A review on the effect of garlic on diabetes, BDNF, and VEGF as a potential treatment for diabetic retinopathy

BACKGROUND

Garlic is one of the favorite herbs in traditional medicine that has been reported to have many medicinal features. The aim of the current study is to review the latest documents on the effect of garlic on diabetes, VEGF, and BDNF and, finally, to review the existing studies on the effect of garlic on diabetic retinopathy.

MAIN TEXT

The therapeutic effect of garlic on diabetes has been investigated in various studies. Diabetes, especially in advanced stages, is associated with complications such as diabetic retinopathy, which is caused by the alteration in the expression of molecular factors involved in angiogenesis, neurodegeneration, and inflammation in the retina. There are different in-vitro and in-vivo reports on the effect of garlic on each of these processes. Considering the present concept, we extracted the most related English articles from Web of Science, PubMed, and Scopus English databases from 1980 to 2022. All in-vitro and animal studies, clinical trials, research studies, and review articles in this area were assessed and classified.

RESULT AND CONCLUSION

According to previous studies, garlic has been confirmed to have beneficial antidiabetic, antiangiogenesis, and neuroprotective effects. Along with the available clinical evidence, it seems that garlic can be suggested as a complementary treatment option alongside common treatments for patients with diabetic retinopathy. However, more detailed clinical studies are needed in this field.

Allium sativum: A potential natural compound for NAFLD prevention and treatment

Introduction

Non-alcoholic fatty liver disease (NAFLD) results from an excessive accumulation of fat particles that causes liver inflammation, which ultimately causes liver damage. There is still considerable uncertainty about the effects of any nutritional supplements compared to no additional intervention. This review aimed to evaluate the efficacy of Allium sativum (A. sativum), known as garlic, in preventing and treating NAFLD.

Methods

A systematic search based on a search strategy consisting of two components of "NAFLD" and "Allium sativum" in databases including PubMed, Web of Science (WoS), and SCOPUS was conducted on papers evaluating the effects of A. sativum on NAFLD treatment and prevention. We obtained studies from inception until 20 September 2022, followed by study selection and data extraction based on our eligibility criteria. Consequently, qualitative and quantitative synthesis was conducted.

Results

Our qualitative analysis reveals that A. sativum consumption is linked to the prevention of NAFLD, especially in males, although qualitative data in this study regarding the therapeutic properties of NAFLD was controversial. Our meta-analysis showed that NAFLD patients treated with A. sativum have significantly declined aminotransferase levels. That is to say, our meta-analysis revealed a lower alanine transaminase (ALT) (SMD = -0.580, 95%CI = -0.822 to -0.338), and aspartate transaminase (AST(SMD = -0.526, 95%CI = -0.767 to -0.284) in NAFLD patients treated with A. sativum compared to the placebo group. Also, pooling data from case-control studies showed that A. sativum consumption decreases the odds of being diagnosed with NAFLD by 46% (OR = 0.538, 95%CI = 0.451-0.625).

Conclusion

A. sativum consumption is not merely associated with NAFLD prevention but also results in a considerable decline in blood aminotransferase levels in patients diagnosed with NAFLD. To put it simply, A. sativum is linked to a decline in AST and ALT, which are considered reliable biomarkers of NAFLD response to treatment. Nevertheless, A. sativum is insufficient to improve NAFLD independent of other dietary amendments and lifestyle modifications.

Bromatological Analysis and Characterization of Phenolics in Snow Mountain Garlic

The remarkable properties of garlic A. sativum L. have been described, but little is known about Snow mountain garlic. Understanding general aspects of this garlic composition, including the presence of phenolics, will establish its possible use for health or infer which compounds can contribute to improving it. This study aimed to determine the ash content, lipid profile, and characterization of phenolics in Snow mountain garlic. The organic content was obtained by common techniques (oven drying, calcination, Kjeldahl method, etc.). The quantitative analysis of the ashes was made by Inductively Coupled Plasma Emission Spectrometry. The fatty acid profile was determined by Gas Chromatography. The presence of phenolics was determined by foam, Libermann–Burchard, Dragendorff, Salkowski, ferric chloride, vanillin, catechin, Constantinescu, and Shinoda reactions. The total phenolic content was determined via the Folin–Ciocalteu method, and antioxidant activity was determined using the DPPH radical method. The bromatological analysis showed a 51.1% humidity, and the main organic compounds were carbohydrates (46.7%). Ash analysis showed 287.46 g/kg of potassium. The fatty acid profile showed 75.61% of polyunsaturated fatty acid. Phenolics like saponins, alkaloids, triterpenes, tannins, and flavonoids were present. Antioxidant activity was found by radical DPPH of 25.64 (±0.78) µmol TE/1 g dw. Snow mountain garlic shares a composition similar to those found in other garlic.

Black Garlic and Its Bioactive Compounds on Human Health Diseases: A Review

Black garlic (BG) is a form of aged garlic obtained from raw garlic (Allium sativum) via Millard reaction under high temperature (60-90 °C) and humidity (70-90%) for a period of time. Several studies reported higher contents of water-soluble antioxidants compounds (S-allyl cysteine, S-allyl-mercapto cysteine), 5-hydroxymethylfurfural, organosulfur compounds, polyphenol, volatile compounds, and products of other Millard reactions compared to fresh garlic after the thermal processing. Recent studies have demonstrated that BG and its bioactive compounds possess a wide range of biological activities and pharmacological properties that preserve and show better efficacy in preventing different types of diseases. Most of these benefits can be attributed to its anti-oxidation, anti-inflammation, anti-obesity, hepatoprotection, hypolipidemia, anti-cancer, anti-allergy, immunomodulation, nephroprotection, cardiovascular protection, and neuroprotection. Substantial studies have been conducted on BG and its components against different common human diseases in the last few decades. Still, a lot of research is ongoing to find out the therapeutic effects of BG. Thus, in this review, we summarized the pre-clinical and clinical studies of BG and its bioactive compounds on human health along with diverse bioactivity, a related mode of action, and also future challenges.

The effect of single clove Black garlic on the hemostasis status and lipid profile in male Sprague Dawley rats with non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) patients have alteration in hemostasis components. Thus, including excess expression of plasminogen activator inhibitor-1 (PAI-1), causing fibrinolysis disorders; the majority of these patients are hypercoagulable state prone to thrombosis. Some evidence suggests that garlic and garlic supplements have antithrombotic and anti-inflammatory properties. Besides, garlic stimulates fibrinolytic activity and normalizes plasma lipid imbalances. Black garlic is processed garlic that is produced through natural aging at a controlled temperature (70 °C) and high humidity (90%) for several days, without other additives. This study aimed to prove the effect of single clove black garlic (SCBG) (Allium sativum Linn) on PAI-1 levels and lipid profiles of NAFLD rats induced by a high-fat fructose diet (HFFD) containing 1.25% cholesterol and 0.5% cholic acid.The rats were then divided into healthy control group (K1+); NAFLD control group without treatment (K2+); 0.9 mg simvastatin treatment group (K1-); 45 mg metformin treatment group (K2-); SCBG 450 mg per 200g BW (X1); 900 mg per 200 g BW (X2); and 1350 mg per 200 g BW (X3). All treatments were administered for 4 weeks via oral gavage. As a result, significant differences in PAI-1 levels and lipid profiles between groups after the administration (p = 0.001) were noted and also by simvastatin and metformin, respectively. There was a correlation between PAI-1 and lipid profile of SCBG treatment. In conclusion, the administration of SCBG (1350 mg per 200 g BB per day) for 4 weeks had a significant effect on PAI-1 levels, and the lipid profiles in Sprague Dawley rats modeled NAFLD (p = 0.001). SCBG has provided benefits that can be useful in the management of NAFLD but it’s not equivalent to medicine.

Effects of garlic supplementation on oxidative stress and antioxidative capacity biomarkers: A systematic review and meta-analysis of randomized controlled trials

Evidence suggests that garlic supplementation may have an effect on oxidative stress by augmenting the rate of enzymatic and non-enzymatic antioxidants and diminishing pro-oxidant enzymes. Given inconsistencies across studies, we aimed to systematically review the current literature and quantify the effects of garlic supplementation on oxidative stress. We conducted a systematic search with multiple databases (Scopus, PubMed, and Web of Science) to find relevant articles published prior to October 2020. Results were reported as bias-corrected standardized mean difference (Hedges' g) with 95% confidence intervals (CI) using random-effects models. Cochrane's Q and I squared (I² ) tests were used to determine heterogeneity among the studies included. Twelve randomized controlled trials (RCTs) were included. Garlic doses ranged from 80 to 4,000 mg/day, and intervention duration varied between 2 and 24 weeks. Garlic supplementation increased serum level of total antioxidant capacity (TAC) (Hedges' g: 2.77, 95% CI: 1.37 to 4.17, p < 0.001) and superoxide dismutase (SOD) (Hedges' g: 13.76, 95% CI: 4.24 to 23.29, p = 0.004), while it reduced the malondialdehyde serum level (MDA) (Hedges' g: -1.94, 95% CI: -3.17 to -0.70, p = 0.002). Due to limited data available, glutathione (GSH) was not considered for the current meta-analysis. The nonlinear dose-response effect of garlic supplementation was not observed with regard to serum TAC and MDA levels (TAC: p-nonlinearity = 0.398; MDA: p-nonlinearity = 0.488). Garlic supplementation appears to improve serum levels of TAC, MDA, and SOD. Garlic supplementation may be useful to reduce oxidative stress and related diseases. Future studies with large sample sizes and longer duration are required to confirm these findings.

Influence of Variety and Storage Time of Fresh Garlic on the Physicochemical and Antioxidant Properties of Black Garlic

Black garlic is made from the fresh kind, submitting it to a controlled temperature (~65 °C) and humidity (>85 °C) for a prolonged period of time. The aim of this study was to assess the differences in the process and in the final product as a result of employing three garlic varieties (Spanish Roja, Chinese Spring and California White), and to check the influence of the storage time on fresh garlic in the quality of the final product by using garlic obtained in two different agricultural seasons, that of the current year (2014) and of the previous one (2013). The results revealed some differences in the parameters analysed during the manufacturing of the black garlic from the three varieties used, and even according to the harvest in question. However, when comparing initial and final values of the samples, a very similar evolution in their acidity, reducing sugars, °Brix, pH, polyphenol content, and antioxidant capacity was noted.

Amelioration of Single Clove Black Garlic Aqueous Extract on Dyslipidemia and Hepatitis in Chronic Carbon Tetrachloride Intoxicated Swiss Albino Mice

Single clove garlic is the product of atypical bulbing process of garlic under specific conditions. Therefore, the number of researches on single clove garlic bioactivity is limited. Recently, the hepatoprotective effect of single clove garlic has been demonstrated. In this study, we investigated amelioration of single clove black garlic aqueous extract, a processed product from single clove garlic, on dyslipidemia and hepatitis induced by chronic administration of CCl₄. Mice were randomly divided into four groups: control, extract control, CCl₄ intoxication, and coadministrated CCl₄ and extract group. Mice were orally given a dose of 1 ml/kg body weight of CCl₄ for 28 days twice a week to establish chronic liver injury model. To evaluate the hepatoprotective effect of single clove black garlic, mice were cotreated with CCl₄ and single clove black garlic extract (200 mg/kg body weight) via gastric gauge for 30 days. Cotreatment with CCl₄ and extract could improve the changes of body weight, liver weight, and relative liver weight as compared to CCl₄ intoxicated mice. Single clove black garlic ameliorated dyslipidemia and the elevation of ALT and AST levels induced by chronic CCl₄ intoxication. Histological studies revealed that single clove black garlic could prevent mononuclear cells infiltration and hepatocyte necrosis.

Physicochemical Properties, Biological Activity, Health Benefits, and General Limitations of Aged Black Garlic: A Review

Garlic (Allium sativum) has been used as a medicinal food since ancient times. However, some people are reluctant to ingest raw garlic due to its unpleasant odor and taste. Therefore, many types of garlic preparations have been developed to reduce these attributes without losing biological functions. Aged black garlic (ABG) is a garlic preparation with a sweet and sour taste and no strong odor. It has recently been introduced to Asian markets as a functional food. Extensive in vitro and in vivo studies have demonstrated that ABG has a variety of biological functions such as antioxidant, anti-inflammatory, anti-cancer, anti-obesity, anti-diabetic, anti-allergic, cardioprotective, and hepatoprotective effects. Recent studies have compared the biological activity and function of ABG to those of raw garlic. ABG shows lower anti-inflammatory, anti-coagulation, immunomodulatory, and anti-allergic effects compared to raw garlic. This paper reviews the physicochemical properties, biological activity, health benefits, adverse effects, and general limitations of ABG.

The effects of black garlic (Allium satvium) extracts on lipid metabolism in rats fed a high fat diet

BACKGROUD/OBEJECTIVES

The mechanism of how black garlic effects lipid metabolism remains unsolved. Therefore, the objectives of this study were to determine the effects of black garlic on lipid profiles and the expression of related genes in rats fed a high fat diet.

MATERIALS/METHODS

Thirty-two male Sqrague-Dawley rats aged 4 weeks were randomly divided into four groups (n=8) and fed the following diets for 5 weeks: normal food diet, (NF); a high-fat diet (HF); and a high-fat diet + 0.5% or 1.5% black garlic extract (HFBG0.5 or HFBG1.5). Body weights and blood biochemical parameters, including lipid profiles, and expressions of genes related to lipid metabolism were determined.

RESULTS

Significant differences were observed in the final weights between the HFBG1.5 and HF groups. All blood biochemical parameters measured in the HFBG1.5 group showed significantly lower values than those in the HF group. Significant improvements of the plasama lipid profiles as well as fecal excretions of total lipids and triglyceride (TG) were also observed in the HFBG1.5 group, when compared to the HF diet group. There were significant differences in the levels of mRNA of sterol regulatory element binding protein-1c (SREBP-1c), acetyl-CoA carboxylase (ACC), fatty acid synthase (FAS), and glucose-6-phosphate dehydrogenase (G6PDH) in the HFBG1.5 group compared to the HF group. In addition, the hepatic expression of (HMG-CoA) reductase and Acyl-CoA cholesterol acyltransferase (ACAT) mRNA was also significantly lower than the HF group.

CONCLUSIONS

Consumption of black garlic extract lowers SREBP-1C mRNA expression, which causes downregulation of lipid and cholestrol metahbolism. As a result, the blood levels of total lipids, TG, and cholesterol were decreased.

Hepatoprotective effect of aged black garlic extract in rodents

In this study, we investigated the hepatoprotective effects of aged black garlic (ABG) in rodent models of liver injury. ABG inhibited carbon tetrachloride-induced elevation of aspartate transaminase (AST) and alanine transaminase (ALT), which are markers of hepatocellular damage, in SD rats. D-galactosamineinduced hepatocellular damage was also suppressed by ABG treatment. However, ABG does not affect the elevation of alkaline phosphatase (ALP), a marker of hepatobilliary damage, in rats treated with carbon tetrachloride or D-galactosamine. We also examined the effect of ABG on high-fat diet (HFD)-induced fatty liver and subsequent liver damage. ABG had no significant effect on body weight increase and plasma lipid profile in HFD-fed mice. However, HFD-induced increase in AST and ALT, but not ALP, was significantly suppressed by ABG treatment. These results demonstrate that ABG has hepatoprotective effects and suggest that ABG supplementation might be a good adjuvant therapy for the management of liver injury.

Fermented garlic protects diabetic, obese mice when fed a high-fat diet by antioxidant effects

This study examined the bioactivity of yeast (Saccharomyces cerevisiae)-fermented aged black garlic (FBG) on obese mice supplied a high-fat diet (HFD) and its in vitro antioxidant activity. Aged black garlic (BG) exhibits potent antioxidative effects and has been subjected to extensive research. In addition, the bioactivity of some natural products is increased by fermentation. In a preliminary test, this study found that the antioxidant activity of FBG is stronger than that of BG. Therefore, it was hypothesized that the bioactivity of BG would be increased by yeast fermentation and would be a good candidate as a nutraceutical product for improving the oxidative defense systems in older patients or patients affected by various oxidative stresses, for example, diabetes and diabetic complications. To test this hypothesis, the bioactivities of FBG in diabetic and obese mice as well as the antioxidant activity in vitro were examined. After 91 days of continuous HFD supply, the mice showed marked obesity, hyperglycemia, hyperlipemia, and liver and kidney damages. Black garlic and all 3 different doses of FBG showed favorable hepatoprotective, nephroprotective, hypolipidemic, and antiobesity effects compared with the HFD control, but no hypoglycemic effects. In particular, more favorable bioactivity against all 4 HFD-induced diabetic complications was detected in the FBG-treated groups compared with the group given equivalent doses of BG. These findings suggest that the bioactivities of BG can be improved by yeast fermentation.

Anti-metabolic syndrome and immunostimulant activities of Egyptian fenugreek seeds in diabetic/obese and immunosuppressive rat models

Preliminary trials have suggested possible hypoglycaemic, hypolipidaemic and immunomodulatory properties of the fenugreek plant. Here, we evaluated and compared the efficacy of Egyptian fenugreek seed powder (FSP, 0·5 and 1·0 g/kg body weight) in alleviating the experimentally induced metabolic syndrome (in type 1 diabetic and obese rat models) and experimentally induced immunosuppression and delay in burn-healing (in cyclophosphamide (CP)-treated rats). FSP significantly alleviated (P < 0·05-0·001) most signs of the metabolic syndrome resulting from experimentally induced type 1 diabetes and obesity by 40-76 and 56-78 %, respectively, including hyperglycaemia, hyperlipidaemia, elevation in atherogenic indices, impairment of liver functions, severe changes in body weight and oxidative stress. Besides, FSP (especially the high dose) completely modulated the immunosuppressive activity of CP including leucopenia (resulting from neutropenia and lymphopenia), decrease in weights and cellularity of lymphoid organs, serum γ-globulin level, delayed type of hypersensitivity response and delay in the skin-burning healing process. FSP decreased the immunosuppressive activity of CP by 57-108 %. These beneficial effects of FSP were dose dependent in most cases, and FSP doses used here were considered safe in general. FSP was more efficient in alleviating the signs of the metabolic syndrome in the obese animals (over 9 %) than in the type 1 diabetic animals. Moreover, the immunostimulant activity of fenugreek seeds exceeded their anti-metabolic syndrome activity by 15-24 %. In conclusion, fenugreek seeds may be useful not only as a dietary adjunct for the control of the metabolic syndrome in diabetic/obese patients, but also as an immunostimulant in immunocompromised patients such as those under chemotherapeutic interventions.