Keywords: Mice, Bone marrow, Doxorubicin, Naringin, Glutathione, Glutathione-S-Transferase, Catalase, Lipid peroxidation.
Though the mechanism of action of doxorubicin remains a bit controversial, it is well established that the doxorubicin kills neoplastic cells by binding to nucleic acids and by inhibiting topoisomerase enzymes, presumably by specific intercalation of the planar anthracycline nucleus with the DNA double helix [8,9]. The recent reports indicate that doxorubicin induces oxidative stress by free radical production and mitochondrial dysfunction [10]. The presence of iron in mitochondria helps to increase free radical production leading to cardiotoxicity, because heart tissue has only a limited defense system and cannot cope up with the free radical induced toxicity of doxorubicin [10-14]. Another adverse effect of DNA intercalating agents is production of second malignancies in the long-term survivors [15]. Apart from cardiotoxicity the use of doxorubicin is also associated with bone marrow and hematological toxicities. Since doxorubicin is highly effective anticancer agent its full potential can only be realized if its adverse effects are considerably reduced. Therefore, it is necessary to screen natural products that can alleviate the doxorubicin induced adverse side effects.
The grapefruit (Citrus paradisii), arose in Barbados as an accidental cross between an orange (C. sinensis) and a shaddock or pomelo (C. maxima), both of which were introduced from Asia in the seventeenth century, and was first introduced into Florida in the 1820s. The three major types of grapefruits that exist today are white, pink/red and ruby/rio red varieties. Grapefruit juice combines the sweet and tangy flavour of the orange and shaddock and also provides up to 69% of the recommended dietary allowance (RDA) for vitamin C. The grapefruit juice contains flavonoids in the form of glycosides. Naringin is the most abundant flavonoid present in the juice, flower, and rind of grapefruit and constitutes up to 10% of the dry weight. It is relatively soluble in water and grapefruit juice contains up to 100 to 867 mg/L of naringin [16]. Upon ingestion, the naringin is converted into aglycone form known as naringenin and sugars by the action of intestinal flora [17]. Naringin has a wide range of biological actions including cholesterol-lowering, antiatherogenic and anti-inflammatory [18,19]. It has been reported to act as a cardioprotective, radioprotective, neuroprotective and antimutagenic agent [20-27]. Naringin has been found to reduce belomycin and doxorubicin induced genotoxicity in mice bone marrow, inhibit chemical carcinogenesis in mice, protect against iron-induced oxidative stress, lung fibrosis, osteoporosis, lipodystrophy and dyslipidemia in rats [28-34]. The administration of 16 g/kg b. wt. naringin to rats in acute toxicity studies has been reported to be nontoxic and its daily administration for 13 weeks at a dose of 1250 mg/kg did not induce any adverse side effects in rats indicating its safety [35]. Apart from cardiotoxicity doxorubicin also causes bone marrow depression that hampers utilization of its full potential in cancer treatment regimens. Therefore, it was desired to study the protective effect of naringin on the doxorubicin induced oxidative stress in the bone marrow of mice [36].
1. DOX group:- The animals of this group were intraperitoneally administered with 0, 1, 5 or 10 mg/kg b. wt. of doxorubicin alone.
2. NIN+DOX:- This group of animals was intraperitoneally administered with 10mg/kg b. wt. Naringin one hour before administration of 0, 1, 5 or 10 mg/kg b. wt. doxorubicin. The 10 mg/kg naringin was selected based on our earlier study where 10 mg/kg b. wt. of naringin was found to provide maximum protection against the DOX-induced DNA damage, when compared to other doses [30].
3. DOX+NIN:- The animals of this group were given 10 mg/kg b. wt. naringin intraperitoneally one hour after the administration of 0, 1, 5 or 10 mg/kg b. wt. doxorubicin.
The animals of all groups were killed by cervical dislocation at 0.5, 1, 2 and 4 h posttreatment for determination of glutathione (GSH), glutathione-s-transferase (GST), catalase, superoxide dismutase (SOD) and lipid peroxidation (LOO) in the bone marrow of mice. Usually five animals were used for each dose of DOX in each group at each time point and a total of 240 animals were used for the whole experiment. The bone marrow cells were extracted by removing the femora of each animal at the above specified posttreatment times and placed onto a wet Whatman filter paper. The femora were freed from muscles and other tissues, cleaned and the bone marrow was flushed using PBS into individual tubes.
GST activity = Absorbance of sample – Absorbance of blank× 1000/9.6 × Vol of sample
Post treatment time (h) |
Doxorubicin(mg/kg body weight) |
|||||||||
0 |
1 |
5 |
10 |
|||||||
Control |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
|
0.5 |
1.80±0.03 |
0.36±0.01‡ |
0.53±0.013* |
0.43±0.013 |
0.18±0.018‡ |
0.29±0.018 |
0.23±0.019 |
0.12±0.003‡ |
0.20±0.006 |
0.18±0.009 |
1 |
1.80±0.03 |
0.42±0.02‡ |
0.57±0.016* |
0.50±0.022 |
0.23±0.035‡ |
0.35±0.037 |
0.29±0.037 |
0.13±0.022‡ |
0.18±0.073 |
0.16±0.015 |
2 |
1.80±0.03 |
0.48±0.05‡ |
0.65±0.05* |
0.55±0.05 |
0.30±0.024‡† |
0.42±0.022† |
0.36±0.023 |
0.14±0.011‡ |
0.19±0.011 |
0.16±0.011 |
4 |
1.80±0.09 |
0.51±0.01‡† |
0.68±0.018* |
0.58±0.015† |
0.31±0.017‡† |
0.43±0.018† |
0.30±0.075 |
0.11±0.011‡ |
0.17±0.011 |
0.13±0.016 |
‡- statistical significance was calculated against control with the positive control i.e DOX treatment alone.
*- statistical significance was calculated against DOX alone treatment in their respective treatment hours.
#- statistical significance was calculated against DOX+NIN combination treatment in their respective treatment hours.
†- statistical significance was calculated against their corresponding 0.5h treatment combinations.
Post treatment times (h) |
Doxorubicin(mg/kg body weight) |
|||||||||
0 |
1 |
5 |
10 |
|||||||
Control |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
|
0.5 |
4.25±0.01 |
3.99±0.19 |
4.70±0.10* |
4.61±0.057 |
3.42±0.26‡ |
4.11±0.06* |
3.99±0.11 |
2.76±0.02‡ |
3.28±0.18† |
3.23±0.01 |
1 |
4.25±0.01 |
4.07±0.13 |
4.52±0.18 |
4.30±0.33 |
3.36±0.14‡ |
3.82±0.23 |
3.75±0.12 |
2.35±0.22‡ |
3.01±0.19* |
3.07±0.2* |
2 |
4.25±0.01 |
3.67±0.01 |
4.29±0.05* |
3.97±0.12* |
3.12±0.15‡ |
3.56±0.06 |
3.55±0.10 |
2.31±0.04‡ |
2.81±0.02 |
2.81±0.02 |
4 |
4.25±0.01 |
3.56±0.14 |
4.20±0.11† |
3.85±0.02 |
2.98±0.12‡† |
3.53±0.02 |
3.46±0.13 |
2.33±0.10‡ |
2.71±0.12 |
2.65±0.11 |
‡- statistical significance was calculated against control with the positive control i.e DOX treatment alone.
*- statistical significance was calculated against DOX alone treatment in their respective treatment hours.
#- statistical significance was calculated against DOX+NIN combination treatment in their respective treatment hours.
†- statistical significance was calculated against their corresponding 0.5h treatment combinations.
Post-treatment times (h) |
Doxorubicin (mg/kg body weight) |
||||||||||
0 |
1 |
5 |
10 |
||||||||
Control |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
||
0.5 |
29.17±0.03 |
11.63±1.21‡ |
19.49±0.70*# |
18.49±1.16* |
10.63±0.60‡ |
14.63±1.91*# |
12.73±0.69* |
8.71±1.30‡ |
13.86±0.31* |
11.85±0.51* |
|
1 |
29.17±0.03 |
8.54±0.62‡† |
15.79±0.66*† |
15.14±0.15*† |
7.87±0.23‡† |
10.95±1.92*† |
9.91±0.42*† |
7.54±0.27‡† |
8.97±0.37*† |
8.23±0.40*† |
|
2 |
29.17±0.03 |
10.07±0.57‡† |
16.28±1.02*#† |
14.52±1.14*† |
8.67±1.39‡ |
10.54±0.71*† |
10.03±1.40† |
7.38±0.85‡† |
8.91±1.27* |
8.22±1.36*† |
|
4 |
29.17±0.03 |
9.83±0.53‡† |
16.29±0.41*#† |
15.18±0.87*† |
8.99±0.43‡† |
10.50±0.45*#† |
9.29±0.47*† |
5.52±0.49‡ |
9.94±0.82*† |
8.85±0.56*† |
‡- statistical significance was calculated against control with the positive control i.e DOX treatment alone.
*- statistical significance was calculated against DOX alone treatment in their respective treatment hours.
#- statistical significance was calculated against DOX+NIN combination treatment in their respective treatment hours.
†- statistical significance was calculated against their corresponding 0.5h treatment combinations.
Post treatment times (h) |
Doxorubicin(mg/kg body weight) |
|||||||||
0 |
1 |
5 |
10 |
|||||||
Control |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
|
0.5 |
5.12±0.03 |
3.03±0.07‡ |
4.55±0.08* |
4.43±0.13* |
2.78±0.09‡ |
3.95±0.09* |
3.62±0.10* |
1.83±0.11‡ |
3.12±0.10* |
2.90±0.12* |
1 |
5.12±0.03 |
2.61±0.06‡† |
4.13±0.07* |
4.01±0.12* |
2.36±0.08‡ |
3.53±0.08* |
3.20±0.09* |
1.41±0.10‡ |
2.70±0.09* |
2.48±0.11* |
2 |
5.12±0.03 |
2.30±0.08‡† |
3.81±0.09* |
3.69±0.14 |
2.04±0.10‡ |
3.21±0.10* |
2.88±0.11 |
1.09±0.12‡† |
2.38±0.10* |
2.16±0.13* |
4 |
5.12±0.03 |
2.21±0.07‡† |
4.02±0.08* |
3.78±0.13* |
1.96±0.09‡† |
3.42±0.09* |
2.97±0.10* |
1.01±0.11‡† |
2.59±0.10* |
2.25±0.12* |
‡- statistical significance was calculated against control with the positive control i.e DOX treatment alone.
*- statistical significance was calculated against DOX alone treatment in their respective treatment hours.
#- statistical significance was calculated against DOX+NIN combination treatment in their respective treatment hours.
†- statistical significance was calculated against their corresponding 0.5h treatment combinations.
Post treatment times (h) |
Doxorubicin (mg/kg body weight) |
|||||||||
0 |
1 |
5 |
10 |
|||||||
Control |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
DOX |
NIN+DOX |
DOX+NIN |
|
0.5 |
0.09±0.002 |
0.12±0.002‡ |
0.12±0.008 |
0.10±0.01 |
0.17±0.005‡ |
0.14±0.001 |
0.13±0.007 |
0.20±0.005‡ |
0.195±0.01 |
0.194±0.01 |
1 |
0.09±0.002 |
0.13±0.003‡ |
0.13±0.001 |
0.12±0.003 |
0.16±0.007‡ |
0.162±0.01 |
0.161±0.004 |
0.24±0.02‡ |
0.23±0.02 |
0.24±0.004 |
2 |
0.09±0.002 |
0.14±0.01‡ |
0.14±0.006 |
0.13±0.004 |
0.19±0.015‡ |
0.18±0.00 |
0.18±0.01 |
0.24±0.02‡ |
0.23±0.02 |
0.22±0.02 |
4 |
0.09±0.002 |
0.13±0.006‡ |
0.12±0.01 |
0.11±0.008 |
0.18±0.003‡ |
0.18±0.01 |
0.17±0.01 |
0.23±0.005‡ |
0.22±0.007 |
0.22±0.01 |
‡- statistical significance was calculated against control with the positive control i.e DOX treatment alone.
*- statistical significance was calculated against DOX alone treatment in their respective treatment hours.
#- statistical significance was calculated against DOX+NIN combination treatment in their respective treatment hours.
†- statistical significance was calculated against their corresponding 0.5h treatment combinations.
The GSH (γ-glutamylcysteinylglycine), a low molecular, water soluble non-protein thiol is synthesized in all living cells from three amino acids including glutamic acid, cysteine and glycine, which play a crucial role in combating oxidative stress in the cells by donating one electron and donation of two electrons by GSH results in the formation of GSSG, which is converted back to GSH by glutathione reductase [44-47]. The doxorubicin treatment has increased the oxidative stress in the bone marrow cells of mice by alleviating the GSH contents in a dose dependent manner. A similar effect has been observed earlier in the liver of mouse and rats treated with DOX [25,48-50]. Treatment of mice with naringin before and after DOX administration raised the GSH contents and the effect was better in the naringin pretreated group than the naringin post-treatment. Earlier investigations conform to our observations where a similar effect has been observed in mice heart and rat livers pretreated with naringin however, reports on post-treatment studies are lacking [25,26,50,51]. The other agents like Agele marmelos and glutamine, an amino acid have been reported to increase the GSH concentration in mice and rats treated with DOX [48,49].The reduction in oxidative stress by GSH is the outcome of its reaction with free radicals directly or its participation through other enzymatic reaction [52]. It also conjugates with NO radical to form S-nitrosoglutathione adduct. This product is cleaved by thioredoxin system to generate GSH and NO back [47]. The other functions of GSH include its conjugation with electrophiles and physiological metabolites, which are essential in cell physiology [53].
The observation that DOX inhibited the GST activity in mouse bone marrow is in accordance with earlier findings where DOX has been reported to reduce GST activity in mouse heart and mice and rat liver [25, 51]. The treatment of naringin before and after DOX treatment elevated the GST activity and the effect of both pre and post naringin treatment was almost similar. The earlier studies have shown that naringin pretreatment elevated the GST activity in mouse heart and liver and rat liver [25, 50]. DOX-induced GST alleviation may have played a significant role in inducing oxidative stress as GSTs are essential in protecting against the toxic insult and DNA damage [54]. GSTs catalyze conjugation of a variety of substances with GSH causing detoxification and it also modulates cell proliferation and death [55]. The reduction of GSTs by DOX may be crucial in suppressing cell death and enhanced cell killing. Their overexpression in cancer cells have been considered as a cause of chemotherapy resistance [56].
Catalase or oxidoreducatase is a tetrameric intra cellular enzyme present in animals, plants and microorganisms. The accumulation of hydrogen peroxide in cellular milieu is detrimental to the health of cells and catalase mainly cleaves hydrogen peroxide into non-toxic products like water and molecular hydrogen, neutralizing the toxic effect of hydrogen peroxide [57]. Treatment of mice with different doses of DOX resulted in a dose dependent reduction in the catalase activity in their bone marrow cells, which could be one of the reasons of myelosuppression in the patients. The earlier studies have reported a reduction in the catalase activity after DOX treatment in the mice and rat heart and liver [25,26,49,50]. The administration of mice with naringin before and after DOX treatment elevated the catalase activity, where both the pre- and post-treatment were equally effective especially at higher DOX doses. Likewise, early studies have indicated an increase in the catalase activity in the mouse and rat heart and liver [25,26,50,51]. The extract of Aegle marmelos has been found to reduce the DOX induced catalase activity in mouse heart earlier [49]. This increase in catalase activity by naringin may have played an important role in reducing the oxidative stress triggered by DOX in the present study.
The superoxide ions are generated during respiration, which are converted into the less harmful product hydrogen peroxide, which is neutralized by glutathione peroxidase and catalase [58-60]. However, DOX enhances the generation of these radicals and presence of iron converts the superoxide radicals into the more reactive, toxic and damaging species of OH radicals [10]. The DOX treatment has been found to deplete SOD activity in a dose dependent manner in the bone marrow of mice in the present study. A similar effect has been reported earlier in the mice heart and liver and rat liver [25,49,50]. The naringin treatment before and after DOX administration has been reported to retard DOX-induced attrition in the SOD activity. Earlier naringin treatment has been reported to protect against the DOX-induced depletion in the SOD activity in mice and rats [25,26,50,51]. The elevated level of SOD may have protected mice bone marrow cells from DOX-induced oxidative stress.
Lipid peroxidation is produced as a result of membrane damage as the lipids of the cell membrane interact with free radicals produced and undergo lipid peroxidation [61]. The production of lipid peroxidation has been considered as one of the hallmarks of oxidative stress. The DOX increased lipid peroxidation in the mouse bone marrow which is in conformation to earlier studies where DOX has been found to increase lipid peroxidation in the mouse and rat heart and liver [25,26,48-51,62]. Earlier studies have shown that naringin pretreatment resulted in the reduction of DOX induced lipid peroxidation in vitro and in mouse and rat heart and liver [23,26, 29,31,50,51]. Similarly, naringin alleviated the bleomycin-induced lipid peroxidation in rat lung earlier [33]. However, naringin treatment was not very effective in arresting the lipid peroxidation in bone marrow cells in the present study.
The exact mechanism of reduction of oxidative stress by naringin in the bone marrow cells of mice is not clearly understood. The DOX generates free radicals by the activation of NADPH oxidase system and naringin has been reported to inhibit the activation of NADPH oxidase leading to the attrition of free radical formation [63,64]. Therefore suppression of DOXinduced free radical generation by naringin may be one of the important mechanisms that may have helped to keep the activity of GST, catalase and SOD higher accompanied by more availability of glutathione. The presence of naringin may have neutralized free radicals immediately after their production since it has been reported to scavenge free radicals earlier [24]. It is well established that DOX generates higher amount of free radicals in the presence of iron and chelation of iron by naringin may have arrested the DOX induced free radicals reducing oxidative stress. Naringin has been reported to chelate iron [31]. DOX has been reported to transcriptionally activate NF-κB and COX-II in cardiomyocytes which is responsible for increased oxidative stress and inhibition of NF-κB and COX-II by naringin may have reduced DOX-induced oxidative stress [65-67]. Naringin has been reported to arrest transcriptional activation of of NF-κB and COXII in vitro [64,68]. Nrf2 is essential in the expression of various antioxidant genes and its inhibition by DOX may have contributed to raise the oxidative stress in mice bone marrow cells leading to decline in all these antioxidants. The activation of Nrf2 elements by naringin may have been responsible for increased activities of GST, catalase and SOD along with raised GSH. The naringin has been reported to activate Nrf2 signalling pathway earlier [69].
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