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Xia C, Deng J, Tong W, Chen J, Xiang Z, Yang X, Zhu B, Sun P, Li J, Pan Y, Zhu Y. Evaluation of the Antioxidant Potential of Citrus medica from Different Geographical Regions and Characterization of Phenolic Constituents by LC-MS. ACS OMEGA 2023; 8:32526-32535. [PMID: 37720798 PMCID: PMC10500571 DOI: 10.1021/acsomega.3c02861] [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: 04/26/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
The varying antioxidant potential of Citrus medica associated with different geographical regions makes the evaluation of C. medica for natural antioxidants essential. This work aimed to compare the antioxidant potential of the phenolic constituents from different geographical regions. The chemical compositions were characterized by ultra-high-performance liquid chromatography (UPLC) coupled with mass spectrometry (MS). A total of 67 compounds including 29 coumarin derivatives and 38 flavonoids were tentatively identified by UPLC-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS). To evaluate the quality of C. medica from seven different geographical regions, water and 80% methanol fractions were subjected to quantitative analysis. Antioxidant potentials were determined by 2,2-diphenyl-1-picrylhydrazyl, 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), iron chelation, and reduction methods. The samples collected from Sichuan province showed the highest content of total phenolic compounds. Combined with antioxidant results, the sample from Sichuan province presented good antioxidant activity. This study also showed that total phenolic compounds significantly contributed to the antioxidant activities (2,2-azinobis(3-ethyl-benzothiazoline-6-sulphonic acid) and radical scavenging activity) of C. medica samples (p < 0.01). These results provided chemical information and potential antioxidant value for further research, providing ideal evidence for the quality evaluation and exploitation of the source.
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Affiliation(s)
- Chen Xia
- Institute
of Agro-Products Processing Science and Technology, Sichuan Academy of Agricultural Sciences, 60 Shizishan Road, Chengdu, Sichuan 610066, China
| | - Junlin Deng
- Institute
of Agro-Products Processing Science and Technology, Sichuan Academy of Agricultural Sciences, 60 Shizishan Road, Chengdu, Sichuan 610066, China
| | - Wen Tong
- Industrial
Crop Research Institute, Sichuan Academy
of Agriculture Sciences, Chengdu 610300, Sichuan, China
| | - Jian Chen
- Institute
of Agro-Products Processing Science and Technology, Sichuan Academy of Agricultural Sciences, 60 Shizishan Road, Chengdu, Sichuan 610066, China
| | - Zhuoya Xiang
- Institute
of Agro-Products Processing Science and Technology, Sichuan Academy of Agricultural Sciences, 60 Shizishan Road, Chengdu, Sichuan 610066, China
| | - Xing Yang
- Institute
of Agro-Products Processing Science and Technology, Sichuan Academy of Agricultural Sciences, 60 Shizishan Road, Chengdu, Sichuan 610066, China
| | - Boyu Zhu
- Institute
of Agro-Products Processing Science and Technology, Sichuan Academy of Agricultural Sciences, 60 Shizishan Road, Chengdu, Sichuan 610066, China
| | - Pei Sun
- Industrial
Crop Research Institute, Sichuan Academy
of Agriculture Sciences, Chengdu 610300, Sichuan, China
| | - Juan Li
- Institute
of Agro-Products Processing Science and Technology, Sichuan Academy of Agricultural Sciences, 60 Shizishan Road, Chengdu, Sichuan 610066, China
| | - Yu Pan
- State
Key Laboratory of Quality Research in Chinese Medicine, Macau
University of Science and Technology, Macau 999078, China
| | - Yongqing Zhu
- Institute
of Agro-Products Processing Science and Technology, Sichuan Academy of Agricultural Sciences, 60 Shizishan Road, Chengdu, Sichuan 610066, China
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2
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Yow YY, Goh TK, Nyiew KY, Lim LW, Phang SM, Lim SH, Ratnayeke S, Wong KH. Therapeutic Potential of Complementary and Alternative Medicines in Peripheral Nerve Regeneration: A Systematic Review. Cells 2021; 10:cells10092194. [PMID: 34571842 PMCID: PMC8472132 DOI: 10.3390/cells10092194] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022] Open
Abstract
Despite the progressive advances, current standards of treatments for peripheral nerve injury do not guarantee complete recovery. Thus, alternative therapeutic interventions should be considered. Complementary and alternative medicines (CAMs) are widely explored for their therapeutic value, but their potential use in peripheral nerve regeneration is underappreciated. The present systematic review, designed according to guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, aims to present and discuss the current literature on the neuroregenerative potential of CAMs, focusing on plants or herbs, mushrooms, decoctions, and their respective natural products. The available literature on CAMs associated with peripheral nerve regeneration published up to 2020 were retrieved from PubMed, Scopus, and Web of Science. According to current literature, the neuroregenerative potential of Achyranthes bidentata, Astragalus membranaceus, Curcuma longa, Panax ginseng, and Hericium erinaceus are the most widely studied. Various CAMs enhanced proliferation and migration of Schwann cells in vitro, primarily through activation of MAPK pathway and FGF-2 signaling, respectively. Animal studies demonstrated the ability of CAMs to promote peripheral nerve regeneration and functional recovery, which are partially associated with modulations of neurotrophic factors, pro-inflammatory cytokines, and anti-apoptotic signaling. This systematic review provides evidence for the potential use of CAMs in the management of peripheral nerve injury.
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Affiliation(s)
- Yoon-Yen Yow
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya 47500, Malaysia; (T.-K.G.); (K.-Y.N.); (S.R.)
- Correspondence: (Y.-Y.Y.); (L.-W.L.); (K.-H.W.); Tel.: +603-7491-8622 (Y.-Y.Y.); +852-3917-6830 (L.-W.L.); +603-7967-4729 (K.-H.W.)
| | - Tiong-Keat Goh
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya 47500, Malaysia; (T.-K.G.); (K.-Y.N.); (S.R.)
| | - Ke-Ying Nyiew
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya 47500, Malaysia; (T.-K.G.); (K.-Y.N.); (S.R.)
| | - Lee-Wei Lim
- Neuromodulation Laboratory, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, L4 Laboratory Block, Hong Kong
- Correspondence: (Y.-Y.Y.); (L.-W.L.); (K.-H.W.); Tel.: +603-7491-8622 (Y.-Y.Y.); +852-3917-6830 (L.-W.L.); +603-7967-4729 (K.-H.W.)
| | - Siew-Moi Phang
- Institute of Ocean and Earth Sciences, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
- Faculty of Applied Sciences, UCSI University, Cheras, Kuala Lumpur 56000, Malaysia
| | - Siew-Huah Lim
- Department of Chemistry, Faculty of Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Shyamala Ratnayeke
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya 47500, Malaysia; (T.-K.G.); (K.-Y.N.); (S.R.)
| | - Kah-Hui Wong
- Department of Anatomy, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence: (Y.-Y.Y.); (L.-W.L.); (K.-H.W.); Tel.: +603-7491-8622 (Y.-Y.Y.); +852-3917-6830 (L.-W.L.); +603-7967-4729 (K.-H.W.)
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Denaro M, Smeriglio A, Xiao J, Cornara L, Burlando B, Trombetta D. New insights into
Citrus
genus: From ancient fruits to new hybrids. FOOD FRONTIERS 2020. [DOI: 10.1002/fft2.38] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Marcella Denaro
- Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences (ChiBioFarAm) University of Messina Messina Italy
| | - Antonella Smeriglio
- Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences (ChiBioFarAm) University of Messina Messina Italy
| | - Jianbo Xiao
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Research in Chinese Medicine University of Macau Taipa Macau
| | - Laura Cornara
- Department of Earth, Environment, and Life Sciences (DISTAV) University of Genova Genova Italy
| | - Bruno Burlando
- Department of Pharmacy (DIFAR) University of Genova Genova Italy
| | - Domenico Trombetta
- Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences (ChiBioFarAm) University of Messina Messina Italy
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Rezaeizadeh H, Rahimi R, Abbasi M. Fatigue Due to Multiple Sclerosis: A Comparison Between Persian Medicine and Conventional Medicine. Galen Med J 2019; 8:e1139. [PMID: 34466464 PMCID: PMC8343931 DOI: 10.31661/gmj.v8i0.1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/06/2018] [Accepted: 08/02/2018] [Indexed: 11/22/2022] Open
Abstract
Fatigue is one of the most debilitating symptoms of multiple sclerosis (MS), and its definite pathophysiology is unclear. Studies have suggested some correlates for it including dysfunction or atrophy in different parts of the brain. This narrative review study compares the viewpoint of conventional medicine and Persian medicine (PM) about fatigue due to MS and introduces the treatments used for this complaint in PM with an evidence-based approach. PM scholars have used the term I’ya equal to fatigue and stated that I’ya might be due to exertion or not, while the latter (spontaneous I’ya) can be prodromal of a disease. This pathologic fatigue can be seen in a wide variety of neurologic diseases, though it is the most common in MS patients. Fatigue in MS can be considered one of the equivalents of spontaneous I’ya. According to PM texts, neurotonic herbs like Ferula, Citrus medica, Asarum europaeum, Ficus carica, and Juglans regia may be beneficial in alleviating fatigue by brain reinforcement. Different pharmacological mechanisms have been introduced for these plants including antioxidant and/or anti-inflammatory activities. The medicinal plants can be assumed as a valuable source for discovering new medicines for fatigue in MS. Designing preclinical and clinical studies evaluating the effects of mentioned medicinal herbs in fatigue is proposed for obtaining more conclusive results.
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Affiliation(s)
- Hossein Rezaeizadeh
- Department of Traditional Iranian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Roja Rahimi
- Department of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abbasi
- Department of Traditional Iranian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Correspondence to: Maryam Abbasi, Department of Traditional Iranian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran Telephone Number: +982188990837 Email Address :
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Weng YS, Wang HF, Pai PY, Jong GP, Lai CH, Chung LC, Hsieh DJY, HsuanDay C, Kuo WW, Huang CY. Tanshinone IIA Prevents Leu27IGF-II-Induced Cardiomyocyte Hypertrophy Mediated by Estrogen Receptor and Subsequent Akt Activation. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2016; 43:1567-91. [PMID: 26621443 DOI: 10.1142/s0192415x15500895] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IGF-IIR plays important roles as a key regulator in myocardial pathological hypertrophy and apoptosis, which subsequently lead to heart failure. Salvia miltiorrhiza Bunge (Danshen) is a traditional Chinese medicinal herb used to treat cardiovascular diseases. Tanshinone IIA is an active compound in Danshen and is structurally similar to 17[Formula: see text]-estradiol (E[Formula: see text]. However, whether tanshinone IIA improves cardiomyocyte survival in pathological hypertrophy through estrogen receptor (ER) regulation remains unclear. This study investigates the role of ER signaling in mediating the protective effects of tanshinone IIA on IGF-IIR-induced myocardial hypertrophy. Leu27IGF-II (IGF-II analog) was shown in this study to specifically activate IGF-IIR expression and ICI 182,780 (ICI), an ER antagonist used to investigate tanshinone IIA estrogenic activity. We demonstrated that tanshinone IIA significantly enhanced Akt phosphorylation through ER activation to inhibit Leu27IGF-II-induced calcineurin expression and subsequent NFATc3 nuclear translocation to suppress myocardial hypertrophy. Tanshinone IIA reduced the cell size and suppressed ANP and BNP, inhibiting antihypertrophic effects induced by Leu27IGF-II. The cardioprotective properties of tanshinone IIA that inhibit Leu27IGF-II-induced cell hypertrophy and promote cell survival were reversed by ICI. Furthermore, ICI significantly reduced phospho-Akt, Ly294002 (PI3K inhibitor), and PI3K siRNA significantly reduced the tanshinone IIA-induced protective effect. The above results suggest that tanshinone IIA inhibited cardiomyocyte hypertrophy, which was mediated through ER, by activating the PI3K/Akt pathway and inhibiting Leu27IGF-II-induced calcineurin and NFATC3. Tanshinone IIA exerted strong estrogenic activity and therefore represented a novel selective ER modulator that inhibits IGF-IIR signaling to block cardiac hypertrophy.
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Affiliation(s)
- Yueh-Shan Weng
- Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hsueh-Fang Wang
- Institute of Biomedical Nutrition, Hungkuang University, Taichung, Taiwan
| | - Pei-Ying Pai
- Division of Cardiology, China Medical University Hospital, Taichung, Taiwan
| | - Gwo-Ping Jong
- Division of Cardiology, Armed Force Taichung General Hospital, Taichung, Taiwan
| | - Chao-Hung Lai
- Graduate Institute of Aging Medicine, China Medical University, Taichung, Taiwan
- Division of Cardiology, Armed Force Taichung General Hospital, Taichung, Taiwan
| | - Li-Chin Chung
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Tainan County, Taiwan
| | - Dennis Jine-Yuan Hsieh
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| | - Cecilia HsuanDay
- Department of Nursing, Mei Ho University, Pingguang Road, Pingtung, Taiwan
| | - Wei-Wen Kuo
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Chih-Yang Huang
- Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
- Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
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Ju DT, Kuo WW, Ho TJ, Paul CR, Kuo CH, Viswanadha VP, Lin CC, Chen YS, Chang YM, Huang CY. Protocatechuic Acid from Alpinia oxyphylla Induces Schwann Cell Migration via ERK1/2, JNK and p38 Activation. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2015; 43:653-65. [PMID: 26119854 DOI: 10.1142/s0192415x15500408] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Alpinia oxyphylla MIQ (Alpinate Oxyphyllae Fructus, AOF) is an important traditional Chinese medicinal herb whose fruits is widely used to prepare tonics and is used as an aphrodisiac, anti salivary, anti diuretic and nerve-protective agent. Protocatechuic acid (PCA), a simple phenolic compound was isolated from the kernels of AOF. This study investigated the role of PCA in promoting neural regeneration and the underlying molecular mechanisms. Nerve regeneration is a complex physiological response that takes place after injury. Schwann cells play a crucial role in the endogenous repair of peripheral nerves due to their ability to proliferate and migrate. The role of PCA in Schwann cell migration was determined by assessing the induced migration potential of RSC96 Schwann cells. PCA induced changes in the expression of proteins of three MAPK pathways, as determined using Western blot analysis. In order to determine the roles of MAPK (ERK1/2, JNK, and p38) pathways in PCA-induced matrix-degrading proteolytic enzyme (PAs and MMP2/9) production, the expression of several MAPK-associated proteins was analyzed after siRNA-mediated inhibition assays. Treatment with PCA-induced ERK1/2, JNK, and p38 phosphorylation that activated the downstream expression of PAs and MMPs. PCA-stimulated ERK1/2, JNK and p38 phosphorylation was attenuated by individual pretreatment with siRNAs or MAPK inhibitors (U0126, SP600125, and SB203580), resulting in the inhibition of migration and the uPA-related signal pathway. Taken together, our data suggest that PCA extract regulate the MAPK (ERK1/2, JNK, and p38)/PA (uPA, tPA)/MMP (MMP2, MMP9) mediated regeneration and migration signaling pathways in Schwann cells. Therefore, PCA plays a major role in Schwann cell migration and the regeneration of damaged peripheral nerve.
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Affiliation(s)
- Da-Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Wen Kuo
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Tsung-Jung Ho
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Chinese Medicine Department, China Medical University, Beigang Hospital, Taiwan
| | - Catherine Reena Paul
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Chia-Hua Kuo
- Laboratory of Exercise Biochemistry, TPEC, Taipei, Taiwan
| | | | - Chien-Chung Lin
- Orthopaedic Department, Armed Forces General Hospital, Taichung, Taiwan
| | - Yueh-Sheng Chen
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | | | - Chih-Yang Huang
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan.,Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
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Lee HC, Hsu YM, Tsai CC, Ke CJ, Yao CH, Chen YS. Improved Peripheral Nerve Regeneration in Streptozotocin-Induced Diabetic Rats by Oral Lumbrokinase. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2015; 43:215-30. [DOI: 10.1142/s0192415x15500147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We assessed the therapeutic effects of lumbrokinase, a group of enzymes extracted from the earthworm, on peripheral-nerve regeneration using well-defined sciatic nerve lesion paradigms in diabetic rats induced by the injection of streptozotocin (STZ). We found that lumbrokinase therapy could improve the rats' circulatory blood flow and promote the regeneration of axons in a silicone rubber conduit after nerve transection. Lumbrokinase treatment could also improve the neuromuscular functions with better nerve conductive performances. Immunohistochemical staining showed that lumbrokinase could dramatically promote calcitonin gene-related peptide (CGRP) expression in the lamina I–II regions in the dorsal horn ipsilateral to the injury and cause a marked increase in the number of macrophages recruited within the distal nerve stumps. In addition, the lumbrokinase could stimulate the secretion of interleukin-1 (IL-1), nerve growth factor (NGF), platelet-derived growth factor (PDGF), and transforming growth factor-β (TGF-β) in dissected diabetic sciatic nerve segments. In conclusion, the administration of lumbrokinase after nerve repair surgery in diabetic rats was found to have remarkable effects on promoting peripheral nerve regeneration and functional recovery.
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Affiliation(s)
- Han-Chung Lee
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Division of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Yuan-Man Hsu
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Chin-Chuan Tsai
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan
- Chinese Medicine Department, E-DA Hospital, Kaohsiung, Taiwan
| | - Cherng-Jyh Ke
- Department of Orthopedics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Hsu Yao
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Biomedical Informatics, Asia University, Wufeng District, Taichung, Taiwan
| | - Yueh-Sheng Chen
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Biomedical Informatics, Asia University, Wufeng District, Taichung, Taiwan
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Qu L, Liang X, Gu B, Liu W. Quercetin alleviates high glucose-induced Schwann cell damage by autophagy. Neural Regen Res 2014; 9:1195-203. [PMID: 25206782 PMCID: PMC4146282 DOI: 10.4103/1673-5374.135328] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 01/02/2023] Open
Abstract
Quercetin can reverse high glucose-induced inhibition of neural cell proliferation, and therefore may have a neuroprotective effect in diabetic peripheral neuropathy. It is difficult to obtain primary Schwann cells and RSC96 cells could replace primary Schwann cells in studies of the role of autophagy in the mechanism underlying diabetic peripheral neuropathy. Here, we show that under high glucose conditions, there are fewer autophagosomes in immortalized rat RSC96 cells and primary rat Schwann cells than under control conditions, the proliferative activity of both cell types is significantly impaired, and the expression of Beclin-1 and LC3, the molecular markers for autophagy, is significantly lower. After intervention with quercetin, the autophagic and proliferative activity of both cell types is rescued. These results suggest that quercetin can alleviate high glucose-induced damage to Schwann cells by autophagy.
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Affiliation(s)
- Ling Qu
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College, China Academy of Medical Sciences, Beijing, China
| | - Xiaochun Liang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College, China Academy of Medical Sciences, Beijing, China
| | - Bei Gu
- Cell Center, Institute of Basic Medical Science, Peking Union Medical College, China Academy of Medical Sciences, Beijing, China
| | - Wei Liu
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College, China Academy of Medical Sciences, Beijing, China
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