ajmal Khan
- Natural
and Medical Sciences Research Center, University
of Nizwa, Nizwa 616, Oman
| | - Hamdy Kashtoh
- Department
of Biotechnology, Yeungnam University, Gyeongsan 38541, Gyeongbuk, Republic
of Korea
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Shakirova V, Markelova M, Davidyuk Y, Stott-Marshall RJ, Foster TL, Khaiboullina S, Rizvanov A, Martynova E. Rosuvastatin as a Supplemental Treatment for the Clinical Symptoms of Nephropathia Epidemica: A Pilot Clinical Study. Viruses 2024; 16:306. [PMID: 38400081 PMCID: PMC10892398 DOI: 10.3390/v16020306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Nephropathis epidemica (NE), a mild form of hemorrhagic fever with renal syndrome (HFRS), is an acute zoonotic disease endemic in the Republic of Tatarstan. This study aimed to assess the impact of rosuvastatin on the clinical and laboratory results of NE. A total of 61 NE patients and 30 controls were included in this study; 22 NE patients and 7 controls received a daily dose of rosuvastatin (10 mg) for ten consecutive days. Serum samples were collected on days 1, 5, and 10 after admission to the hospital. These samples were analyzed to determine the levels of lipids, cytokines, and kidney toxicity markers. Our findings indicate that rosuvastatin reduced the duration of the second wave of fever and alleviated back pain and headache symptoms. Additionally, low-density lipoprotein cholesterol (LDL-C) serum levels were significantly decreased on days 5 and 10 upon rosuvastatin treatment. Furthermore, rosuvastatin decreased the levels of cytokines in the serum, particularly proinflammatory cytokines IL-1β and IL-8. NE patients had significantly altered levels of the kidney toxicity markers albumin and osteopontin. The data from our study provide evidence supporting the therapeutic potential of rosuvastatin in NE cases.
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Affiliation(s)
- Venera Shakirova
- Department of Infection Diseases, Kazan State Medical Academy, Kazan 420012, Russia;
| | - Maria Markelova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia; (M.M.); (Y.D.); (S.K.); (A.R.)
| | - Yuriy Davidyuk
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia; (M.M.); (Y.D.); (S.K.); (A.R.)
| | - Robert J. Stott-Marshall
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK; (R.J.S.-M.); (T.L.F.)
| | - Toshana L. Foster
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK; (R.J.S.-M.); (T.L.F.)
| | - Svetlana Khaiboullina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia; (M.M.); (Y.D.); (S.K.); (A.R.)
| | - Albert Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia; (M.M.); (Y.D.); (S.K.); (A.R.)
| | - Ekaterina Martynova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia; (M.M.); (Y.D.); (S.K.); (A.R.)
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Elshabrawy HA, Abo Dena AS, El-Sherbiny IM. Triple-layered platform utilizing electrospun nanofibers and 3D-printed sodium alginate-based hydrogel for effective topical treatment of rheumatoid arthritis. Int J Biol Macromol 2024; 259:129195. [PMID: 38184049 DOI: 10.1016/j.ijbiomac.2023.129195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/08/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
Rheumatoid arthritis (RA), an autoimmune disease impacting the joints, significantly diminishes the quality of life for patients. Conventional treatments predominantly rely on oral or injectable formulations, underscoring the crucial need for an effective topical remedy. The present study reports a novel triple-layered transdermal platform for efficient RA treatment. The patches are based on an electrospun/electrosprayed diclofenac (DIC)-conjugated polyvinyl alcohol (PVA) nanofibers/nanoparticles (NFs/NPs) composite layer sandwiched between an electrospun supporting layer of polycaprolactone (PCL) NFs, and a 3D-printed sodium alginate-based hydrogel (HG) layer incorporating sodium hyaluronate (HA) and rosuvastatin (ROS)-loaded core-shell lipid nanocapsules (LNCs). The ingeniously designed transdermal patches release the chemically conjugated DIC via skin-secreted esterases at the inflamed sites. The LNCs and patches were characterized using DLS, FTIR, DSC, and electron microscopy. ROS-loaded LNCs (<50 nm as per the TEM micrographs) were able to release about 97 % of ROS during 5 days. In-vitro and in-vivo evaluations definitively established the efficacy of the developed platform, showcasing a substantial reduction in IL-6 and TNF-α through sandwich ELISA measurements in cell culture and Rattus norvegicus plasma samples. Besides, the stained photomicrographs of the rats' ankle joints confirmed the alleviation of the RA symptoms via reducing cell infiltration with a preserved joint tissue structure.
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Affiliation(s)
- Hend A Elshabrawy
- Nanomedicine Laboratories, Center for Materials Science, Zewail City of Science and Technology, 6th of October City 12578, Giza, Egypt.
| | - Ahmed S Abo Dena
- Nanomedicine Laboratories, Center for Materials Science, Zewail City of Science and Technology, 6th of October City 12578, Giza, Egypt.
| | - Ibrahim M El-Sherbiny
- Nanomedicine Laboratories, Center for Materials Science, Zewail City of Science and Technology, 6th of October City 12578, Giza, Egypt.
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Kimariyo PF, Kurati SP, Babu PS, Moyo AA, Muthyala MKK. Synthesized diterpene lactone derivative attenuated Freund's complete adjuvant-induced arthritis in Wistar rats. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2024; 27:1197-1208. [PMID: 39055869 PMCID: PMC11266735 DOI: 10.22038/ijbms.2024.75023.16295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/02/2024] [Indexed: 07/28/2024]
Abstract
Objectives In this study, the SP-38 (Diterpene Lactone derivative) was designed, synthesized from clerodane diterpene (lactone) isolated from Polyanthia longifolia var. pendula, and tested for anti-arthritic activity using the FCA-induced arthritic rat model. Materials and Methods This study examined the in vivo effects of SP-38 using three different doses (20, 10, and 5 mg/kg) by oral administration for 21 days from day 8 after 0.1 ml FCA sub-planter injection until day 28. Arthritis index, paw swelling, ankle diameter, body weight as well as biochemical, hematological, histopathological, and radiological parameters were examined. Results Administered SP-38 reduced arthritis index, paw volume, and joint swelling compared to the arthritic control group. Accordingly, rats treated with SP-38 showed a remarkable increase in body weight and improved biochemical, hematological, histopathological, and radiological parameters. Furthermore, it reduced the increased production of CRP and RF while simultaneously decreasing ESR in all SP-38-treated rats. However, SP-38 showed promising liver protection by reducing elevated serum levels of liver and kidney function markers SGOT, SGPT, and ALP. Furthermore, splenic index, TNF-α, and IL-6 levels were significantly reduced compared to arthritic control rats at certain doses. Conclusion The result of the present study concludes that SP-38 has significant anti-arthritic potential in FCA-induced arthritis in Wistar rats. SP-38 therefore showed promising anti-arthritic activity, as evidenced by attenuation of inflammation, inflammatory markers, and pro-inflammatory cytokine levels.
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Affiliation(s)
- Patrick Francis Kimariyo
- AU College of Pharmaceutical Sciences, Pharmaceutical Chemistry Department, Andhra University, Visakhapatnam, Andhra Pradesh 530003, India
- Dar es Salaam Institute of Technology (DIT), Science and Laboratory Technology Department, Bibititi and Morogoro Rd Junction P. O. Box 2958. Dar es Salaam, Tanzania
| | - Sony Priya Kurati
- AU College of Pharmaceutical Sciences, Pharmaceutical Chemistry Department, Andhra University, Visakhapatnam, Andhra Pradesh 530003, India
| | - Perupogu Suvarna Babu
- AU College of Pharmaceutical Sciences, Pharmaceutical Chemistry Department, Andhra University, Visakhapatnam, Andhra Pradesh 530003, India
| | - Alfredi Alfred Moyo
- Medicinal Chemistry Research Laboratory, Department of Chemistry, Shivaji University, Kolhapur 416004, Maharashtra, India
- Mabibo Traditional Research Centre, National Institute for Medical Research (NIMR), Barack Obama Drive, P.O.Box 9653, 11101 Dar es Salaam, Tanzania
| | - Murali Krishna Kumar Muthyala
- AU College of Pharmaceutical Sciences, Pharmaceutical Chemistry Department, Andhra University, Visakhapatnam, Andhra Pradesh 530003, India
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Qasim S, Khan YH, Uttra AM, Alotaibi NH, Alanazi AS, Alzarea AI, Alatawi AD, Mallhi TH. Appraisal of anti-inflammatory and immunomodulatory potential of ramipril against Freund's adjuvant-provoked arthritic rat model. Inflammopharmacology 2023; 31:3115-3125. [PMID: 37543980 DOI: 10.1007/s10787-023-01306-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
Because of evident role of renin-angiotensin system in the etiology of rheumatoid arthritis, the current study's objective was to assess the anti-arthritic efficacy of ramipril through CFA-instigated arthritic model. The drug has been shown to have anti-inflammatory potential. CFA-instigated arthritic model assessed the anti-arthritic efficacy of ramipril by estimating different parameters, including paw volume, arthritic index scoring, haematological and biochemical attributes, histological and radiographic analyses, and various cytokines level. Ramipril significantly (p < 0.001) reduced paw volume and the arthritic index especially at the dose of 4mg/kg. The biochemical and haematological changes were likewise restored to normal by ramipril administration with an increase in anti-inflammatory cytokines while reducing pro-inflammatory cytokines level. Ramipril's ability to prevent arthritis by preserving the normal architecture of arthritis-induced joints is further supported by radiographic and histological investigation. The study's findings demonstrated ramipril's considerable anti-arthritic activity. To identify the precise mechanism of action, however, thorough mechanistic studies are still needed.
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Affiliation(s)
- Sumera Qasim
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia.
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia.
| | - Ambreen Malik Uttra
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, Pakistan
| | - Nasser Hadal Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Abdullah Salah Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Abdulaziz I Alzarea
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Ahmed D Alatawi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
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Chong CF, Hasnizan NYU, Ahmad Mokhtar AM. Navigating the landscape of Rho GTPase signalling system in autoimmunity: A bibliometric analysis spanning over three decades (1990 to 2023). Cell Signal 2023; 111:110855. [PMID: 37598919 DOI: 10.1016/j.cellsig.2023.110855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
Ras-homologous (Rho) guanosine triphosphatases (GTPases) are considered a central player in regulating various biological processes, extending to immune regulation. Perturbations in Rho GTPase signalling have been implicated in immune-related dysregulation, contributing to the development of autoimmunity. This study presents a scientometric analysis exploring the interlink between the Rho GTPase signalling system and autoimmunity, while also delving into the trends of past studies. A total of 967 relevant publications from 1990 to 2023 were retrieved from the Web of Science Core Collection database after throrough manual filtering of irrelevant articles. The findings show an upward trajectory in publications related to this field since 2006. Over the past three decades, the United States of America (41.68%) emerged as the primary contributor in advancing our understanding of the association between the Rho GTPase signalling system and autoimmunity. Research in autoimmunity has mainly centered around therapeutic interventions, with an emphasis on studying leukocyte (macrophage) and endothelial remodelling. Interestingly, within the domains of multiple sclerosis and rheumatoid arthritis, the current focus has been directed towards comprehending the role of RhoA, Rac1, and Cdc42. Notably, certain subfamilies of Rho (such as RhoB and RhoC), Rac (including Rac2 and RhoG), Cdc42 (specifically RhoJ), and other atypical Rho GTPases (like RhoE and RhoH) consistently demonstrating compelling link with autoimmunity, but still warrants emphasis in the future study. Hence, strategic manipulation of the Rho signalling system holds immense promise as a pivotal approach to addressing the global challenge of autoimmunity.
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Affiliation(s)
- Chien Fung Chong
- Bioprocess Technology Division, School of Industrial Technology, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia.
| | - Nik Yasmin Umaira Hasnizan
- Bioprocess Technology Division, School of Industrial Technology, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia.
| | - Ana Masara Ahmad Mokhtar
- Bioprocess Technology Division, School of Industrial Technology, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia.
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9
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Zhang W, Zhang Y, Zhang J, Deng C, Zhang C. Naringenin ameliorates collagen-induced arthritis through activating AMPK-mediated autophagy in macrophages. Immun Inflamm Dis 2023; 11:e983. [PMID: 37904715 PMCID: PMC10588338 DOI: 10.1002/iid3.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Naringenin is widely recognized for its notable attributes, including anti-inflammatory, anti-cancer, and immunomodulatory activities. However, its specific implications for rheumatoid arthritis (RA) and the underlying mechanisms remain to be explored. This study aimed to investigate the therapeutic efficacy and pharmacological mechanism of Naringenin in the treatment of collagen-induced arthritis (CIA). METHODS A CIA model was established in DBA/1 mice, and various doses of Naringenin were administered orally to assess its impact on RA. The study also involved lipopolysaccharides (LPS)-induced RAW264.7 cells to further evaluate the effects of Naringenin. Mechanistic studies were conducted to elucidate the signaling pathways involved in Naringenin's actions. RESULTS Naringenin significantly alleviated foot inflammation in DBA/1 CIA mice and attenuated the levels of pro-inflammatory cytokines in serum. It also enhanced antioxidant capacity in the CIA model. In vitro studies with LPS-induced RAW264.7 cells demonstrated that Naringenin attenuated pro-inflammatory cytokines and reactive oxygen species (ROS) levels. Mechanistic studies confirmed that Naringenin activated autophagy and increased autophagic flux. Blocking autophagy, either by silencing Atg5 or inhibiting autophagolysosome using chloroquine, effectively counteracted the impact of Naringenin on pro-inflammatory cytokines. Further exploration revealed that Naringenin activated the AMPK/ULK1 signaling pathway, and inhibition of AMPK reversed the initiation of autophagy and reduced pro-inflammatory cytokine secretion induced by Naringenin. CONCLUSIONS This study unveils a novel mechanism by which Naringenin may be used to treat RA. It demonstrates the therapeutic efficacy of Naringenin in a CIA model by reducing inflammation, modulating cytokine levels, and enhancing antioxidant capacity. Moreover, the activation of autophagy through the AMPK/ULK1 signaling pathway appears to play a critical role in Naringenin's anti-inflammatory effects. These findings suggest potential strategies for the development of anti-rheumatic medications based on Naringenin.
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Affiliation(s)
- Wei Zhang
- Department of OrthopedicAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Yuan Zhang
- Department of OrthopedicAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Jianguang Zhang
- Department of OrthopedicAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Chunbiao Deng
- Department of OrthopedicAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Chao Zhang
- Department of OrthopedicAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
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Faustino C, Pinheiro L, Duarte N. Triterpenes as Potential Drug Candidates for Rheumatoid Arthritis Treatment. Life (Basel) 2023; 13:1514. [PMID: 37511889 PMCID: PMC10381804 DOI: 10.3390/life13071514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by joint inflammation, swelling and pain. Although RA mainly affects the joints, the disease can also have systemic implications. The presence of autoantibodies, such as anti-cyclic citrullinated peptide antibodies and rheumatoid factors, is a hallmark of the disease. RA is a significant cause of disability worldwide associated with advancing age, genetic predisposition, infectious agents, obesity and smoking, among other risk factors. Currently, RA treatment depends on anti-inflammatory and disease-modifying anti-rheumatic drugs intended to reduce joint inflammation and chronic pain, preventing or slowing down joint damage and disease progression. However, these drugs are associated with severe side effects upon long-term use, including immunosuppression and development of opportunistic infections. Natural products, namely triterpenes with anti-inflammatory properties, have shown relevant anti-arthritic activity in several animal models of RA without undesirable side effects. Therefore, this review covers the recent studies (2017-2022) on triterpenes as safe and promising drug candidates for the treatment of RA. These bioactive compounds were able to produce a reduction in several RA activity indices and immunological markers. Celastrol, betulinic acid, nimbolide and some ginsenosides stand out as the most relevant drug candidates for RA treatment.
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Affiliation(s)
- Célia Faustino
- iMed.ULisboa, Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisbon, Portugal
| | - Lídia Pinheiro
- iMed.ULisboa, Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisbon, Portugal
| | - Noélia Duarte
- iMed.ULisboa, Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisbon, Portugal
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11
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Nawaz S, Muhammad Irfan H, Akram M, Jahan S. Linalool: Monoterpene alcohol effectiveness in chronic synovitis through lowering Interleukin-17, spleen and thymus indices. Int Immunopharmacol 2023; 121:110517. [PMID: 37348232 DOI: 10.1016/j.intimp.2023.110517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Interleukin-17 has a positive role in the initial induction and late chronic phases of many inflammatory disorders like arthritis. This cytokine has a strong option for therapeutic targeting due to the fact that it was found in the inflamed joints of individual with rheumatoid arthritis (RA) and persuasive evidence from experimental arthritis models indicating its pro-inflammatory actions. IL-17 suppression lessened the asperity of arthritis. The present study aimed to assess the anti-arthritic potential of linalool in a model of chronic joint inflammation (CFA-mediated rheumatoid arthritis) in rats. Linalool markedly lowered spleen and thymus indices as opposed to arthritic control. The over-formation of IL-17, COX-2, TNF-α IL-1β, iNOS and IL-6 were markedly impaired in all linalool treated rats, but IL-10 was raised as compared to arthritic animals in Real time-PCR. There was reduction in associated parameters like paw volume, arthritic index, mobility score, and flexion pain score and a marked increase in stance score in CFA model as compared to the arthritic control group. Furthermore, there was improvement in body weight, hematological, tissue, and radiological parameters in the CFA-model. Molecular docking study exhibited strong binding interaction of linalool with IL-17, PGE-2, iNOS and COX-2, thus providing a good correlation among experimental and theoretical results. The current findings show that linalool reduces adjuvant arthritis by suppressing pro-inflammatory mediators, arthritic development, and spleen and thymus indices. Thus, linalool may be employed therapeutically to alleviate arthritis in humans.
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Affiliation(s)
- Shoaib Nawaz
- College of Pharmacy University of Sargodha, Sargodha, Pakistan
| | | | - Muhammad Akram
- College of Pharmacy University of Sargodha, Sargodha, Pakistan
| | - Shah Jahan
- Department of Immunology, University of Health Sciences, Lahore 54600, Pakistan
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12
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Khan YH, Qasim S, Uttra AM, Alotaibi NH, Alanzi AS, Alzarea AI, Alatawi AD, Hussain T. Enalapril attenuated CFA provoked arthritic manifestation by modulating proinflammatory and anti-inflammatory cytokine network. Life Sci 2023; 324:121742. [PMID: 37146938 DOI: 10.1016/j.lfs.2023.121742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
Enalapril with documented anti-inflammatory potential was evaluated in current investigation to explore its anti-arthritic efficacy. For anti-arthritic evaluation of enalapril, CFA-instigated arthritic model was employed after which various parameters comprising paw volume, body weight, arthritic index, hematological and biochemical parameters, radiographic analysis and level of various cytokines were estimated. Enalapril demonstrated significant (p˂0.001) anti-arthritic activity by suppressing paw volume, arthritic index while preserved CFA instigated weight loss. Likewise, enalapril also normalized the hematological and biochemical alterations, suppressed the level of proinflammatory cytokines with elevation of anti-inflammatory cytokines. Radiographic and histopathological analysis also further validates the anti-arthritic attribute of enalapril where enalapril preserved the normal architecture of arthritis induced joints. Outcomes of the study pointed out a notable anti-arthritic activity of enalapril. However detailed mechanistic studies are still required to point out the exact mechanism of action.
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Affiliation(s)
- Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Saudi Arabia.
| | - Sumera Qasim
- Department of Pharmacology, College of Pharmacy, Jouf University, Saudi Arabia.
| | - Ambreen Malik Uttra
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Pakistan
| | - Nasser H Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Saudi Arabia
| | | | - Abdulaziz I Alzarea
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Saudi Arabia
| | - Ahmad D Alatawi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Saudi Arabia
| | - Tauqeer Hussain
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Saudi Arabia
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13
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Faheem MA, Akhtar T, Naseem N, Aftab U, Zafar MS, Hussain S, Shahzad M, Gobe GC. Chrysin Is Immunomodulatory and Anti-Inflammatory against Complete Freund's Adjuvant-Induced Arthritis in a Pre-Clinical Rodent Model. Pharmaceutics 2023; 15:pharmaceutics15041225. [PMID: 37111711 PMCID: PMC10144384 DOI: 10.3390/pharmaceutics15041225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Chrysin (5,7-dihydroxyflavone) has many pharmacological properties including anti-inflammatory actions. The objective of this study was to evaluate the anti-arthritic activity of chrysin and to compare its effect with the non-steroidal anti-inflammatory agent, piroxicam, against complete Freund's adjuvant (CFA)-induced arthritis in a pre-clinical model in rats. Rheumatoid arthritis was induced by injecting CFA intra-dermally in the sub-plantar region of the left hind paw of rats. Chrysin (50 and 100 mg/kg) and piroxicam (10 mg/kg) were given to rats with established arthritis. The model of arthritis was characterized using an index of arthritis, with hematological, biological, molecular, and histopathological parameters. Treatment with chrysin significantly reduced the arthritis score, inflammatory cells, erythrocyte sedimentation rate, and rheumatoid factor. Chrysin also reduced the mRNA levels of tumor necrosis factor, nuclear factor kappa-B, and toll-like recepter-2 and increased anti-inflammatory cytokines interleukin-4 and -10, as well as the hemoglobin levels. Using histopathology and microscopy, chrysin reduced the severity of arthritis in joints, infiltration of inflammatory cells, subcutaneous inflammation, cartilage erosion, bone erosion, and pannus formation. Chrysin showed comparable effects to piroxicam, which is used for the treatment of rheumatoid arthritis. The results showed that chrysin possesses anti-inflammatory and immunomodulatory effects that make it a potential drug for the treatment of arthritis.
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Affiliation(s)
- Muhammad Asif Faheem
- Department of Pharmacology, University of Health Sciences, Lahore 54600, Pakistan
| | - Tasleem Akhtar
- Department of Pharmacology, University of Health Sciences, Lahore 54600, Pakistan
| | - Nadia Naseem
- Department of Morbid Anatomy and Histopathology, University of Health Sciences, Lahore 54600, Pakistan
| | - Usman Aftab
- Department of Pharmacology, University of Health Sciences, Lahore 54600, Pakistan
| | | | - Safdar Hussain
- Centre for Applied Molecular Biology (CAMB), University of the Punjab, Lahore 53700, Pakistan
| | - Muhammad Shahzad
- Department of Pharmacology, University of Health Sciences, Lahore 54600, Pakistan
| | - Glenda Carolyn Gobe
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
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14
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Gallo G, Sarzani R, Cicero AFG, Genovese S, Pirro M, Gallelli L, Faggiano A, Volpe M. An Expert Opinion on the Role of the Rosuvastatin/Amlodipine Single Pill Fixed Dose Combination in Cardiovascular Prevention. High Blood Press Cardiovasc Prev 2023; 30:83-91. [PMID: 37020154 PMCID: PMC10089988 DOI: 10.1007/s40292-023-00570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/13/2023] [Indexed: 04/07/2023] Open
Abstract
Current cardiovascular disease prevention strategies are based on the management of cardiovascular risk as a continuum, redefining the therapeutic goals for each individual based on the estimated global risk profile. Given the frequent clustering of the principal cardiovascular risk factors, such as hypertension, diabetes and dyslipidaemia, in the same individual, patients are required to take multiple drugs to achieve therapeutic targets. The adoption of single pill fixed dose combinations may contribute to achieve better control of blood pressure and cholesterol compared to the separate administration of the individual drugs, mostly due to better adherence related to therapeutic simplicities. This paper reports the outcomes of an Expert multidisciplinary Roundtable. In particular, the rational and potential clinical use of the single pill fixed dose combination "Rosuvastatin-Amlodipine" for the management of concomitant hypertension/hypercholesterolemia in different clinical fields are discussed. This Expert Opinion also illustrates the importance of an early and effective management of total cardiovascular risk, highlights the substantial benefits of combining blood pressure and lipid-lowering treatments in a single-pill fixed dose combination and attempts to identify and overcome the barriers to the implementation in clinical practice of the fixed dose combinations with dual targets. This Expert Panel identifies and proposes the categories of patients who may benefit the most from this fixed dose combination.
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Affiliation(s)
- Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University 'Politecnica delle Marche', Ancona, Italy
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular Risk Research Unit, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS AOU Policlinico di S. Orsola, Bologna, Italy
| | - Stefano Genovese
- Endocrine and Metabolic Diseases Unit IRCCS Centro Cardiologico Monzino, 20138, Milan, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Gallelli
- Department of Health Sciences, Campus "Salvatore Venuta", University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy
| | - Andrea Faggiano
- Cardiovascular Unit, Internal Medicine Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
- IRCCS San Raffaele Roma, Rome, Italy.
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15
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Alsaffar RM, Ali A, Rashid SM, Ahmad SB, Alkholifi FK, Kawoosa MS, Ahmad SP, Rehman MU. Zerumbone Protects Rats from Collagen-Induced Arthritis by Inhibiting Oxidative Outbursts and Inflammatory Cytokine Levels. ACS OMEGA 2023; 8:2982-2991. [PMID: 36713739 PMCID: PMC9878628 DOI: 10.1021/acsomega.2c05749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/22/2022] [Indexed: 05/25/2023]
Abstract
Rheumatoid arthritis (RA) is an immunocompromised disorder characterized by a marked increase in the synthesis of inflammatory molecules that stimulates the destruction of bones and cartilage. The conventional treatment modalities for RA are associated with adverse side effects and lack sensitivity, suggesting an immediate demand for alternate beneficial therapeutic remedies. The current study sought to understand more about zerumbone's anti-inflammatory properties in diagnosing collagen-induced arthritis (CIA) in experimental animals. The current study observed that zerumbone reduced clinical severity in CIA-induced animals compared to healthy animals. Zerumbone administration significantly decreased (p < 0.001) the concentration of SOD, CAT, GR, and GSH in treatment groups. Zerumbone administration drove down significantly (p < 0.001) the concentration of inflammatory cytokine molecules. Zerumbone was effective in bringing significant changes in levels of MPO, NO, LDH, MMP-8, and ELA. The therapeutic potential of zerumbone was found to be associated with reduced joint destruction and restored normal histology in the cartilage and tissue. Adsorption, distribution, metabolism, excretion, and toxicity studies were used to determine the druglike properties of zerumbone. ProTox-II studies revealed that zerumbone did not possess toxic properties like hepatotoxicity, immunotoxicity, carcinogenicity, mutagenicity, and cytotoxicity. Therefore, the present study evaluated the therapeutic properties of zerumbone in CIA animal models.
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Affiliation(s)
- Rana M Alsaffar
- Department
of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj 11942, Saudi
Arabia
| | - Aarif Ali
- Division
of Veterinary Biochemistry, Faculty of Veterinary
Science and Animal Husbandry, SKUAST-Kashmir, Shuhama, Alusteng, Srinagar, Jammu and Kashmir 190006, India
| | - Shahzada Mudasir Rashid
- Division
of Veterinary Biochemistry, Faculty of Veterinary
Science and Animal Husbandry, SKUAST-Kashmir, Shuhama, Alusteng, Srinagar, Jammu and Kashmir 190006, India
| | - Sheikh Bilal Ahmad
- Division
of Veterinary Biochemistry, Faculty of Veterinary
Science and Animal Husbandry, SKUAST-Kashmir, Shuhama, Alusteng, Srinagar, Jammu and Kashmir 190006, India
| | - Faisal K Alkholifi
- Department
of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj 11942, Saudi
Arabia
| | - Majid Shafi Kawoosa
- Mycoplasma
Laboratory, Faculty of Veterinary Sciences
and Animal Husbandry, Shuhama, Alusteng, Srinagar, Jammu and Kashmir 190006, India
| | - Sheikh Parvaiz Ahmad
- Department
of Statistics, University of Kashmir, Srinagar, Jammu and Kashmir 190006, India
| | - Muneeb U Rehman
- Department
of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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16
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Rosuvastatin Induces Renal HO-1 Activity and Expression Levels as a Main Protective Mechanism against STZ-Induced Diabetic Nephropathy. Medicina (B Aires) 2022; 58:medicina58030425. [PMID: 35334601 PMCID: PMC8953801 DOI: 10.3390/medicina58030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Nephroprotective effect of statins is still controversial. The aim of this study was to investigate the possible hemin-like nephroprotective effect of rosuvastatin (RSV) in streptozotocin (STZ)-induced diabetic rats. Materials and Methods: DN was induced in rats via a single dose of 50 mg/kg STZ i.p., with or without RSV (10 mg/kg orally) for 30 days. To investigate hemin-like effect of RSV on renal heme oxygenase-1 (HO-1), RSV was administered in the presence or absence of an inhibitor of HO-1; zinc protoporphyrin-XI (ZnPP), in a dose of 50 µmol/kg i.p. Results: Induction of diabetes with STZ caused, as expected, significant hyperglycemia, as well as deteriorated kidney function, lipid profile and histopathological architecture. The DN group also showed renal oxidative stress, indicated by decreased superoxide dismutase, catalase, and reduced glutathione, with increased malondialdehyde, myeloperoxidase and nitric oxide. Renal expression of inflammatory marker TNF-α, and pro-apoptotic marker caspase 3, were also increased in the DN group. Administration of RSV in DN rats did not improve glucose level but succeeded in recovering kidney function and normal structure as well as improving the lipid profile. RSV also improved renal oxidative, inflammatory, and apoptotic statuses. Interestingly, the administration of RSV increased renal expression and activity of HO-1 compared to the untreated DN group. Co-administration of ZnPP blocked the effect of RSV on HO-1 and deteriorated all RSV favorable effects. Conclusions: RSV can protect against DN, at least in part, via increasing renal HO-1 expression and/or activity, which seems to be upstream to RSV antioxidant, anti-inflammatory, and anti-apoptotic effects.
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17
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Rui Z, Zhang L, Li X, Han J, Yuan Y, Ding H, Liu Y, Ding X. Pterostilbene exert an anti‐arthritic effect by attenuating inflammation, oxidative stress, and alteration of gut microbiota. J Food Biochem 2022; 46:e14011. [PMID: 35060152 DOI: 10.1111/jfbc.14011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Ze Rui
- Department of Foot and Ankle Surgery The Second Affiliated Hospital of Shandong First Medical University Tai'an City China
| | - Ling Zhang
- Department of Medical Examination The Second Affiliated Hospital of Shandong First Medical University Tai'an City China
| | - Xuefei Li
- Department of Foot and Ankle Surgery The Second Affiliated Hospital of Shandong First Medical University Tai'an City China
| | - Jinxue Han
- Department of Foot and Ankle Surgery The Second Affiliated Hospital of Shandong First Medical University Tai'an City China
| | - Yufeng Yuan
- Department of Critical Medicine Tai'an Traditional Chinese Medicine Hospital Tai'an City China
| | - Hui Ding
- Shandong Liming Vocational and Technical College Tai'an City China
| | - Yang Liu
- Department of Foot and Ankle Surgery The Second Affiliated Hospital of Shandong First Medical University Tai'an City China
| | - Xiaolin Ding
- Department of Foot and Ankle Surgery The Second Affiliated Hospital of Shandong First Medical University Tai'an City China
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