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Received: 7 June 2018 Revised: 12 July 2018 Accepted: 13 July 2018

DOI: 10.1002/ptr.6174

RESEARCH ARTICLE

Artichoke leaf extract, as AKR1B1 inhibitor, decreases sorbitol


level in the rat eye lenses under high glucose conditions ex vivo
Ivana Šušaníková1 | Jana Balleková2 | Milan Štefek2 | Jan Hošek3 | Pavel Mučaji1

1
Department of Pharmacognosy and Botany,
Faculty of Pharmacy, Comenius University, In the previous study, the artichoke leaf extract showed effective inhibition of AKR1B1,
Bratislava, Slovakia
the first enzyme of polyol pathway, which reduces high level of glucose to osmotically
2
Institute of Experimental Pharmacology and
Toxicology, Slovak Academy of Sciences, active sorbitol, important for development of chronic diabetic complications. In the
Bratislava, Slovakia present study, the effect of artichoke leaf extract and of several participating phenols
3
Department of Molecular Biology and
(caffeic acid, chlorogenic acid, quinic acid, and luteolin) was tested on sorbitol level in
Pharmaceutical Biotechnology, Faculty of
Pharmacy, University of Veterinary and rat lenses exposed to high glucose ex vivo, on cytotoxicity as well as on oxidative stress
Pharmaceutical Sciences Brno, Brno, Czech
in C2C12 muscle cell line induced by high glucose in vitro. The concentration of sorbitol
Republic
Correspondence
was determined by enzymatic analysis, the cytotoxicity was provided by WST‐1 test
Ivana Šušaníková, Department of and intracellular content of reactive oxygen species was determined by fluorescence
Pharmacognosy and Botany, Faculty of
Pharmacy, Comenius University in Bratislava,
of 2′‐7′‐dichlorofluorescein probe. The extract and the compounds tested showed
Odbojárov 10, 83232 Bratislava, Slovakia. significant protection against toxic effects of high concentration of glucose in both
Email: ivana.susanikova@gmail.com
models. On balance, the artichoke leaf extract thus represents a prospective preventive
Funding information
Agentúra Ministerstva školstva, vedy, agent of development of chronic diabetic complications, probably due to phenols
výskumu a športu SR, Grant/Award Numbers: content, concerning preclinical and clinical studies.
APVV‐15‐0308 and APVV‐16‐0207; Faculty
of Pharmacy, Comenius University in Brati-
slava, Grant/Award Number: FaF UK/6/2016; KEY W ORDS
Ministerstvo školstva, vedy, výskumu a športu aldo‐keto reductases, polyol pathway, oxidative stress, chronic diabetic complications, Cynara
Slovenskej republiky, Grant/Award Numbers:
cardunculus, glucose toxicity
VEGA 1/0290/16, VEGA 1/0359/18, VEGA
1/0561/18 and VEGA 2/0041/15; Veterinární
a Farmaceutická Univerzita Brno, Grant/
Award Number: IGA VFU 313/2018/FaF

1 | I N T RO D U CT I O N Chlorogenic, caffeic, and quinic acids, present in the extract


(Kuczmannová et al., 2015), may be responsible for these effects.
Our previous study reported on biological activities of artichoke leaf The aldo‐keto reductase superfamily includes more than 150 structur-
extract (Miláčková, Kapustová, Mučaji, & Hošek, 2017). The extract ally related NAD(P)H‐dependent enzymes, which reduce carbonyls to
effectively inhibited isolated human aldose reductase AKR1B1 their appropriate alcohols. AKR1B1, a member of this family, is
(IC50 = 5.12 ± 0.11 μg/ml) and its rat equivalent rat lens aldose reduc- included in the intracellular inflammatory pathway as well as the first
tase (RL‐AKR; IC50 = 3.06 ± 0.08 μg/ml) and effectively reduced enzyme of the polyol pathway, in which it reduces glucose to osmotic
NF‐κB activity during LPS incubation in human leukemic monocytes. active alcohol sorbitol under hyperglycemic conditions. The sorbitol
accumulation in tissues may result in disruption of cellular osmotic
Abbreviations: AKR1B1, human aldose reductase; Art, artichoke leaf extract; homeostasis (Kador, Lee, Fijisawa, Blessing, & Lou, 2000). In addition,
CA, caffeic acid; ChA, chlorogenic acid; COX‐2, cyclooxygenase‐2; DCF, 2′‐7′‐
the increased flux of glucose through the polyol pathway and conse-
dichlorofluorescein; DCFH‐DA, 2,7‐dichlorodihydrofluorescein diacetate;
DMEM, Dulbecco's Modified Eagle Medium; DMSO, dimethyl sulfoxide; LPS, quent depletion of nicotinamide adenine dinucleotide phosphate
bacterial lipopolysaccharide; Lut, luteolin; MMP‐2, matrix metalloproteinase (NADPH) may inhibit the activity of other NADPH‐requiring enzymes,
type 2; NADH, nicotinamide adenine dinucleotide; NADPH, nicotinamide
including those of the glutathione redox cycle. The decreased levels of
adenine dinucleotide phosphate; PBS, phosphate buffered saline; QA, quinic
acid; RL‐AKR, rat lens aldose reductase; ROS, reactive oxygen species; SDH, reduced glutathione increase the susceptibility of cells to damage by
sorbitol dehydrogenase oxidative stress (Hamada, Araki, Horiuchi, & Hotta, 1996; Obrosova,

Phytotherapy Research. 2018;1–7. wileyonlinelibrary.com/journal/ptr © 2018 John Wiley & Sons, Ltd. 1
2 ŠUŠANÍKOVÁ ET AL.

2005). This mechanism, along with other factors of glucose toxicity 2.3 | Cell culture
like protein‐kinase C‐dependent activation of NAD(P)H oxidase, could
The mouse myoblast cell line C2C12 was obtained from the European
lead to increase of oxidative stress. Osmotic stress together with oxi-
Collection of Cell Cultures (Salisbury, UK). Cells were maintained in
dative stress may contribute to the development of chronic diabetic
DMEM medium supplemented with 10% heat‐inactivated fetal bovine
complications as cataract, diabetic neuropathy, nephropathy, and
serum, 100 U/ml penicillin and 100 μg/ml streptomycin at 37 °C in an
others (Alexiou, Pegklidou, Chatzopoulou, Nicolaou, & Demopoulos,
incubator with humidified atmosphere and flow of 5% CO2. The cells
2009; Kador, 1998; Yabe‐Nishimura, 1998). Antioxidants and aldose
were passaged approximately twice a week.
reductase inhibitors were recognized as important factors in the strat-
egy of prevention and attenuation of long‐term diabetic complications
(Coudert et al., 1994; Juranek, Horakova, Rackova, & Stefek, 2009;
2.4 | Animals
Karasu et al., 2012; Stefek et al., 2008).
Artichoke (Cynara cardunculus L.; Asteraceae family) is grown The lenses removed from the experimental rats in the Department of
mainly in Italy, Spain, and Peru, and its flesh leaves (bracts) are cooked Pharmacology and Toxicology of the Faculty of Pharmacy of the
and eaten worldwide. The artichoke leaves were investigated for their Comenius University in Bratislava, Slovakia, were designated for other
beneficial effects (mainly due to polyphenolic compounds) such as experiments. All experimental procedures, involving the use of exper-
inhibition of the biosynthesis of cholesterol, induction of choleresis, imental animals, were approved by the local Ethical Committee and
mobilization of energy reserves, as well as their antibacterial and hepa- the State Veterinary and Food Administration of the Slovak Republic.
toprotective actions (Gabbay, 2004; Zhu, Zhang, & Lo, 2004). Arti- The investigation conforms to the Guide for the Care and Use of Lab-
choke extracts are also recognized for their hypoglycemic effect and oratory Animals: Eighth Edition (2010) published by the US Committee
beneficial effect on lipid metabolism of diabetic rats (Hosseini, for the Update of the Guide for the Care and Use of Laboratory Ani-
Mousaei, & Tavakoli, 2015; Magied, Hussien, Zaki, & Said, 2016; mals, National Research Council, and to the EU adopted Directive
Salem et al., 2017). 2010/63/EU of the European Parliament and of the Council on the
Potential effects of artichoke leaf extract on sorbitol content in protection of animals used for experimental and other scientific
tissues exposed to hyperglycemia have not been thoroughly investi- purposes.
gated. The aim of this work was to elucidate the effect of artichoke
leaf extract and several compounds of its content on high‐glucose‐
induced oxidative stress and on sorbitol accumulation in tissues 2.5 | In vitro analysis of cytotoxicity and cell
exposed to high glucose, which are the potential mechanisms leading proliferation
to the development of chronic diabetic complications.
The effects of the compounds tested on the activity of mitochondrial
dehydrogenases of cells were assessed using the reduction of tetrazo-
lium salt WST‐1. C2C12 cells were seeded (18,000 cells/100 μl/well)
2 | MATERIALS AND METHODS
into a 96‐well plate. After 24 hr, different concentrations of the sam-
ples tested were added. The samples were dissolved in cultivation
2.1 | Materials medium or in DMSO and medium in case of luteolin. The final concen-
The DMEM low glucose (5.5 mM) with sodium pyruvate (110 mg/L) tration of DMSO never exceeded 0.5%. Following 24‐hr incubation, a
was purchased from Biosera (Nuaille, France). The penicillin–strepto- WST‐1 assay kit was used according to the manufacturer's instruc-
mycin mixture was purchased from Lonza (Verviers, Belgium). Phos- tions to determine cytotoxicity. The amount of formazan created
phate‐buffered saline (PBS), fetal bovine serum, dimethyl sulfoxide (which corresponds to the number of viable and metabolically active
(DMSO), β‐NAD+, diaphorase, resazurin, M‐199 medium (M 3769), cells) was calculated as a percentage of the control cells which were
set as 100%.
D‐glucose, chlorogenic acid, caffeic acid, quinic acid, luteolin, and
HClO4 were purchased from Sigma‐Aldrich (Germany). 2,7‐
dichlorodihydrofluorescein diacetate (DCFH‐DA) was purchased from
Cayman Chemical (Ann Arbor, MI, USA). The WST‐1 assay kit and the 2.6 | Determination of intracellular oxidative stress
sorbitol dehydrogenase were obtained from Roche Diagnostics under high‐glucose conditions
(Mannheim, Germany).
The generation of reactive oxygen species (ROS) was assessed using a
DCFH‐DA probe. C2C12 cells were seeded in DMEM low glucose
medium (5.5 mM) into a black 96‐well plate (18,000 cells/100 μl/well).
2.2 | Extract After 24‐hr incubation, the test samples were added. After 1 hr, the
The water infusion of artichoke leaves (C. cardunculus L., Asteraceae glucose dissolved in PBS or pure PBS was added for increasing glucose
family [European Pharmacopoeia 8th edition]) from material pur- concentration to 55 mM or retaining normal glucose conditions
chased from Fytopharma (Malacky, Slovak Republic) was prepared (5.5 mM). After 3.5‐hr incubation, DCFH‐DA (10 μM) dissolved in
according to the Pharmacopoeia Bohemoslovaca 4. It was lyophilized the medium was introduced. After further 30 min, the intracellular
at −53 °C and 0.043 Pa in a SCANVAC CoolSafe freeze dryer fluorescence was measured (λ [excitation/emission] = 480/530 nm)
(LaboGene, Lynge, Denmark) according to the instructions. in Fluostar Omega Microplate Reader (BMG Labtech).
ŠUŠANÍKOVÁ ET AL. 3

2.7 | Eye lenses sorbitol assay chronic diabetic complications such as cataract, diabetic nephropathy,
neuropathy, and others (Coudert et al., 1994; Juranek et al., 2009;
The animals in light ether anesthesia were sacrificed by bleeding the
Karasu et al., 2012; Stefek et al., 2008).
cervical artery, and the eye globes were excised. The lenses were
The aim of this experimental work was to expand the findings
quickly dissected, rinsed with PBS, and weighed. The lenses were
about potential therapeutic effects of artichoke leaf extract on chronic
incubated at 37 °C in tubes (one lens per tube) in M‐199 medium at
diabetic complications. The effects of artichoke extract on models of
pH 7.4, bubbled with pneumoxide (5% CO2 and 95% O2), and with
cell culture and isolated organ under high‐glucose conditions were
the compounds tested, they were soluted in the medium. After
evaluated. Phenolic compounds present in the extract were investi-
30 min, glucose was added to the tubes to the final concentration of
gated to better understand which particular constituent is responsible
50 mM, except the negative control. Then the incubation was contin-
for the effect. However, the concentrations of the phenolic com-
ued following 3 hr at 37 °C with occasional (in about 30‐min intervals)
pounds used are greater than their concentrations in raw extract.
bubbling of the mixture for approximately 30 s periods with
Moreover, many derivatives of caffeic acid and quinic acid occur in
pneumoxide. The incubation was terminated by cooling the mixtures
the extract. These derivatives could possess similar effects as their
in an ice bath, followed by washing the lenses three times with
parental molecules, or they could be metabolized into parental
ice‐cold PBS (1 ml). Short‐term cultivations were preferred to avoid
molecules.
substantial permeability changes of the eye lenses. The washed lenses
The cell line C2C12, mouse myoblasts, was chosen for these
were kept deep‐frozen for sorbitol determination, which was per-
experiments. Muscle cells are very active in glucose transport and
formed as described before (Juskova et al., 2009). In brief, the frozen
metabolism. The cytotoxicity of the substances tested and their ability
lenses were let to melt at ambient temperature. Then distilled water
to inhibit proliferation were investigated by WST‐1 assay (Figure 1).
(0.2 ml/one lens) was added. The lenses were disrupted by a glass
The amount of formazan formed, by reduction of the tetrazolium salt
rod. The tissue material stuck to the rod was washed out twice with
WST‐1, corresponds directly to the number of viable cells with active
distilled water (0.1 ml) back into the tube, and the suspension was
mitochondrial reductases. The concentrations of artichoke extract up
ultrasounded for 5 min. Then ice cold HClO4 (9%, 0.4 ml) was added
to 50 μg/ml were significantly cytotoxic. None of the participating
and mixed thoroughly. The mixture was ultrasounded for further
compounds tested did show cytotoxic effects at 50‐μM concentra-
5 min and then kept on ice for 30 min to let proteins precipitate.
tion. The concentrations of the substances tested, which did not
The precipitated protein was spun off (15 min at 3,000 rpm) at 4 °C.
decrease the cell count (2 and 6 μg/ml for artichoke extract and 2
The supernatant was neutralized with 60 μl of concentrated K2CO3
and 6 μM for pure compounds), were chosen for subsequent studies
(4 M). The neutralized supernatant was used for determination of
on cell culture.
the concentration of sorbitol by modified enzymatic analysis (Mylari
The muscle cells C2C12 were incubated with the test samples in
et al., 2003). The amount of sorbitol in nanomole per gram of lens
two concentrations (Figure 2) in the models of normoglycemia
wet weight in each sample was determined by comparison with a
(5.5 mM; Figure 2a) and hyperglycemia (55 mM glucose; Figure 2b)
linear regression of sorbitol standards.
for 4 hr. Oxidative stress was determined by DCFH‐DA fluorescence
probe. After 4 hr, the intracellular content of ROS in the cells incu-
2.8 | Statistical analysis bated in high‐glucose conditions was significantly (p < 0.01) increased
to 129.81% ± 14.13% (positive control) contrary to normal glucose
The data were graphed as means ± standard error of mean. Compari-
conditions (negative control; 100%). In a similar study in C2C12 cells,
sons among groups were made using the Student t test (calculated by
ROS level increased to about 180% in high‐glucose conditions
website in‐silico.net/tools/statistics/t‐test) with equal variance.
(100 mM glucose) compared with normal glucose conditions after
2 hr of incubation (Kang et al., 2015).
3 | RESULTS AND DISCUSSION In normal glucose conditions, incubation with the samples tested
significantly decreased basal ROS concentration by 15%–30%, except
The artichoke leaves are well known for their beneficial therapeutic for 6 μM quinic acid (10%) and 6 μM luteolin (0%). Of phenolic com-
effects in enhancing lipid metabolism, choleresis, and hepatic func- pounds, luteolin showed weaker antioxidant capacity confirmed in
tions. In several studies, the extracts from artichoke leaves showed in vitro study (Rice‐Evans, Miller, & Paganga, 1996). In high‐glucose
also decreasing activities of glucose level and beneficial effect on lipid conditions, incubation with all samples tested protected cells against
metabolism of diabetic rats (Hosseini et al., 2015; Magied et al., 2016; oxidative stress, along with significant decrease of ROS concentration
Salem et al., 2017) as well as effective AKR1B1 and RL‐AKR inhibi- in the range of 20%–40%.
tions (Miláčková et al., 2017). Human AKR1B1 (and rat equivalent There are several studies that determined intracellular level of
RL‐AKR) is the first enzyme of the polyol pathway that reduces ROS after short‐term or long‐term incubations with high glucose
glucose to sorbitol more intensively under diabetic conditions. (Busik, Mohr, & Grant, 2008; Mousavi, Tayarani, & Parsaee, 2010;
Increased flow of the polyol pathway could cause osmotic stress due Wu et al., 2004). The studies show differences among cell types in
to the created sorbitol and oxidative stress as result of consumed the sensitivity to glucose toxicity. A number of parameters could be
cofactor NADPH, important for glutathione. For a long time, many affected by glucose toxicity, like expression and regulation of different
in vitro and in vivo studies have presented inhibitors of AKR1B1 and types of glucose transporters and hexokinase isoforms, the rate of
antioxidants like potential therapeutic agents against development of glycolysis versus oxidative phosphorylation, antioxidant protection
4 ŠUŠANÍKOVÁ ET AL.

FIGURE 1 Comparison of the viabilities (assessed by mitochondrial reduction of WST‐1) of C2C12 cells after 24‐hr treatment with (a) artichoke
leaf extract, (b) caffeic acid, (c) chlorogenic acid, (d) quinic acid, and luteolin. The values are expressed as percentage of control (100%) and are the
means ± standard error of three independent experiments. * indicates p < 0.05, ** p < 0.01, and *** p < 0.001 (vs. untreated control) [Colour figure
can be viewed at wileyonlinelibrary.com]

level, and others. In any case, the test samples showed significant reductase is the first enzyme of the polyol pathway which is believed
antioxidative effects under normal and high‐glucose conditions and to have a key role in the development of diabetic cataract and other
could be used for prevention of oxidative damage caused by glucose chronic diabetic complications. As shown in Figure 3, significantly
toxicity. Artichoke leaf extracts exhibited antioxidative properties in increased sorbitol levels were recorded in the isolated rat lenses
a number of studies (Brown & Rice‐Evans, 1998; Miccadei et al., incubated with high‐glucose concentration (50 mM; positive control)
2008) due to their phenol content. The well‐known antioxidants in comparison with controls incubated without glucose (negative
caffeic acid, chlorogenic acid, quinic acid, and luteolin showed signifi- control). This reflects an increased flux of glucose through the polyol
cant antioxidative activities also in this study. The effect of ROS on pathway. Similarly, threefold increase of sorbitol level in the eye lenses
muscle cells could have hormetic nature. In muscles, ROS may trigger incubated with high glucose for 4 hr was observed in a previous study
different signaling pathways leading to diverging responses, from (Milackova et al., 2015). Sorbitol production (determined by fluores-
adaptation to cell death. Whether a “positive” or “negative” response cent method) was significantly inhibited by all test samples (Art, ChA,
will prevail, depends on some variables such as the persistence of and CA in two concentrations). The findings indicate that all three
ROS flow, the antioxidant capacity and the energy status of muscle samples are readily taken up by eye lens cells where they interfere
cells and others (Barbieri & Sestili, 2012). with cytosolic aldose reductase. The content compounds of artichoke
The next experiment was performed at the level of isolated organ leaf extract, caffeic acid, and chlorogenic acid as well as several other
using rat eye lens, the organ containing high concentration of aldose caffeoyl derivatives of quinic acid have been recognized as effective
reductase protein (Lee, Chung, & Chung, 1995), in hyperglycemic inhibitors of the first enzyme of the polyol pathway (Jang et al.,
surroundings. It is a model of development of chronic diabetic compli- 2010; Kim et al., 2011; Yoon, Lee, Kim, Suh, & Lim, 2013), and thus,
cations in vitro and has been conventionally used (Chylack, Henriques, they may contribute to the sorbitol decreasing effect of the extract.
& Tung, 1979; Moghaddam, Kumar, Reddy, & Ghole, 2005). Aldose To our knowledge, artichoke extracts have never been studied in the
ŠUŠANÍKOVÁ ET AL. 5

FIGURE 2 Effect of test samples on the


generation of ROS in C2C12 cells in the model
of (a) normoglycemia (5.5 mM of glucose) and
(b) hyperglycemia (55 mM of glucose). The
cells were pretreated with the test samples or
with vehicle only (controls) for 1 hr. Then
glucose or PBS only was added to reach the
demanded glucose conditions. After 3.5‐hr
incubation, DCFH‐DA was introduced. After
further 30 min, the intracellular fluorescence
of DCF was measured, which determined the
intracellular ROS level. The values are
expressed as percentage of negative control
(Neg Ctrl; 100%) in the case of (a) or positive
control (Pos Ctrl; 100%) in the case of (b) and
are means ± SE of three independent
experiments. * indicates p < 0.05, ** p < 0.01,
and *** p < 0.001 (vs. untreated controls). Art:
artichoke leaf extract; CA: caffeic acid; ChA:
chlorogenic acid; QA: quinic acid; Lut: luteolin;
PBS: phosphate buffered saline; DCF: 2′‐7′‐
dichlorofluorescein; DCFH‐DA, 2,7‐
dichlorodihydrofluorescein diacetate; ROS:
reactive oxygen species; SE: standard error

FIGURE 3 Effects of Art and two phenolic


compounds on sorbitol accumulation in
isolated rat lenses cultivated with high
glucose. The lenses were incubated in medium
with the samples tested for 30 min at 37 °C.
Then glucose was added in the final
concentration of 50 mM, except for negative
control (Neg Ctrl), and incubation continued
for the following 3 hr. The sorbitol level in the
lenses was determined by enzymatic analysis.
The values are expressed as nmol/g of lens
and are the means ± SE of three independent
experiments. * indicates p < 0.05, ** p < 0.01,
and *** p < 0.001 (vs. positive control [Pos
Ctrl]). Art: artichoke leaf extract; CA: caffeic
acid; ChA: chlorogenic acid; SE: standard
deviation

relation to chronic diabetic complications and our results provide new In conclusion, the present study extends our previous work on bio-
information to this field. A few in vivo studies of cataract were done logical activities of artichoke leaf extract (Miláčková et al., 2017) reveal-
with phenolic compounds. Chlorogenic acid was reported to act pre- ing antioxidant activity in cultured C2C12 cells exposed to high glucose.
ventively against development of sugar cataract on the galactose‐fed In addition, the extract effectively inhibited accumulation of sorbitol in
rat model (Kim et al., 2011). Caffeic acid phenethyl ester effectively the rat eye lenses exposed to high glucose ex vivo. On balance, the
suppressed sodium‐selenite‐induced cataract formation in rats artichoke leaf extract represents a prospective preventive agent of
(Doganay et al., 2002). chronic diabetic complications in view of preclinical and clinical studies.
6 ŠUŠANÍKOVÁ ET AL.

ACKNOWLEDGMENTS of Erigeron annuus inhibits protein glycation, aldose reductase,


and cataractogenesis. Biological and Pharmaceutical Bulletin, 33(2),
This work was supported by grants VEGA 1/0359/18, VEGA 1/0561/ 329–333.
18, VEGA 1/0290/16, VEGA 2/0041/15 (Agentúra Ministerstva Juranek, I., Horakova, L., Rackova, L., & Stefek, M. (2009). Antioxidants in
Školstva, Vedy, Výskumu a Športu SR), FaF UK/6/2016 (Faculty of treating pathologies involving oxidative damage: An update on medici-
Pharmacy, Comenius University in Bratislava), APVV‐15‐0308, nal chemistry and biological activity of stobadine and related
pyridoindoles. Current Medicinal Chemistry, 17, 552–570.
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Slovenskej republiky), and IGA VFU 313/2018/FaF (J.H., Veterinární
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