Phytochemicals and antidiabetic activity of the aqueous extract of the Punica granatum fruit in streptozotocin-induced diabetic mice

The effects of pomegranate consumption on liver function enzymes in adults: A systematic review and meta-analysis

BACKGROUND

We performed a systematic review and meta-analysis of all published clinical trial studies to provide a more accurate estimation of pomegranate effects on liver enzymes in different clinical conditions.

METHODS

A systematic literature search was carried out using electronic databases, including PubMed, Web of Science, and Scopus, up to March 2023 to identify eligible randomized clinical trials (RCTs) evaluating the effect of pomegranate consumption on liver function enzymes. Heterogeneity tests of the selected trials were performed using the I2 statistic. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as the weighted mean difference with a 95% confidence interval.

RESULTS

Out of 3811 records, 9 eligible RCTs were included in the current study. However, there are limitations in the included studies, which can be mentioned in the dose, duration, and type of interventions that are different among the studies, as well as the small number of included studies. All this causes heterogeneity among studies and this heterogeneity limits the consistency of the results. Our meta-analysis showed that pomegranate intake had a significant effect on lowering aspartate aminotransferase (AST) levels in long-term intervention (> 8 weeks), obese (BMI≥30) individuals, or patients with metabolic disorders. Furthermore, results showed a significant decrease in alanine aminotransferase (ALT) levels in the long-term intervention (> 8 weeks) or in patients with metabolic disorders following the pomegranate intake. Combined results from the random-effects model indicated a significant reduction in gamma-glutamyl transferase (GGT) levels (WMD: -5.43 IU/L 95% CI: -7.78 to -3.08; p < 0.001;) following the pomegranate intake. The results of Egger's test mentioned a significant publication bias for the trials examining the effect of pomegranate intake on AST (p = 0.007) and ALT (p = 0.036).

CONCLUSION

Our results suggest that long-term pomegranate intake may be effective in ameliorating liver enzymes in adults with obesity and metabolic disorders who are more likely to have elevated baseline liver enzymes due to some degree of liver injury or tissue damage. However, some studies failed to conduct independent biochemical characterization of the product used, including the presence and quantity of polyphenols, antioxidants, and proanthocyanidins.

Therapeutic Potential of Pomegranate in Metabolic Disorders

Metabolic syndrome and associated disorders have become one of the major challenging health problems over the last decades. Considerable attention has been paid to natural products and herbal medicines for the management of metabolic disorders in recent years. Many studies have investigated the therapeutic effects of different parts (arils, peels, seeds, and flowers) of pomegranate (Punica granatum L.) for the prevention and treatment of this syndrome. This study aims to provide an updated review on the in vitro and in vivo studies as well as clinical trials investigating the effects of pomegranate and its active compounds on different components of metabolic problems such as hyperglycemia, hyperlipidemia, hypertension, as well as obesity over the last two decades. Besides, the key mechanisms by which pomegranate affects these pathogenic conditions are also discussed. The studies show that although pomegranate has promising beneficial effects on diabetes, hypertension, hyperlipidemia, and obesity in various cellular, animal, and clinical models of studies, there are some conflicting results, particularly for hyperglycemic conditions. The main mechanisms include influencing oxidative stress and anti-inflammatory responses. Overall, pomegranate seems to have positive effects on the pathogenic conditions of metabolic syndrome according to the reviewed studies. Although pomegranate is not suggested as the first line of therapy or monotherapy, it could be only used as an adjunctive therapy. Nevertheless, further large and long-term clinical studies are still required.

Evaluation of antidiabetic effect of Cistus salviifolius L. (Cistaceae) in streptozotocin-nicotinamide induced diabetic mice

Objectives Cistus salviifoluis L. is a shrub from Cistaceae family used in many traditional medicines for the treatment of various diseases including diabetes mellitus. The aim of this study was to evaluate the in vivo antidiabetic potential of the aerial parts aqueous extract of Cistus salviifolius L. (CSA). Methods Experimental diabetes was induced in adult male mice by intra-peritoneal injection of Streptozotocin-nicotinamide (STZ-NC). CSA at a dose of 500 mg/kg was administered daily to the diabetic mice for four weeks. The effect of the extract on hyperglycemia, body weight, serum total cholesterol, triglycerides, hepatic and renal functional markers were determined. Histopathological examination of the mice pancreas was also performed. The diabetic animals treated with CSA were compared with animals treated by the standard drug metformin. Results Treatment with CSA showed a significant reduction in blood glucose, total triglycerides and creatinine levels and prevented the reduction of body weight caused by diabetes. Furthermore, histopathological analysis of the mice pancreas showed that the group treated with CSA reduced damage induced by STZ-NC on islets of Langerhans cells when compared to the diabetic control. Conclusions The results suggest that the aqueous extract of Moroccan C. salviifolius L. possesses beneficial effect on treatment of diabetes.

Evaluation of the in vitro ⍺-amylase inhibitory, antiglycation, and antioxidant properties of Punica granatum L. (pomegranate) fruit peel acetone extract and its effect on glucose uptake and oxidative stress in hepatocytes

Punica granatum L. (pomegranate) is a widely eaten fruit. The antidiabetic, antioxidative, and antilipidemic properties of the hydroalcoholic extracts of the different plant's parts have been extensively studied, with scarce information on the acetone extract (ACE). This study investigated antidiabetic, antioxidative, and antiobesogenic properties of ACE of the fruit peel. Preliminary data showed that ACE showed stronger antioxidant (radical-scavenging IC₅₀  = 1.56 μg/ml) and ⍺-amylase inhibitory (IC₅₀  = 10.6 μg/ml) properties than the hydroalcoholic extracts and Acarbose. The ACE inhibited protein glycation and lipase activity. In hepatocytes, ACE impaired oxidative stress-induced lipid peroxidation and reduced glutathione depletion but increased glucose uptake without decreasing the cell viability. HPLC analysis showed predominant presence of bioactive phenolic acids (ferulic, caffeic, and gallic acids) in this extract. This study suggests that ACE of P. granatum fruit peel may be an understudied extract that contains potent antidiabetic and antioxidative bioactive principles with minimal toxicity. PRACTICAL APPLICATIONS: Plant derived medicines have been an affordable and effective alternative therapy for many metabolic diseases, including diabetes. The fruit juice and fruits of pomegranate is widely consumed for the palatable taste and cardiovascular benefits. This study provides preliminary experimental evidences confirming that of the acetone extracts of pomegranate fruit peel, which has been sparsely studied, may possess more potent antidiabetic and antioxidative property than to the routinely studied hydroalcoholic counterparts. Additionally, the acetone extract is rich in bioactive phenolic acids, suggesting that the acetone extract of pomegranate fruit peel may be a promising candidate for further antidiabetic study and a source of bioactive principles for the management of diabetes and oxidative complications.