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Journal of Ethnopharmacology
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Article history: Ethnopharmacological relevance: Leea macrophylla Roxb. ex Hornem. (Leeaceae) commonly known as
Received 8 December 2015 Hastikarnapalasa is mainly distributed throughout the tropical parts of India. Traditionally, the plant is
Received in revised form found to be effective against guinea worm, ringworm and is applied to sores and wounds.
17 April 2016
Aim of the study: The present study aims to validate traditional wound healing claim of Leea macrophylla
Accepted 13 June 2016
scientifically.
Available online 14 June 2016
Material and methods: Box–Behnken design (BBD) was used to optimize the extraction process. The opti-
Keywords: mized root tuber extract of Leea macrophylla was standardized with chlorogenic acid by HPLC for the first
Leea macrophylla time. Both oral and topical routes were selected as administrative means for the wound healing study using
Bioadhesive gel excision and incision wound model. For topical treatment bioadhesive gel was formulated and characterized
Wound healing
for mechanical and physical characteristics by texture profile analysis (TPA) and scanning electron micro-
Proinflammatory cytokines
scopy (SEM). The effect on wound healing was also assessed by evaluating antioxidant enzymes viz. glu-
VEGF
Ki-67
tathione (GSH), superoxide dismutase (SOD) and catalase (CAT), free radicals lipid peroxidation (LPO) and
nitric oxide (NO), inflammatory marker myeloperoxidase (MPO), collagen markers hydroxyproline, hex-
osamine and hexuronic acid along with the histopathological examination. Furthermore, the effect on the
level of the proinflammatory cytokines interleukin-1β (IL-1β), interleukin -6 (IL-6), tumor necrosis factor-α
(TNF-α) and growth factor, vascular endothelial growth factor (VEGF) were determined. The expression of cell
proliferation nuclear marker Ki-67 was also analyzed by Western blot analysis.
Results: With mesh openings Sieve no. 20, semi polar nature of solvent (92.5:7.5 ethanol-water blend) and
extraction time of 18 h, substantially greater extraction efficiency (29%) and phenolic yield (181.54 mg/g)
were obtained. The content of chlorogenic acid in ethanol extracts of Leea macrophylla was obtained as 9.01%
w/w. In incision model, oral treatment with 500 mg/kg ethanolic extract increased wound breaking strength
by 23.41% while bioadhesive gel (5% w/v) showed a higher increase of 44.68%. Topical application produced
complete wound contraction in 20 days against 22 days taken by oral treatment. Topical treatment also
produced a significant (po0.05) increase in antioxidants glutathione, superoxide dismutase and catalase
whereas the level of enzymes lipid peroxidation and nitric oxide and inflammatory markers myeloperoxidase
were reduced. Further advantageous effects were reflected by significantly (po0.05) increased levels of
hydroxyproline, hexosamine and hexuronic acid. Favorable effects on the level of proinflammatory cytokines
interleukin-1β, interleukin-6, tumor necrosis factor – α and growth factor, vascular endothelial growth factor
were also observed. The wound healing potential of Leea macrophylla was further supported by its ability to
promote cell proliferation during wound healing as demonstrated by Western blot analysis of proliferation
marker Ki-67.
Conclusion: The study justified traditional use of Leea macrophylla in wound healing and demonstrated that the
bioadhesive gel of ethanolic extract produced faster and more significant healing as compared to oral treatment.
& 2016 Elsevier Ireland Ltd. All rights reserved.
Abbreviations: BBD, Box–Behnken design; ELM, Ethanolic extract of Leea macrophylla; HPLC, High Performance Liquid Chromatography; CGA, Chlorogenic acid; CMC,
Carboxymethylcellulose; SCMC, Sodium carboxy methyl cellulose; PVP, Polyvinyl pyrrolidone; PC, Polycarbophil; ELMO, Oral treatment with ethanolic extract of Leea
macrophylla; ELMT, Topical treatment with bioadhesive gel of ethanolic extract of Leea macrophylla; WBS, Wound breaking strength; HA, Healed area; TWA, Total wound
area; CAT, Catalase; SOD, Superoxide dismutase; GSH, Reduced glutathione; NO, Nitric oxide; LPO, Lipid peroxidase; HTAB, Hexadecyl trimethyl ammonium bromide; MPO,
Myeloperoxidase; IL-1β, Interleukin-1β; IL-6, Interleukin-6; TNF-α, Tumor necrosis factor-α; VEGF, Vascular endothelial growth factor; ELISA, Enzyme linked immunosorbent
assay; ANOVA, Analysis of variance; TPA, Texture profile analysis; SEM, Scanning Electron Microscopy; ROS, Reactive oxygen species; FRSE, Free radical scavenging enzymes
n
Corresponding author.
E-mail address: shemalatha.phe@itbhu.ac.in (S. Hemalatha).
http://dx.doi.org/10.1016/j.jep.2016.06.034
0378-8741/& 2016 Elsevier Ireland Ltd. All rights reserved.
96 A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106
2. Material and methods Young albino rats (Charles Foster) of either sex weighing from
150 to 200 g bred in the Institutional animal facility, were utilized
2.1. Plant material and extraction for animal studies. Rats were granted free access to standard feed
and water. Temperature and relative humidity were maintained at
The root tubers of Leea macrophylla were collected from a 25 °C and 50% respectively. The animals were afforded with suf-
medicinal plant garden of Department of Dravyaguna, Banaras ficient time for acclimatization before experiment initiation. Care
Hindu University in the month of September – October 2013 and and non-experimental handling of animals were performed by
were authenticated by Prof. V.K. Joshi, Department of Dravyaguna, dedicated animal house staff. All experimental protocols were
Banaras Hindu University and submitted to Department of conducted after approval from Central Animal Ethical Committee
A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106 97
Excision wound was created in a parallel group of animals, and sectional thickness of the wound tissue was collected followed by
similar treatment was given as mentioned above. On 10th post- immediate blotting, drying and fixing in 10% formalin. The treated
wounding day, the treated animals from the parallel groups were tissues were parched in dehydrant acetone and embedded in
sacrificed, and the granulation tissue was removed from the re- paraffin wax blocks only to be cut into thin sections (5 μm) using a
spective wound patches. Biochemical evaluations and histological microtome cutter. Haematoxylin-eosin stained sections were then
studies were performed using the granulation tissue samples ob- examined with the help of a microscope (Nikon Trinocular Mi-
tained from the parallel group. croscope, Model E-200, Japan) (Piskin et al., 2014).
Fig. 1. Physicochemical characteristics of bioadhesive gel of ethanolic extract of Leea macrophylla. (A) Hardness, compressibility and adhesiveness of the batches of
bioadhesive gel formulated. Considering the highest adhesiveness, moderate hardness and compressibility BG2 was selected as the best topical formulation (B) Force time
plot of best selected topical formulation BG2. Surface morphology of (C) blank gel and (D) bioadhesive gel BG2 captured by scanning electron microscope.
The results of acute oral toxicity study found the safety limit of
extract to be 5 g/kg when administered via p.o. route. The extract
did not exhibit any behavioral modulation or symptoms of toxicity
or morbidity in the experimental animals.
Interestingly 5% w/v and 7.5% w/v bioadhesive gel of Leea macro- Further advantageous effects on wound healing were reflected
phylla extract exerted almost parallel effects on the tensile by significantly increased levels of hydroxyproline, hexosamine
strength of wounded tissue. Therefore, 500 mg/kg orally was fixed and hexuronic acid levels per unit of dried granulation tissue (g) as
as effective dose of ELM and 5% w/v for topical application for well protein (mg). However, the effect was more pronounced and
further investigation. significant in the case of topical application in comparison to oral
administration.
3.6.2. Excision wound model
In excision wound model the untreated control rats exhibited 3.6.4. Estimation of IL-1β, IL-6, TNF-α and VEGF
chronologically retracting wound contraction, with complete Fig. 5 represents the effect of ethanolic extract of Leea macro-
wound contraction attained on the 24th day. Healing rate of ex- phylla on proinflammatory cytokines IL-1β, IL-6, TNF-α and growth
cised wound was faster in rats treated orally or topically with factor VEGF. On 10th post-wounding day in excision model level of
ethanolic extract compared to the control group. A statistically IL-1β were significantly reduced (1232.89 79.26 pg/ml) in orally
significant difference, within the treatment modules (oral and treated animals whereas the effect were more pronounced in to-
topical), was also observed. Topical treatment with ELM showed pically treated animals (646.67710.73 pg/ml) and were compar-
optimum wound contraction on 16th day (96.8%), which was faster able to topical standard drug Aloe (601.38 78.18) while untreated
as compared to oral treatment (91.7%), also evident with complete control animals showed higher levels (2061.2477.01 pg/ml). The
wound contraction which was found to be on 20th day with to- results also indicated a significant decrease in IL-6 when treated
pical treatment while that with oral treatment was observed on with ethanolic extract of Leea macrophylla. Control animals de-
22nd day (Figs. 3 and 7). monstrated a higher level of IL-6 (3328.13 73.84 pg/ml) and the
The results also depicted that topically treated animals showed decrease was more in topically treated animals (1468.6778.67 pg/
faster healing as compared to oral treatment and the results were ml) than orally treated (2932.44 74.75 pg/ml). The data from
comparable to standard Vitamin E as well as Aloe vera cream. ELISA analysis further showed a higher reduction in TNF-α levels
Mean epithelization period and scar area justified significant when animals were treated topically (2040.067 13.25 pg/ml) as
healing effect of topically treated animals in comparison to oral compared to orally administered (4563 78.61 pg/ml) while levels
treatment (Fig. S3A and B). were higher in control animals (6528.44 710.20 pg/ml). The re-
sults depicted significant augmentation in VEGF production in
3.6.3. Biochemical estimations treated groups as compared to control group which showed a low
Animals which underwent topical treatment showed a greater level of VEGF (418.35 74.71 pg/ml). Topical application
increase in weight of granulation tissue and protein in comparison (907.217 7.48 pg/ml) illustrated effect comparable to topical
to those receiving oral treatment (Fig. S4). The increment in dry standard Aloe (1112.31 79.48 pg/ml) in comparison to oral treat-
and wet weight of granulation tissue and protein content was ment (714.35 75.41 pg/ml).
highly significant in the topically treated group when compared to
control group. Increase in wet tissue and protein was found to be 3.6.5. Western Blot analysis for proliferation marker Ki-67
37.94% and 28.09% respectively, and dry tissue and protein was Cell proliferation in wounded skin investigated by Western blot
found to be 36.90% and 37.01% respectively when treated topically analysis of proliferation marker Ki67 indicated that the expression
with ELM bio gel. Oral treatment also afforded significant rise in of Ki67 was evident from day 1 post-wounding in control and
wet granulation tissue (17.68%), protein content (12.77%) and dry treated groups (orally and topically treated with ethanolic extract
granulation tissue weight (22.04%). However, the increase in dry of Leea macrophylla) however there was no significant difference
tissue protein was not significant. in its level between the groups. On 7th day rise in the level of Ki67
Fig. 4 represents the effect of the extract on antioxidants, free was highly significantly in orally and topically treated animals as
radicals, inflammatory markers and collagen determinants. ELM compared to control however the increase in Ki67 level was
extract exhibited a significant increase in the value of antioxidants greater in topically treated. On 14th day decline in Ki67 was evi-
GSH, SOD and CAT whereas the level of free radical generating dent in all groups however the decline rate was considerably
enzymes LPO and NO, and inflammatory markers, MPO was higher in topically treated groups followed by orally treated and
reduced. control groups. The study illustrated that ethanolic extract of Leea
macrophylla treatment triggered cell proliferation during wound
healing while the effect was more prominent with topical treat-
ment as compared to oral administration (Fig. 6).
Fig. 4. Effect of oral and topical treatment of ethanolic extract of Leea macrophylla on (A) Reduced glutathione (B) Superoxide dismutase (C) Catalase (D) Lipid peroxidation
(E) Nitric oxide (F) Myeloperoxidase(G) Hydroxyproline (H) Hexosamine and (I) Hexuronic Acid. Value are mean 7SEM (n¼ 6). Statistical comparison was determined by one
way ANOVA followed by Newman–Keuls multiple comparison test where ap o 0.05 vs. control, bp o 0.05 vs. ELM oral, cpo 0.05 vs. ELM topical, dp o 0.05 vs. VTE. Effect of
ELM treatment on level of antioxidants, free radicals and collagen determinants were evaluated by oral administration and topical application.
Soxhlet extraction, which was further utilized to develop a re- But significant improvement was considerably more when the
sponse surface model that in turn aided estimation of a descriptive ethanolic extract was applied topically by means of a bioadhesive
mathematical model (Singh et al., 2015a). For detailed discussion gel. In incision model, the wound breaking strength was assessed
please refer to Supplementary information. after oral and topical application. During initial stages of wound
Biogels fabricated for topical delivery should have low hardness processing, only the formed blood clot holds edges of the wound
and compressibility yet high adhesiveness. Low gel hardness will together, and consequently, little breaking strength is required to
reduce the mechanical input required to take out the gel from a disrupt or reopen the wound (Kumara Swamy et al., 2007). With
storage container, whereas low compressibility will improve the the progression of time, breaking strength increases via re-
flow property of gel (relatable to spreadability) and application arrangement of collagen and production of stable intra and in-
onto the topical biologic membrane. High gel adhesiveness will termolecular crosslinked fibre (Mallefet and Dweck, 2008). From
ensure prolonged contact of the biogel onto the wounded area. the study, it was evident that topical treatment was decisively
BG2 aptly combined these three properties with a low magnitude more effective than oral administration.
of compressibility, hardness and adequate adhesiveness prompted Excision wound model showed progressive lessening of
us to select it for further preclinical evaluation. The presence of wounded area amongst the treated groups. The fastest and most
distorted irregular entities in case of lyophilized BG2 (Fig. 1D) is complete wound healing (100% wound contraction) was observed
probably the evidence of precipitated microparticles of Leea mac- with ELMT (5% w/v) within 20 days whereas orally treated rats
rophylla extract. This is the most critical distinction, between blank showed complete healing within 22 days as compared to the
gel and BG2, suggesting proper incorporation of extract in bioad- control group where complete healing took more than 22 days.
hesive gel network. Hence, topical treatment explicates faster rate of wound con-
The results obtained from excision and incision model as well traction, epithelization period and reduced scar area. The success
as from biochemical estimations demonstrated potential wound of any medicament professing wound healing hinges on its ability
healing effect of Leea macrophylla via both oral and topical route. to cause immediate wound closure without scar formation (Clark,
102 A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106
Fig. 5. Effect of oral and topical treatment of ethanolic extract of Leea macrophylla on (A) IL-1β (B) IL-6 (C) TNF α and (D) VEGF. Value are mean 7 SEM (n¼ 6). Statistical
comparison was determined by one way ANOVA followed by the Newman–Keuls multiple comparison test where ap o 0.05 vs. control, bpo 0.05 vs. ELM oral, cp o 0.05 vs.
ELM topical, dpo 0.05 vs. VTE. Levels of IL-1β, IL-6, TNF α and VEGF were determined using ELISA kits on granulation tissue homogenate obtained on 10th post-wounding day
from excision wound model. ELM treatment lowered the level of pro-inflammatory cytokines while level of VEGF was augmented. The results were more pronounced with
topical treatment.
1996). Contraction is characterized by a reduction in the wound, species (ROS). Balance between reactive oxygen species (ROS) and
thus accelerating healing without new tissue formation; and free radical scavenging enzymes (FRSE) is essential for completion
centripetal movement of the contracting wound edges to expedite of wound healing (Joshi et al., 2013). Although originally unin-
closure of wound opening determines the period of epithelializa- tended, these responses thrust an oxidative stress on the damaged
tion (Upadhyay et al., 2013). tissue and delay wound healing as a result of an imbalance be-
Regular immunological representatives (monocytes) and con- tween free radical generation and antioxidants. Such is the di-
nective cells like fibroblasts are crucial for normal wound closure lemma with the ubiquitousness of inflammatory responses that
(Kant et al., 2013). To validate their role, the data from excision both their over expression and under expression lead to deleter-
model was substantiated by histological finding which showed re- ious consequences like susceptibility to innocuous environmental
appearance of skin structure with distinct layers of dermis and factors, severe damage and even tumorogenesis. Therefore, cur-
epidermis in treated groups (Fig. 7). On comparison: the control tailing the influence of ROS on wound openings could be an im-
group had lesser intact tissue in dermal layer than the treated portant alternative strategy (White and Heckler, 1990; Mikhal’chik
group animals. Formation, alignment and contraction of extra- et al., 2006). ROS can be eliminated by enhancing expression of
cellular matrix molecules determine the intactness of tissue. Re- antioxidant enzymes like SOD, GSH and CAT or by scavenging pre-
establishment is critically dependent on the efficiency of re- existing free radicals such as LPO products and NO. SOD carries out
organization of extra cellular matrix molecules (Yariswamy et al., disproportionation of superoxide radicals and quenches genera-
2013). The rise in granulation tissue mass and protein amount tion of any new free radicals. MPO, on the other hand, generates
signifies increased cellular proliferation resulting in increased free radicals. Its elevated status in any milieu (for instance gran-
synthesis of collagen which is the principal extracellular protein in ulation tissue or infiltrating neutrophils) is indicative of bur-
the granulation tissue (Fikru et al., 2012). Increase in collagen in geoning inflammation. MPO activity and neutrophil derived oxi-
orally and topically treated drug is also evident through histolo- dants subject tissue to significant oxidative stress and contribute
gical studies. significantly towards wound recovery induced chronic inflamma-
Our studies on SOD, CAT, GSH, LPO, NO, and MPO status in tion (Zhang et al., 2011). GSH assists in detoxification of radicals by
granulation tissue revealed significant anti-oxidant activity which acting as a helper participant in the glutathione peroxidase (GPx)-
would reduce free radicals stress and nominal MPO level which instigated reduction of H2O2 and lipid peroxides (Roy et al., 2012).
would prevent oxidative damage and thereby accelerate the Biochemical estimation elucidated increased levels of hydro-
healing process. Inflammatory actions instigated by phagocytic xyproline, hyaluronic acid and hexosamine in topically treated
cells during healing often lead to the generation of reactive oxygen animals as compared to oral treatment. The implications of these
A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106 103
Fig. 6. Effect of oral and topical treatment of ethanolic extract of Leea macrophylla on cellular proliferation. Ki67 in rat wound was determined by Western blot at indicated
days. The IOD (integration optical density) of Ki67 protein band was calibrated using β-actin. Value are mean 7 SEM (n¼ 3). Statistical comparison was performed by two way
ANOVA followed by Bonferroni post hoc test. *po 0.05 and ***po 0.001 compared to control group. Treated groups showed a significant increase in expression of proliferation
marker Ki-67 this suggested treatment with ethanolic extract of Leea macrophylla promotes cellular proliferation and hence wound healing.
Fig. 7. Wound images obtained from excision wound model with oral and topical treatment of ethanolic extract of Leea macrophylla. (A) Day 0 of the experiment (B) Day 20
of the experiment (C) Histopathological view of excision wound on 10th post-operative day. Arrow indicates the epithelization zone.
104 A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106
finding can be discerned in the following explanation. Collagen is carbohydrate and saponins were present in the extract. Phenolics
made up of hydroxyproline, and its relative concentration is an (flavonoids and phenolic acids) have been reported for their redox
indicator of collagen production (Joshi et al., 2013). The enhanced potential, which allows them to chip in significantly as oxygen
production of collagen is stabilized by hexosamine content which quenchers and reducing agents and in some cases even metal
provides collagen sites for electrostatic bonding. Since, collagen chelators (Pattanayaka and Sunita, 2008) imparting them potential
critically controls the healing process by making up a major por- in tackling inflammation (Sengar et al., 2015) and thereby wound
tion of connective tissue and also manages its construction, de- healing (Akkol et al., 2012). Moreover, phenolic compounds have
position and ensuing evolution; a higher concentration of hydro- the ability to facilitate wound healing at different stages of wound
xyproline and hexosamine, therefore, promote faster wound healing either by stimulating collagen synthesis, cell proliferation
healing. Collagen is also vital for re-epithelialisation of cellular- and angiogenic effect (Agar et al., 2015). Chlorogenic acid quanti-
matrix and inter-cellular interactions thereby strengthening and fied in the present study is a phenolic acid representing the class
integrating the wound matrix (Pather and Kramer, 2012). Collagen of hydroxycinnamic acid polyphenolic compounds and is a dimer
not only provides the tissue matrix with strength and integrity, of quinic acid and caffeic acid connected with an ester bond (Sato
but it also caters to the homeostatic demands in the latter portion et al., 2011). It is a natural antioxidant found abundantly amongst
of wound healing timeline (Roy et al., 2012). The above stated plant species reportedly possessing antimicrobial, antimutagenic,
functions of collagen are complimented by hyaluronic acid, which anti-inflammatory activity and wound healing properties (Chen
does not participate in its synthesis or maintenance but instead it et al., 2013; Xiang and Ning, 2008). Wound healing potential of
is involved in water retention, nutrient exchange, cell differentia- chlorogenic acid is accredited to its ability to increase cellular
tion and cell mobilization. Hyaluronic acid plays an active role in a proliferation and its antioxidant potential accelerating the process
variety of physiologic and pathophysiologic developments in- (Chen et al., 2013). Earlier studies have also reported that honey
cluding embryo implantation, cutaneous wound healing and os- which exhibits presence of chlorogenic acid also illustrated wound
teoarthritis. Historically, dermatologists and cosmetic practitioners healing potential through free radical scavenging activity pro-
have been investigated hyaluronic acid for its contributory roles moting cell proliferation in the acquisition of concurrence ap-
which help in regaining elasticity, turgor and moisture of skin proaching rapid wound healing (Chaudhary et al., 2015). Further-
(Chen et al., 2014). more, tannins act by chelating free radicals, facilitating wound
The results supported the finding as treatment with ethanolic contraction, accelerating capillary vessel and fibroblast formation
extract of Leea macrophylla reduces the level of proinflammatory and by instigating keratinocyte proliferation thus hastening the
cytokines including IL-1β, IL-6 and TNF-α which are involved in the process of wound healing (Prasad et al., 2010). Hence, all these
process of inflammation, trauma and wound healing regulated by class of phytochemicals has a significant role in wound healing
activity released by macrophages, endothelial and keratinocytes processes. Therefore, the observed potent wound healing activity
(Grellner, 2002). VEGF levels were enhanced by treatment. VEGF is of the extract may be attributed to the presence of chlorogenic
another imperative growth factor involved in wound healing acid along with the cumulative effect of other phytochemicals
produced from keratinocytes smooth muscle cells, fibroblasts, present in the extract. Probably such effect is the result of a sy-
thrombocytes, macrophages and neutrophils and endothelial cells nergy with all the molecules contained in the extract.
during wound healing which plays a key role in angiogenesis The study demonstrated that topical application of ethanolic
(Muthukumar et al., 2014). extract of Leea macrophylla showed faster and more significant
Proliferation during wound healing is indicative of multifaceted healing as compared to oral treatment. This can be explained due
events occurring in the time of course. Proliferation occurs during to the fact that topical delivery is mainly used for achieving the
different phases including epithelialization, angiogenesis, granu- local effect. It is expected that systemic administration would re-
lation tissue formation, and collagen deposition in order to restore quire high doses in order to be secreted substantially at a per-
barrier function, protection against fluid loss and bacterial intru- ipheral location. Skin being a large organ, switching to alternative
sion. Impaired proliferation, migration and contraction during routes of administration, such as the topical route, can, in principle
wound healing advances towards the inefficient repair of the provides predicable, effective and reliable drug delivery. Topical
wound, reluctant epithelization, reduced tensile strength and in- application allows local drug targeting with minimal systemic ef-
creased susceptibility towards bacterial infection (Broughton et al., fects and is mainly used for delivery of anti-inflammatory, anti-
2006; Janis and Harrison, 2014). Ki67 is a commonly used pro- histaminic, antibiotics, wound healing and analgesic drugs (Liu
liferation marker. The expression of Ki67 protein is thought to be et al., 2014).
an indicator of growing cells within the overall cell population
(Choi et al., 2012).
The study demonstrated that treatment with ethanolic extract 5. Conclusion
of Leea macrophylla causes an increase in cellular proliferation as
indicated by the level of Ki67, which was found to be highest on The present study corroborates scientifically the traditional
day 7 post wounding while a decline was observed on the 14th claims of Leea macrophylla in wound healing. This effect may be
day. However, the effect was more pronounced with topical attributed to increased collagen synthesis and reduced in-
treatment as compared to oral administration. Increased cellular flammation through effect on proinflammatory cytokines includ-
proliferation is an essential aspect of wound healing (Lee et al., ing IL-1β, IL-6 and TNF-α and VEGF growth factor, enhanced cel-
2012). Increased cellular proliferation in the study demonstrated lular proliferation as well as potential antioxidant and free radical
early wound healing in treated animals as compared to control scavenging effect which may be mediated due to the presence of
while decline in Ki67 expression may due to the fact that cellular polyphenols mainly chlorogenic acid in the extract. The study also
proliferation might have been subsided as a result of transit from showed that the topical formulation hastens wound healing in
proliferation phase to remodeling phase (Xian et al., 2015) which comparison to the orally treated animals.
was evident from the study as topical treatment exhibited highly
significant decrease in cellular proliferation on 14th day produced Conflict of interest
earlier wound healing on 20th day as compared to oral treatment
where complete wound healing was achieved on 22nd day. The authors report no conflicts of interest. The authors alone
Significant amount of tannins, phenols, flavonoids, are responsible for the content and writing of the paper.
A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106 105
Acknowledgment healing potential of the root extract of Albizzia lebbeck. Planta Med. 79, 737–743.
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