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Regis WFM, Mustafa Gomes Muniz FW, Rocha FR, de Araújo Sales EM, Guedes Peixoto Vieira PHA, Barros MMAF, de Almeida Alves S, Brilhante RSN, Duarte S, Neves BG, Rodrigues LKA. Streptococcus mutans serotyping, collagen-binding genes and Candida albicans in dentin carious lesions: a molecular approach. Clin Oral Investig 2025; 29:52. [PMID: 39779540 DOI: 10.1007/s00784-024-06140-0] [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: 09/03/2024] [Accepted: 12/23/2024] [Indexed: 01/11/2025]
Abstract
OBJECTIVES This cross-sectional study aimed to evaluate the occurrence of Streptococcus spp., Streptococcus mutans, its serotypes (c, e, f, and k), collagen-binding genes (cnm/cbm), and Candida albicans in medium deep (D2) and deep (D3) dentin carious lesions of permanent teeth. MATERIALS AND METHODS Carious dentin was collected from D2 (n = 23) and D3 (n = 24) lesions in posterior teeth from 31 individuals. DNA was extracted and analyzed using polymerase chain reaction (PCR). RESULTS Streptococcus spp. exhibited a high prevalence in both D2 and D3 lesions, with a 100% occurrence rate in D3. Although S. mutans was prevalent in both lesion types, serotype distribution highlighted differences in complexity. Serotype e was the most frequently detected in D2 samples. Serotype c was absent in D2 but present in 19.0% of D3; serotype k was exclusively found in multi-serotype D3 alongside f, c, and e. The cbm gene and undetermined serotypes were detected only in D3. Candida albicans was not found in any samples, regardless of lesion depth. CONCLUSION Dentinal lesions exhibited a complex array of S. mutans serotypes, with a notable prevalence of the genus Streptococcus and an overall S. mutans prevalence of approximately 35%. Candida albicans was absent. In addition, a high diversity of serotypes was observed, including multiple and indeterminate serotypes, along with the presence of the collagen-binding cbm gene. CLINICAL RELEVANCE The identification of diverse Streptococcus mutans serotypes and the cbm gene in carious dentin from permanent teeth offers insights into microbial factors potentially linked to dentinal caries lesions. Additionally, the absence of Candida albicans suggests a limited role in this context.
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Affiliation(s)
- Wanessa Fernandes Matias Regis
- Department of Operative Dentistry, Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Francisco Ruliglésio Rocha
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Brazil
| | - Ernanda Maria de Araújo Sales
- Department of Operative Dentistry, Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Stephanie de Almeida Alves
- Department of Operative Dentistry, Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Raimunda Sâmia Nogueira Brilhante
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Brazil
| | - Simone Duarte
- School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Lidiany Karla Azevedo Rodrigues
- Department of Operative Dentistry, Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil.
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Brazil.
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Pfeifer CS, Lucena FS, Logan MG, Nair D, Lewis SH. Current approaches to produce durable biomaterials: Trends in polymeric materials for restorative dentistry applications. Dent Mater 2024; 40:2122-2134. [PMID: 39424526 PMCID: PMC11637916 DOI: 10.1016/j.dental.2024.10.004] [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: 07/13/2024] [Revised: 09/29/2024] [Accepted: 10/15/2024] [Indexed: 10/21/2024]
Abstract
Dental caries continues to be a public health issue, especially more evident in underserved populations throughout the U.S. Unfortunately, especially with an aging population, hundreds of thousands of resin composite restorations are replaced each year due to recurring decay and fracture. According to several cohort studies, the average life span of this type of restoration is 10 years or less, depending on the caries risk level of the patient and the complexity of the restorative procedure. Any new material development must depart from the simple restoration of form paradigm, in which the filling is simply inert/biocompatible. This review will discuss novel antibiofilm structures, based on a targeted approach specifically against dysbiotic bacteria. Biofilm coalescence can be prevented by using glycosyl transferase - GTF inhibitors, in a non-bactericidal approach. On the tooth substrate side, MMP-inhibiting molecules can improve the stability of the collagen in the hybrid layer. This review will also discuss the importance of testing the materials in a physiologically relevant environment, mimicking the conditions in the mouth in terms of mechanical loading, bacterial challenge, and the presence of saliva. Ultimately, the goal of materials development is to achieve durable restorations, capable of adapting to the oral environment and resisting challenges that go beyond mechanical demands. That way, we can prevent the unnecessary loss of additional tooth structure that comes with every re-treatment. CLINICAL SIGNIFICANCE: While proper restorative technique and patient education in terms of diet and oral hygiene are crucial factors in increasing the longevity of esthetic direct restorations, materials better able to resist and interact with the conditions of the oral environment are still needed. Reproducing the success of dental amalgams with esthetic materials continues to be the Holy Grail of materials development.
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Affiliation(s)
- Carmem S Pfeifer
- Oregon Health & Science University, School of Dentistry, Division of Biomaterial and Biomedical Sciences, 2730 S Moody Ave., Portland, OR 97201, USA.
| | - Fernanda S Lucena
- Oregon Health & Science University, School of Dentistry, Division of Biomaterial and Biomedical Sciences, 2730 S Moody Ave., Portland, OR 97201, USA
| | - Matthew G Logan
- Oregon Health & Science University, School of Dentistry, Division of Biomaterial and Biomedical Sciences, 2730 S Moody Ave., Portland, OR 97201, USA
| | - Devatha Nair
- University of Colorado Anschutz Medical Campus, School of Dental Medicine, Department of Craniofacial Biology, 17500 E 19th Ave, Aurora, CO 80014, USA
| | - Steven H Lewis
- Oregon Health & Science University, School of Dentistry, Division of Biomaterial and Biomedical Sciences, 2730 S Moody Ave., Portland, OR 97201, USA
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Sulyanto RM, Beall CJ, Ha K, Montesano J, Juang J, Dickson JR, Hashmi SB, Bradbury S, Leys EJ, Edgerton M, Ho SP, Griffen AL. Fungi and bacteria occupy distinct spatial niches within carious dentin. PLoS Pathog 2024; 20:e1011865. [PMID: 38805482 PMCID: PMC11161102 DOI: 10.1371/journal.ppat.1011865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/07/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
The role of bacteria in the etiology of dental caries is long established, while the role of fungi has only recently gained more attention. The microbial invasion of dentin in advanced caries especially merits additional research. We evaluated the fungal and bacterial community composition and spatial distribution within carious dentin. Amplicon 16S rRNA gene sequencing together with quantitative PCR was used to profile bacterial and fungal species in caries-free children (n = 43) and 4 stages of caries progression from children with severe early childhood caries (n = 32). Additionally, healthy (n = 10) and carious (n = 10) primary teeth were decalcified, sectioned, and stained with Grocott's methenamine silver, periodic acid Schiff (PAS) and calcofluor white (CW) for fungi. Immunolocalization was also performed using antibodies against fungal β-D-glucan, gram-positive bacterial lipoteichoic acid, gram-negative endotoxin, Streptococcus mutans, and Candida albicans. We also performed field emission scanning electron microscopy (FESEM) to visualize fungi and bacteria within carious dentinal tubules. Bacterial communities observed included a high abundance of S. mutans and the Veillonella parvula group, as expected. There was a higher ratio of fungi to bacteria in dentin-involved lesions compared to less severe lesions with frequent preponderance of C. albicans, C. dubliniensis, and in one case C. tropicalis. Grocott's silver, PAS, CW and immunohistochemistry (IHC) demonstrated the presence of fungi within carious dentinal tubules. Multiplex IHC revealed that fungi, gram-negative, and gram-positive bacteria primarily occupied separate dentinal tubules, with rare instances of colocalization. Similar findings were observed with multiplex immunofluorescence using anti-S. mutans and anti-C. albicans antibodies. Electron microscopy showed monomorphic bacterial and fungal biofilms within distinct dentin tubules. We demonstrate a previously unrecognized phenomenon in which fungi and bacteria occupy distinct spatial niches within carious dentin and seldom co-colonize. The potential significance of this phenomenon in caries progression warrants further exploration.
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Affiliation(s)
- Rosalyn M. Sulyanto
- Department of Dentistry, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts, United States of America
| | - Clifford J. Beall
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, Ohio, United States of America
| | - Kasey Ha
- Department of Dentistry, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts, United States of America
| | - Joseph Montesano
- Harvard School of Dental Medicine, Boston, Massachusetts, United States of America
| | - Jason Juang
- Harvard School of Dental Medicine, Boston, Massachusetts, United States of America
| | - John R. Dickson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shahr B. Hashmi
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, Ohio, United States of America
| | - Seth Bradbury
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, Ohio, United States of America
- Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio, United States of America
| | - Eugene J. Leys
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, Ohio, United States of America
| | - Mira Edgerton
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, Buffalo, New York, United States of America
| | - Sunita P. Ho
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California, United States of America
| | - Ann L. Griffen
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, Ohio, United States of America
- Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio, United States of America
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Wu YT, Lu PW, Lin CA, Chang LY, Jaihao C, Peng TY, Lee WF, Teng NC, Lee SY, Dwivedi RP, Negi P, Yang JC. Development of a zinc chloride-based chemo-mechanical system for potential minimally invasive dental caries removal system. J Dent Sci 2024; 19:919-928. [PMID: 38618085 PMCID: PMC11010630 DOI: 10.1016/j.jds.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/01/2023] [Indexed: 04/16/2024] Open
Abstract
Background/purpose The chemo-mechanical caries-removal technique is known to offer advantages of selective dentin caries treatment while leaving healthy dental tissues intact. However, current sodium hypochlorite based reagents usually excessively damage dentin collagen. Therefore, the purpose of this study was to develop a novel chemo-mechanical caries-removal system to preserve the collagen network for subsequent prosthetic restorations. Materials and methods The calfskin-derived collagen was chosen as a model system to investigate the dissolution behavior of collagen under different operating conditions of chemical-ultrasonic treatment systems. The molecular weight, triple-helix structure, the morphology, and functional group of collagen after treatment were investigated. Results Various concentrations of sodium hypochlorite or zinc chloride together with ultrasonic machinery were chosen to investigate. The outcomes of circular dichroism (CD) spectra demonstrated stability of the triple-helix structure after treatment of a zinc chloride solution. In addition, two apparent bands at molecular weights (MWs) of 130 and 121 kDa evidenced the stability of collagen network. The positive 222 nm and 195 nm negative CD absorption band indicated the existence of a triple-helix structure for type I collagen. The preservation of the morphology and functional group of the collagen network on the etched dentin surface were investigated by in vitro dentin decalcification model. Conclusion Unlike NaOCl, the 5 wt% zinc chloride solution combined with ultra-sonication showed dissolution rather than denature as well as degradation of the dentin collagen network. Additional in vivo evaluations are needed to verify its usefulness in clinical applications.
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Affiliation(s)
- Yu-Tzu Wu
- Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Po-Wen Lu
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, New Taipei, Taiwan
| | - Chih-An Lin
- Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Liang-Yu Chang
- Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Chonlachat Jaihao
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Yu Peng
- School of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Wei-Fang Lee
- School of Dental Technology, Taipei Medical University, Taipei, Taiwan
| | - Nai-Chia Teng
- School of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Yang Lee
- School of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Ram Prakash Dwivedi
- School of Electrical and Computer Science Engineering, Shoolini University, Himachal Pradesh, India
| | - Poonam Negi
- School of Pharmaceutical Sciences, Biotechnology and Management Sciences, Shoolini University, Himachal Pradesh, India
| | - Jen-Chang Yang
- Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
- International Ph.D. Program in Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- Research Center of Biomedical Device, Taipei Medical University, Taipei, Taiwan
- Research Center of Digital Oral Science and Technology, Taipei Medical University, Taipei, Taiwan
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Dohan Z, Friedlander LT, Cooper PR, Li KC, Ratnayake JT, Mei ML. In Vitro Models Used in the Formation of Root Caries Lesions-A Review of the Literature. Dent J (Basel) 2023; 11:269. [PMID: 38132407 PMCID: PMC10743092 DOI: 10.3390/dj11120269] [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: 10/18/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The management of root caries remains a challenge for clinicians due to its unique anatomical location and structure. There is increasing interest in utilising artificial root caries lesions to develop new strategies for remineralisation. An ideal protocol has not yet been agreed upon. The aim of this review is to provide a structured overview of previously reported in vitro root caries models. The literature was screened and mined for information mainly on substrate selection, model systems utilised, and variables used in the models. Human roots (60%) were the most frequently used substrates, followed by bovine roots (40%). Chemical models (69%) were the most frequently utilised model systems, followed by microbiological models (27%), to form root caries lesions. Acetate buffer solution (80%), pH 5.0 or above (40%), and a demineralisation time of five days (25%) were the common variables used in the chemical systems, while mono-species biofilm was most frequently used (73%) in microbiological models and Streptococcus mutans was the most common bacterial strain utilised in these models (80%). This review highlights the variability amongst the experimental approaches, discusses the advantages and limitations of these approaches, and emphasises that standardisation of experimental conditions along with sustained research will benefit root caries research.
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Affiliation(s)
| | | | - Paul R. Cooper
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin 9016, New Zealand; (Z.D.); (L.T.F.); (K.-C.L.); (J.T.R.)
| | | | | | - May L. Mei
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin 9016, New Zealand; (Z.D.); (L.T.F.); (K.-C.L.); (J.T.R.)
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Peled Y, Stewart CA, Glogauer M, Finer Y. The Role of Bacterial, Dentinal, Salivary, and Neutrophil Degradative Activity in Caries Pathogenesis. Dent J (Basel) 2023; 11:217. [PMID: 37754337 PMCID: PMC10528424 DOI: 10.3390/dj11090217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
Until recently, it was widely accepted that bacteria participate in caries pathogenesis mainly through carbohydrate fermentation and acid production, which promote the dissolution of tooth components. Neutrophils, on the other hand, were considered white blood cells with no role in caries pathogenesis. Nevertheless, current literature suggests that both bacteria and neutrophils, among other factors, possess direct degradative activity towards both dentinal collagen type-1 and/or methacrylate resin-based restoratives and adhesives, the most common dental restoratives. Neutrophils are abundant leukocytes in the gingival sulcus, where they can readily reach adjacent tooth roots or gingival and cervical restorations and execute their degradative activity. In this review, we present the latest literature evidence for bacterial, dentinal, salivary, and neutrophil degradative action that may induce primary caries, secondary caries, and restoration failure.
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Affiliation(s)
- Yuval Peled
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada; (Y.P.); (C.A.S.); (M.G.)
| | - Cameron A. Stewart
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada; (Y.P.); (C.A.S.); (M.G.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3E2, Canada
| | - Michael Glogauer
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada; (Y.P.); (C.A.S.); (M.G.)
- Department of Dental Oncology, Maxillofacial and Ocular Prosthetics, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Yoav Finer
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada; (Y.P.); (C.A.S.); (M.G.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3E2, Canada
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Vidal CMP, Carrilho MR. Dentin Degradation: From Tissue Breakdown to Possibilities for Therapeutic Intervention. CURRENT ORAL HEALTH REPORTS 2023; 10:99-110. [PMID: 37928132 PMCID: PMC10624336 DOI: 10.1007/s40496-023-00341-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 11/07/2023]
Abstract
Purpose of the Review Presently, dental materials science is driven by the search for new and improved materials that can trigger specific reactions from the affected tissue to stimulate repair or regeneration while interacting with the oral environment to promote or maintain oral health. In parallel, evidence from the past decades has challenged the exclusive role of bacteria in dentin tissue degradation in caries, questioning our understanding of caries etiopathogenesis. The goal of this review is to recapitulate the current evidence on the host and bacterial contributions to degradation, inflammation, and repair of the dentin-pulp complex in caries. Recent Findings Contrasting findings attribute dentin breakdown to the activity of endogenous enzymes, such as matrix metalloproteinases (MMPs) and cathepsins, while the role of bacteria and their by-products in the destruction of dentin organic matrix and pulp inflammation has been for decades supported as an incontestable paradigm. Aiming to better understand the mechanisms involved in collagen degradation by host enzymes in caries, studies have showed that these proteinases are expressed in the mature dentin (i.e., after dentin formation) and become activated by the low pH in the acidic environment resulted by bacterial metabolism in caries. However, different host sources other than dentin-bound proteinases seem to also contribute to caries progression, such as saliva and pulp. Interestingly, studies evaluating pulp responses to bacteria invasion and inflammation in caries report higher levels of MMPs and cathepsins in inflamed tissue, but also showed MMP potential to resolve inflammation and stimulate wound healing. Notably, as reported for other tissues, MMPs exert dual roles in the dentin-pulp complex in caries, participating or regulating both degradative and reparative mechanisms. Summary The specific roles of host and bacteria and their by-products in caries progression have yet to be clarified. The complex interactions between inflammation and repair in caries pose challenges to a clear understanding of the dentin-pulp complex responses and changes to bacteria invasion. However, it opens new venues for the development of novel therapies and dental biomaterials based on the modulation of specific mechanisms to favor tissue repair and healing.
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Affiliation(s)
- Cristina M. P. Vidal
- Department of Operative Dentistry, College of Dentistry, The University of Iowa, 801 Newton Road, DSB S245, Iowa City, IA 52242, USA
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Salem GEM, Azzam SM, Nasser MA, Malah TE, Abd El-Latief HM, Chavanich S, Khan RH, Anwar HM. Bacterial protease alleviate chronic liver fibrosis induced by thioacetamide through suppression of hepatic stellate cells consequently decrease its proliferative index. Int J Biol Macromol 2023; 239:124243. [PMID: 37011746 DOI: 10.1016/j.ijbiomac.2023.124243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
In chronic liver diseases, liver fibrosis occurs due to excessive extracellular matrix (ECM) protein accumulation. Approximately 2 million deaths occur yearly due to liver disease, while cirrhosis is the 11th most common cause of death. Therefore, newer compounds or biomolecules must be synthesized to treat chronic liver diseases. In this aspect, the present study focuses on the assessment of the anti-inflammatory and antioxidant impact of Bacterial Protease (BP) produced by a new mutant strain of bacteria (Bacillus cereus S6-3/UM90) and 4,4'-(2,5-dimethoxy-1,4-phenylene) bis (1-(3-ethoxy phenyl)-1H-1,2,3-triazole) (DPET) in the treatment of early stage of liver fibrosis induced by thioacetamide (TAA). Sixty male rats were divided into six groups, ten rats each as follows: (1) Control group, (2) BP group, (3) TAA group, (4) TAA-Silymarin (S) group, (5) TAA-BP group, and (6) TAA-DPET group. Liver fibrosis significantly elevated liver function ALT, AST, and ALP, as well as anti-inflammatory interleukin 6 (IL-6) and VEGF. The oxidative stress parameters (MDA, SOD, and NO) were significantly increased with a marked reduction in GSH. Expression of MAPK and MCP-1 was unregulated in the TAA group, with downregulation of Nrf2 was observed. TAA caused histopathological alterations associated with hepatic vacuolation and fibrosis, increasing collagen fibers and high immuno-expression of VEGF. On the other hand, treatment with BP successfully improved the severe effects of TAA on the liver and restored histological architecture. Our study concluded the protective potentials of BP for attenuating liver fibrosis and could be used as adjuvant therapy for treating hepatic fibrosis.
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