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Journal of Ethnopharmacology 191 (2016) 95–106

Contents lists available at ScienceDirect

Journal of Ethnopharmacology
journal homepage: www.elsevier.com/locate/jep

Systematic investigation of ethanolic extract from Leea macrophylla:


Implications in wound healing
Apurva Joshi a, Vinod K. Joshi b, Deepali Pandey a, S. Hemalatha a,n
a
Department of Pharmaceutics, Indian Institute of Technology, Banaras Hindu University, Varanasi 221005, India
b
Department of Dravyaguna, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India

art ic l e i nf o a b s t r a c t

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

1. Introduction Pharmaceutics, Indian Institute of Technology, Banaras Hindu


University, Varanasi (No. COG/LM/01). The acquired root tubers
Compromise in congruity of any tissue is classified as a wound were weighed (200 g), and shade dried followed by a cycle of
(example skin breaks, muscle tears, burns or a bone fracture). It powdering before extraction. The process of Soxhlet extraction
may result from a random fall, a bruising accident, surgery, an was optimized using Box–Behnken design (BBD) where three
infection or a covert etiological ailment. For instance, disruption of discerning factors influencing the extraction process were ana-
skin integrity leads to cutaneous wounds (Mallefet and Dweck, lyzed including mesh size, extraction solvent and extraction time.
2008), whereas abrupt collision with a moving vehicle may cause Design Expert (Version 6.0.0 Trial, Stat-Ease Inc., MN) was used to
visceral, deep lying wounds. The causative factors, signaling in- determine the boundary of the experiment, for evaluating re-
termediaries, pre-existent diseases, and type of injury all cumu- sponse and for finally optimizing the process. Each specific design
latively determine whether the healing process will be acute or factor was constrained at three levels: low, medium and high level.
chronic (Schreml et al., 2010). Following the design, the powdered drug was passed through
Wound healing is a dynamic, complex mechanism aimed to- the sieve (Sieve no. 10, 20 and 40) and then subjected to extraction
wards re-attainment of tissue integrity and homeostasis (Eming in Soxhlet apparatus using ethanol-water blend at different ratios
et al., 2007) involving inflammation, re-epithelization, granulation (85:15, 92.7:7.5 and 100:0) for a particular time (12 h, 18 h and
tissue formation, neovascularization, wound contraction and re- 24 h) at 70 °C. The solvent was removed by concentrating the
modeling of extracellular matrix (Singer and Clark, 1999). It is extract in a rotary evaporator (IKA) at 40 °C under reduced pres-
coordinated by a complicated signaling system involving various sure. The residue left behind was reddish brown in colour and was
growth factors, cytokines and chemokines. Cell proliferation is an stored in a desiccator.
imperative step in tissue repair and regeneration in wound healing
process (Xing et al., 2015). 2.2. Working with BBD towards response surface
Constrained healing hampers the life of plenty, and conse-
quently, more efforts are being directed towards investigating cost The efficiency of Soxhlet extraction depends on factors such as
efficient and accessible therapeutic approaches. Plants and their the degree of sample homogenization, nature of the solvent used
phytoconstituents have been long-established to treat wounds for extraction and length of time invested in the completion of
(Wang et al., 2011). Leea macrophylla Roxb. ex Hornem. (Leeaceae), extraction process (Gullberg et al., 2004). These critical factors
commonly known as Hastikarnapalasa is a wild edible plant with were identified by preliminary experimentation and data mining
high nutritive value in terms of minerals and vitamins content (B1, as being capable of influencing extraction. Please refer to Supple-
B2, C and B12) (Jadhao et al., 2009). The dried powdered root of mentary information for detailed optimization of soxhlet extrac-
Leea macrophylla is taken along with clarified butter in the tion process.
morning as age sustainer (Jadhao and Wadekar, 2010). Tradition-
ally, the plant has been reported to be effective against guinea 2.3. Confirmation of chlorogenic acid in ethanolic extract by High
worm, ringworm and is applied on sores and wounds (Kirtikar and Performance Liquid Chromatography (HPLC)
Basu, 1975; Bhavamishra, 2010). Roots are applied externally to
allay pain and are alexipharmic (Kirtikar and Basu, 1975). In Uttar A validated HPLC method (Yuan et al., 2005) was followed for
Pradesh (India) its local name is Bado hanshia where the local standardizing ethanolic extract of Leea macrophylla. Commercially
tribes use the root tubers orally and locally for treating wound procured chlorogenic acid (CGA, Sigma-Aldrich [purity: 95%]) was
(Anonymous, 1999). Pharmacologically, the plant has been re- employed as standard. HPLC system (Waters) equipped with gra-
ported to possess anti- urolithiasis (Nizami et al., 2012) and anti- dient pumps was used for analysis. A Cosmosil C18 column
inflammatory activities (Dewanjee et al., 2013). Recently, we have (150 mm  4.6 mm, 5 mm particle) was used for chromatographic
successfully evaluated the potential in vitro antioxidant and anti- separation of the sample. The injection volume of sample was
bacterial activity of ethanolic extract of Leea macrophylla root tu- 10 mL. An aqueous phase consisting of 0.4% acetic acid and 4.5%
bers (ELM), which is mainly attributed to the presence of phenolic, tetrahydrofuran in triple distilled water was modified with acet-
tannins, flavonoid, steroids and alkaloid (Joshi et al., 2016). How- onitrile in a variable pattern to form the mobile phase flowing at
ever, the root tubers have not been scientifically validated for their 1 ml/min. Gradient elution began with an aqueous phase to acet-
wound healing activity. onitrile phase ratio of 5:95 and changed up to 25:75 during the
The present study intends to investigate wound healing po- initial 15 min. Further, the ratio of the mobile phase was altered
tential of Leea macrophylla root tuber extract to scientifically va- from 25:75 to 60:40 for next 35 min. An equilibration period of
lidate its traditional claims. Apart from employing statistical de- 10 min was allowed using the initial mobile phase composition
scriptors to optimize the extractive process, the current manu- before injecting the next sample. The entire operation was carried
script also entails the development and thorough mechanical out in ambient conditions. The peak area of extracted data was
characterization of bioadhesive hydrogel for topical application of calculated at 326 nm using class VP series software. The identity of
obtained extract and comparison of its wound healing effect with the peak was affirmed by cross checking retention time of the
its oral formulation, to discern the most feasible route of standard chlorogenic acid sample.
administration.
2.4. Experimental animals

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

of Banaras Hindu University (No. Dean/2015/CAEC/980) as per Table 1


accepted standard guidelines. Experimental design for manufacture of bioadhesive gels with their codes.

Batch no. SCMC (%w/v) PVP (%w/v) PC (gm) (%w/v)


2.5. Oral dose
BG 1 2.5 2.5 2
For oral administration, the ethanolic extract of Leea macro- BG 2 4 2.5 2
BG 3 4 4 2
phylla was suspended in carboxymethylcellulose (CMC, 0.5%) at BG 4 2.5 4 2
250, 500 and 750 mg/kg p.o. Vitamin E (VTE, Sigma-Aldrich,
[purity 95%]) was selected as oral standard drug to evaluate
wound healing activity in experimental animals as reported earlier
(Joshi et al., 2013). Ketamine 100 mg/kg i.p. (Homayouni-Tabrizi 2.8. Acute skin irritation test
et al., 2015) was used as the anesthetizing agent.
The method of Gfeller et al. (1985) was used on rats to de-
2.6. Topical formulation and its characterization termine acute skin irritation of Leea macrophylla extract bioadhe-
sive gel. 500 mm2 area of dorsal hair of animals were shaved and
Sodium carboxy methyl cellulose (SCMC; 2.5 or 4%, w/v) was cleaned. The bioadhesive gel formulations (2.5%, 5% and 7.5% w/v)
initially dispersed in triple distilled water overnight using a were then applied to different groups of animals. The skin of each
magnetic stirrer. Following complete solubilization, poly- animal was checked for any sign and symptom of inflammation
vinylpyrrolidone (PVP; 2.5 or 4%, w/v) was added to swelled SCMC following 4 h of application.
dispersion. To the SCMC/PVP containing gel, polycarbophil (PC; 2%,
w/v) followed by differing concentration of ethanolic solution of 2.9. Wound healing activity
extract (2.5, 5.0 and 7.5 g per ml ethanol) were added and mixed,
which yielded 2.5%, 5% and 7.5% w/v of active extract containing 2.9.1. Incision wound model
bioadhesive gel. All samples were tapped vigorously to remove Each group of animals for this study had six rats. The control
entrapped air and kept in a desiccator. For comparative reference group (Group 1) remained untreated whereas animals in Group
blank gels were also prepared by following the above described 2 were treated with blank gel. The animals in Group 3–5 received
steps with the exception of adding extract. Experimental Design oral treatment with ethanolic extract of Leea macrophylla (ELMO)
for the manufacture of bioadhesive gel is given in Table 1. The at 250, 500 and 750 mg/kg p.o. while Group 6–8 animals were
optimized biogel was lyophilized using lyophilizer (Lypholizer, treated topically with bioadhesive gel of ethanolic extract of Leea
Decibel, India) for 36 h at  40 °C for further analysis (Singh et al., macrophylla (ELMT) at a concentration of 2.5%, 5% and 7.5%. Group
2015c). 9 served as oral standard and was given Vitamin E (200 mg/kg p.
Mechanical behavior of the extract containing bioadhesive gel o.), and Group 10 animals were treated with Aloe vera cream as
was evaluated using a texture analyzer (BrookField, CT3) working topical standard (Chithra et al., 1998). Each animal was kept se-
in TPA mode. TPA was calibrated for the probe, force and frame parately in cages. The rats were anesthetized universally across the
stiffness using Texture Pro CT 64 bit software package which vertebral column, and two paravertebral incisions (6 cm long)
drives the CT3 Texture analyzer. The biogels were packed into the were created along the full thickness of the skin. The wounds were
sample holder, and a polymeric probe (20 mm across) was com- closed with interrupted sutures at a distance of 1 cm. Oral and
pressed twice into them at a rate of 2.0 mm/s to a defined depth topical treatments were continued up to 10 days with sutures
(30 mm) allowing delay period (10 s) between two consecutive being removed after the 6th day. The method described by Lee
compression cycles. From the resultant force–time plot obtained (1968) was used to determine wound breaking strength (WBS) on
for three replicate samples, hardness, compressibility and adhe- the 10th post-wounding day.
siveness were calculated. On the basis of these parameters, the
best topical formulation was selected and carried forward for 2.9.2. Excision wound model
further biological evaluation (Singh et al., 2015c). A total of thirty animals were divided into five groups of six
The surface morphology of optimized gel and the blank gel was animals each. The control (Group 1) remained untreated whilst
captured using scanning electron microscope (EVO-50, ZEISS, Group 2 was administered 500 mg/kg p.o. ethanolic extract of Leea
United Kingdom). The samples were prepared by mounting lyo- macrophylla (equivalent to optimum dose in incision model) and
philized gels on a double adhesive tape attached to an aluminium Group 3 animals were treated with bioadhesive gel of ethanolic
stub and sputter coated with a gold-palladium alloy under an ar- extract of Leea macrophylla at concentration of 5% (dose optimized
gon atmosphere using a high vacuum evaporator (SC7640 Polaron in incision model), Group 4 received standard oral dose of 200 mg/
Sputter Coater). Gels were imaged using a 5 kV accelerating vol- kg Vitamin E, and Group 5 animals received Aloe vera cream as
tage, at a working distance of 10 mm by randomly scanning sev- topical standard. The excision wounds were created as per the
eral imaging fields at appropriate magnifications (Singh et al., protocol prescribed by Morton and Malon (1972). The wound was
2015b). traced on 1 mm2 graph paper on the wounding day and subse-
quently on the passage of each 4-day interval till the 12th day. The
2.7. Acute oral toxicity study tracing process was then accelerated and performed on each al-
ternate day until completion of healing to accurately determine
The study was conducted on fasted regular nulliparous and scar area. Following formula was used for calculating the change in
non-pregnant female rats by orally administering ethanolic extract the wound area.
of Leea macrophylla. The treated animals were then observed % wound contraction = (HA /TWA) × 100
vigilantly for 48 h for signs of acute toxicity (OECD, 2008) by no-
ticing their para-sympathetic and communicative changes. More where healed area (HA) is the difference between the total wound
precisely occurrence of convulsions, excessive salivation, lacrima- area (TWA) and current wound area. Epithelization period is the
tion, defecation, tremors, shivers and any alteration in sleep number of days required for falling off the scar without any re-
feeding pattern were observed. sidual raw wound.
98 A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106

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).

2.9.3. Biochemical estimations 2.10. Statistical analysis


The granulation tissue obtained from excision model was
evaluated for biochemical parameters. A part of granulation tissue The results of the experiment are indicated as mean 7S.E.M.,
was subjected to drying for 24 h at 60 °C to determine the con- with six animals in each group followed by one-way analysis of
nective tissue parameters. The dried tissue was weighed and variance (ANOVA). Newman–Keuls multiple comparison test was
treated with 6N HCl on the water bath for a period of 24 h for selected to compare different groups and to evaluate the statistical
hydrolysis. To the cooled hydrolysate, 10N NaOH using phe- significance between them. Also, two-way ANOVA followed by
nolphthalein was added for neutralization and its concentration Bonferroni post hoc test was used to find the significant level in
was made to 20 mg/ml of dried granulation tissue with distilled excision model and cellular proliferation study. The statistical
water. Hydroxyproline, hexuronic acid and hexosamine were analysis was performed using GraphPad Prism (version 4; San
evaluated by using the final solution as per standard methods. The Diego, CA, USA) software. Po 0.05 was deemed as significant.
remaining part of granulation tissue was homogenized using
phosphate buffered saline (PBS, 10% homogenate) at 4 °C followed
by centrifugation at 40,000  g for 30 min. The supernatant ob- 3. Results
tained was analyzed for catalase (CAT), superoxide dismutase
(SOD) and reduced glutathione (GSH). Free radical inducing com- 3.1. Working with BBD towards response surface
ponents like nitric oxide (NO) and tissue lipid peroxidase (LPO)
were also gauged. Further, acute inflammatory marker myeloper- Ethanolic extract of Leea macrophylla was obtained by using
oxidase was estimated by homogenizing granulation tissue in 0.5% Soxhlet extraction of powdered root tuber. BBD was utilized to
hexadecyl trimethyl ammonium bromide (HTAB, Sigma-Aldrich, optimize the extractive process so as to maximize the extraction
Co., St. Louis, MO, USA) with 50 mM potassium phosphate buffer efficiency and the phenolic content obtained. Three input factors,
(pH 6). The homogenate was freeze-thawed three times; sonicated solvent blend, mesh size and duration of extractive processing
for 10 s followed by cool centrifugation at 4 °C for 45 min at were varied over three levels to arrive at the best response model
14,000  g. The supernatant was then used for evaluation of which was used to predict the conditions for optimized extraction
Myeloperoxidase (MPO) as per standard procedure (Murthy et al., cycle. With mesh openings Sieve no. 20, semi polar nature of
2013). solvent (92.5:7.5 ethanol-water blend) and extraction time of 18 h,
substantially greater extraction efficiency (29%) and phenolic yield
2.9.4. Estimation of IL-1β, IL-6, TNF-α and VEGF (181.54 mg/g) were obtained. See Supplementary information for
The pro-inflammatory cytokines interleukin-1β (IL-1β), inter- detailed results.
leukin  6 (IL-6), tumor necrosis factor – α (TNF-α) and growth
factor, vascular endothelial growth factor (VEGF) were assessed by 3.2. Quantification of chlorogenic acid by HPLC
enzyme linked immunosorbent assay (ELISA) using IL-1β, IL-6,
TNF-α (Komabiotech) and VEGF (RayBiotech) ELISA kits on gran- The phytochemical study revealed that the extract was highly
ulation tissue homogenate obtained on 10th post-wounding day rich in phenolics. As per literature review, it was found that the
from excision wound model. The ELISA protocol was followed as family Leeaceae to which plant belongs had shown the presence of
per manufacturer guideline. CGA (Kubitzki, 2007) which has been implicated with wound
healing potential in several studies (Chen et al., 2013). Considering
2.9.5. Western Blot analysis of proliferation marker Ki-67 the above probability TLC was performed to substantiate the lead.
Effect of Leea macrophylla on cellular proliferation was eval- TLC confirmed the presence of CGA, hence, it was the molecule
uated using Western blot analysis of proliferation marker Ki67. The which we selected out of all the possible active constituents for
rats were divided into three groups including control, ELMO and quantification with the help of HPLC. From calibration plot of
ELMT treated groups with 9 animals of either sex in each. An ex- chlorogenic acid, the content of chlorogenic acid in ethanol ex-
cision wound was created as described earlier and skin wound tracts of Leea macrophylla was obtained as 9.01% w/w (Fig. S2).
specimens were collected on 1st, 7th and 14th-day post- wound-
ing. The excised wound tissue was subjected to homogenization in 3.3. Topical formulation and its texture profile analysis (TPA)
RIPA buffer followed by centrifugation at 14,000  g for 15 min
discarding the supernatant. Separation of protein from aliquots The mechanical properties of the extract containing topical
was processed on sodium dodecyl sulfate polyacrylamide gel bioadhesive gel were obtained using texture profile analysis, as
electrophoresis (SDS-PAGE) and transferred to nitrocellulose presented in Fig. 1A. Fig. 1B is a force time plot of BG2. The
membrane followed by incubating the membrane with primary hardness of gels was: BG1 (1.022 7 0.03 N), BG2 (2.7307 0.04 N),
antibody against ki67 (Sigma, St. Louis, MO). Anti rabbit antibodies BG3 (3.15070.12 N), BG4 (2.400 70.08 N). The compressibility
were used as secondary antibody. Visualization of protein was was: BG1 (14.78 72.10 N-mm), BG2 (25.26 7 0.83 N-mm), BG3
performed by enhanced chemiluminescence employing lumines- (29.66 71.80 N-mm), BG4 (24.6571.60 N-mm). The adhesiveness
cent image analyzer. was: BG1 (14.79 70.31), BG2 (21.80 70.67 N-mm), BG3
(22.09 71.19 N-mm), BG4 (15.807 0.54 N-mm). As it may be dis-
2.9.6. Histological studies cernible from the figure, increasing the concentration of SCMC
The animals from excision wound model were anesthetized on from 2.5% to 4% (w/v) and PVP 2.5–4% (w/v) in BG1 to BG3 sig-
the 10th post-operative day of the experiment, and full cross- nificantly increased formulation hardness, compressibility and
A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106 99

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.

3.4. Acute oral toxicity study

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.

3.5. Acute skin irritation test

Acute dermal toxicity study showed that formulated bioadhe-


sive gel containing ethanolic extract of Leea macrophylla did not
induce any noticeable swelling, inflammation, irritation or any
others abnormalities on the skin of the treated animals.
Fig. 2. Effect of oral and topical treatment of ethanolic extract of Leea macrophylla
on breaking strength in rats. Value are mean 7SEM (n¼ 6). Statistical comparison
determined by one way ANOVA followed by the Newman–Keuls multiple com- 3.6. Wound healing activity
parison test, where ap o 0.05 vs. control, bp o0.05 vs. gel base, cpo 0.05 vs. ELM
250, dp o 0.05 vs. ELM 500, epo 0.05 vs. ELM 750, fp o 0.05 vs. ELM 2.5, gp o0.05 vs.
3.6.1. Incision wound model
ELM 5, hp o 0.05 vs. ELM 7.5, ip o0.05 vs. VTE. A significant rise in WBS was found
in animals treated topically with ELM gel 7.5% w/v (461.677 10.78 g) followed by
Fig. 2 represents the effect of orally administered and topically
ELM gel 5% w/v (453.337 9.19 g) which were comparable to topical standard Aloe applied ethanolic extract of Leea macrophylla on the tensile
(481.677 9.80 g) while increase in WBS with topical treatment with ELM gel 2.5% strength of wounds. The wound breaking strength (WBS) after oral
w/v (398.337 10.14 g) and oral administration with ELM 750 (400.007 8.56 g) and administration and topical application was increased significantly
ELM 500 (386.6776.15 g)were comparable with oral standard VTE
(410.007 10.65 g). Blank gel (321.677 7.03 g) didn’t exhibit any significant increase
when incision study was performed. However, the increase in
in WBS. results was more pronounced when the extract was applied to-
pically. The blank gel alone didn't produce any significant rise in
adhesiveness. Considering the highest adhesiveness, moderate wound breaking effect. Highly significant increment in WBS was
hardness and compressibility of BG2 was selected as the best to- obtained in treated animals, with percentage increase of 23.41%,
pical formulation and used for further studies. BG2 and an 27.66% and 27.13% when treated with ELM orally at 500, 750 mg/kg
equivalent blank gel were lyophilized and observed under Scan- and topically at 2.5% w/v respectively which were comparable
ning Electron Microscopy (SEM). with oral standard Vitamin E (30.85%). A percentage increase of
SEM micrographs for blank gel (Fig. 1C) revealed a smooth 44.68% and 47.34% were observed with topical treatment at 5% w/v
undulating texture. The presence of distorted irregular entities in and 7.5% w/v ELM bioadhesive gel respectively which were com-
case of lyophilized BG2 (Fig. 1D) is probably evidence of pre- parable to topical standard Aloe vera cream (53.73%). However, the
cipitated micro particles of Leea macrophylla extract upon drying. WBS of rats plateaued at doses exceeding 500 mg/kg p.o.
100 A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106

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).

3.6.6. Histological studies


To gain mechanistic insight into the stages of wound healing
(initial inflammation, proliferation and skin remodeling) which
results in re-epithelization; histology of excised skin-wound from
experimental animals was observed on ‘day 10’ after treatment
initiation. Accelerated healing was observed in topically treated
group with greater collagen content, angiogenesis, keratinization,
fibroblast proliferation and epithelialisation compared to orally
treated group. The repaired architecture of skin was observed with
orderly epithelization, along with the renewal of fibroplasia, neo-
vascularization and adnexa in treated groups whereas wound
Fig. 3. Effect of oral and topical treatment of ethanolic extract of Leea macrophylla healing rate was protracted in the control group (Fig. 7).
on wound area. Value are mean 7SEM (n¼ 6). Statistical comparison was per-
formed by two way ANOVA followed by Bonferroni post hoc test. Complete wound 4. Discussion
contraction in animals treated topically with ELM gel 5% w/v were achieved in 20
days while oral treatment with ELM 500 mg/kg exhibited complete wound con-
traction in 22 days. Control animals showed delayed wound healing with complete Design of experiments (DoE) was used to determine the re-
wound contraction in 24 days. levant influential factors and their admissible limit range on
A. Joshi et al. / Journal of Ethnopharmacology 191 (2016) 95–106 101

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

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