Effects ofOxalis barrelieri L. (Oxalidaceae) aqueous extract on diarrhea induced by Shigella dysenteriae type 1 in rats
Abstract
Abstract
Aim
Methods
Antibacterial activity was evaluated in vitro by disc diffusion method and by macrodilution method.
Results
The minimal inhibitory concentration and minimal bactericidal concentration of WOb were, respectively, 6 mg/mL and 25 mg/mL. The mean minimal bactericidal concentration/minimal inhibitory concentration ratio for WOb against
Conclusion
The results suggest that
Aqueous extract of Oxalis barrelieri contains chemical compounds, which have antibacterial properties in vitro and in vivo on Shigella strains. This extract is bacteriostatic, protects the intestinal mucosa against damage caused by Shigella dysenteriae type I, and maintains the normal immune system. This extract could be used as an alternative therapeutic for infectious diarrhea.
1INTRODUCTION
In mammals, the gastrointestinal tract harbors various microbes that play an essential role in maintaining its physiological homeostasis.1 Changes in the composition of these gut microbes can alter the intestinal barrier and the immune system,2, 3 which can lead to gastrointestinal infections. Gastrointestinal infections caused by bacteria, viruses, and parasites are usually manifested by diarrhea or by inflammatory bowel diseases or gastroenteritis.4 Diarrhea is defined as the emission of at least 3 nonmolded or liquid stools per day.5, 6 It is an alteration in normal bowel movement that leads to the increase in water and electrolyte content, volume or liquid stool frequency, and abdominal pain.7 An emission of 10 g/kg BW/d of feces in infants and children and 200 g/kg BW/d in an adolescent or an adult is considered abnormal.8 Diarrhea can be infectious or not. Noninfectious diarrhea can be due to hormones that accelerated intestine transit, to osmotic substances and/or laxatives. Infectious diarrhea can be due to virus, bacteria, and/or parasites.4 In the world and particularly in developing countries, infectious diarrhea still remains one of the leading causes of infant mortality.9 A multicentric study from 6 Asian countries estimated Shigella as the causative agent in 5% of the diarrheal cases.10 As little as 10 to 100 Shigella can cause shigellosis in human,11 whereas 1.2 × 109Shigella can cause dysenteric diarrhea in rats.12 Shigellosis occurs worldwide, in sporadic, endemic, epidemic, and pandemic forms.13 Most of the cases are children <5 years of age. The annual number of shigellosis episodes throughout the world is estimated to be 164.7 million, with 69% of all episodes and 61% of all deaths attributable to shigellosis involving children <5 years of age.10 The economic impact of diarrhea and its treatment are of considerable importance.14, 15 The annual treatment costs for diarrhea are very high and ranged from US$ 907 116 to US$ 1 851 280 for ambulatory clinical consultations and from US$ 701 833 to US$ 4 581 213 for hospitalizations.16 The re‐emergence of Shigella dysenteriae type 1 (Sd1) with added resistance to ciprofloxacin, which has epidemic potential, has also been reported.10 Many synthetic drugs such as diphenoxylate and loperamide are available for the treatment of diarrhea, but they have toxic side effects.17 Therefore, the search for new, safe, more effective, and less toxic molecules has continued to be an important area of research in pharmacology. Since antiquity, diarrhea has been treated with medicinal plants in traditional medicine.17
2MATERIALS AND METHODS
2.1Plant material
Whole plants of
2.2Experimental animals
Prior to the study, male and female Wistar albino rats (60‐98 g), approximately 6 weeks old, were selected and allowed to acclimatize for 1 week to our laboratory environment (22°C‐25°C and 12 h light/12 h of darkness). In vivo experiments on rats were performed according to the European Union guidelines on animal care (CEE Council 86/609) that was adopted by the Ministry of Scientific Research and Innovation of Cameroon.19 Animals housed in metabolic cages (1 animal/cage) were fed a diet consisting of carbohydrates (50%‐55%), fats (15%‐20%), and proteins (25%‐30%).20
2.3Bacterial strain
Clinical isolates of Sd1 from patients with severe infections were provided by the Centre Pasteur of Yaoundé, Cameroon.
2.4In vitro antibacterial susceptibility
2.4.1Disc diffusion method
Minimal inhibitory concentration (MIC) was determined with adapted E‐test according to disc diffusion method.21 Sterile 6‐mm Ø filter paper discs (Schleicher & Schul, no. 2668, Dassel, Germany) were impregnated with 50 μL of
2.4.2Macrodilution method
This method has been adopted from NCCLS M26‐A,22 with modifications.23, 24 The Sd1 strains were adjusted to achieve a turbidity equivalent to a 0.5 McFarland (1 × 108 CFU/mL) and diluted (1:1000)25 in brain heart infusion (Oxoid). A dilution series of the extract, ranging from 50 000 to 24 μg/mL, were prepared and then transferred to the broth in 14 tubes. A 1.0‐mL extract was pipetted into tubes by twofold dilutions. Freshly grown bacteria of 1.0 mL were added to the tubes in a density of 105 CFU/mL (final concentration/tube). The tubes were incubated overnight at 37°C. CFU was determined by diluting each well in tenfold dilutions. From each dilution, aliquots were transferred to agar plates and incubated overnight. On the following day, the number of colonies was evaluated, and the initial CFU/tube retrospectively calculated by the formula:Number ofSd1CFU=number of coloniesVolume of dilutionxDilution factor.26
The lowest concentrations of extract that did not show any visible growth after macroscopic evaluation were considered to be the MIC.27 Minimal bactericidal concentration (MBC, concentration producing 99.99% reduction of CFU [103 CFU/mL] in the initial inoculum) was determined by subculture on nutrient agar. For nutrient agar subculture, culture broths that did not show visible bacterial growth (no turbidity) were seeded on Mueller Hinton agar and SS agar for 24 hours at 37°C. Minimal bactericidal concentration was determined as the lowest concentration of extract that did not show bacterial growth in subcultures.28 Antibacterial activity was determined by the MBC/MIC formula.29
2.5Sd1‐induce diarrhea
2.5.1Diarrhea induction and treatment
Rats were housed separately in metabolic cages. Before diarrhea induction, we checked that our animals were not carrying Shigella. In normal animals, stools were removed by rectal curettage using a tongue depressor. A 0.5‐g stool was dissolved in 4.5 mL of sterile saline solution, and 0.5 mL of the solution was inoculated on SS agar plate and incubated for 24 hours at 37°C. The animals from which the stool cultures were positive were excluded. After verifying that the rats were not carrying Sd1, diarrhea was induced by orally administering to each rat a solution of 1.2 × 109 saline‐diluted Sd1 cells.12, 30, 31, 32
When diarrhea appeared (26 h after administration of Shigella inoculum), the rats were randomly divided into 6 groups of 5 animals each. Groups 1 and 2, diarrheic control (DC), did not receive any treatment, but Group 1 was sacrificed 2 days after induction to determine haematological parameters and nitric oxide (NO) level. Three other groups were treated with antidiarrheal drugs twice daily (6:00 AM and 6:00 PM) for 6 consecutive days: Group 3 (Nor 20), 4 (WOb50), and 5 (WOb100) received, respectively, 20 mg/kg BW antibiotic norfloxacin (positive control, norfloxacine: A‐320 norfen 400 mg tablet; Cadila Pharmaceuticals Ltd), 50 mg/kg BW, and 100 mg/kg BW aqueous extract of
The number of deaths was recorded during treatment. The stools were collected daily using a sterile stool pot of the metabolic cage. The weight and quality of feces were examined daily for 6 consecutive days of treatment. Sd1 counts in feces were done before induction of diarrhea and daily for 6 consecutive days after onset of diarrhea. For this purpose, 0.5 g of stool was dissolved in 4.5 mL of sterile saline solution, serial dilutions were made, and 0.5 mL of each dilution was inoculated on the SS agar plate and incubated for 24 hours at 37°C.30 After incubation, the number of Sd1 was determined.33 After 6 days of treatment, all survival animals were sacrificed and their blood and their colon were collected for blood cells count using manual method34 and/or for NO test using the modified Griess method.35 Colon fragments were fixed in 10% buffered formalin for histopathological examination.30
2.6NO dosage
Nitric oxide concentration was evaluated in serum and in colon homogenates.30 To obtain Griess solution, 0.25 mL of Griess 1 (0.8 g sulfanilic acid + 250 mL acetic acid 30%) was added to 0.25 mL of Griess 2 (0.05 g of α‐naphthylamine + 100 mL acetic acid 30%). A 0.5‐mL serum or homogenate of the colon was added to 0.5 mL of Griess solution, and the mixture obtained was left for 20 minutes at room temperature. After 20 minutes, the optical density of each mixture was read using a spectrophotometer (T60‐1611ESW) at 553 nm and recorded.35
2.7Hematological studies
Figured elements of the blood (red blood cells [RBC], white blood cells [WBC], and platelet cells [PC]) were counted by a manual method34 using a light microscope (MOTIC 1820 LED: SM7432‐MC1ST‐RPIWFM). The hematocrit (Ht) of each rat was determined using the microhematocrit tube. Hemoglobin level (Hb) was determined by the spectrophotometric method. The blood was diluted in a Drabking solution (1/250), and the absorbance was read at 510 nm and recorded. Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC) were calculated, respectively, by the formulae:MCV=HtRBCx10;36MCH=HbRBCx10;37MCHC=HbHtx10.36
2.8Histopathological investigations
Histopathological investigations were done according to methods described in the literature.38 For this purpose, colon fragments of each experimental rat were fixed in 10% buffered formalin in labeled flasks for histological examination. These colon fragments were embedded in paraffin wax, and 2‐μm‐thick sections were made with the microtome. These preparations were mounted on glass slides that were then stained with hematoxylin and eosin and examined under a standard light microscope (MOTIC 1820 LED: SM7432‐MC1ST‐RPIWFM).39
2.9Statistical analysis
The data are means ± standard error of the mean (
3RESULTS
3.1Susceptibility of Sd1 toO barrelieri aqueous extract
In vitro, the
3.2MIC and MBC values ofO barrelieri water extract by the graphic method
The
3.3Antidiarrheal activities
Normal rats that were not inoculated with Shigella and were treated with distilled water showed no signs of diarrhea. A few hours (4 h) after Sd1 inoculum administration, the rats became calm, less mobile, curled up, and showed erect hairs. Twenty‐six hours after inoculum administration, the rats emitted the first diarrheal stool and became more aggressive. During the treatment, rats recovered mobility progressively, and their aggressiveness decreased. Diarrheal stools were soft or liquid containing mucus or blood marks and attracted flies by their fetid odors. These symptoms disappeared after 3 days of treatment. During treatment, no death was recorded in all treated groups and NC. However, we recorded 100% death in DC group (Table 1). The first day of onset of diarrhea, stool weights were 3.06 ± 0.49 g, 2.78 ± 0.62 g, 2.60 ± 0.37 g, and 2.42 ± 0.37 g, respectively, for TD, Nor20, WOb50, and WOb100. These values increased in untreated group over time, decreased significantly (P < .01) from the second day in norfloxacin‐treated group (Nor20) and from the third day in extract‐treated groups (Figure 4). Diarrhea was eliminated by the sixth day of treatment.
Day Treatment | Diarrheic Control | Norfloxaxine (20 mg/kg) | Aqueous Extract of | |
---|---|---|---|---|
50 mg/kg | 100 mg/kg | |||
1 | 0 | 0 | 0 | 0 |
2 | 0 | 0 | 0 | 0 |
3 | 40 | 0 | 0 | 0 |
4 | 60 | 0 | 0 | 0 |
5 | 100 | 0 | 0 | 0 |
6 | … | 0 | 0 | 0 |
After onset of diarrhea in rats, the number of Sd1 was about 1.2 × 109 in all groups. These values increased significantly (P < .05) from third day in untreated group. In all treated groups, these values decreased significantly (P < .01) to 0.9 × 104, 59.4 × 106, and 14.1 × 104 CFU, respectively, for Nor20, WOb50, and WOb100 at the sixth day of treatment (Figure 5).
3.4Effect ofO barrelieri on NO production
In DC rats, NO production in colon was markedly high compared to NC: 418.15 ± 48.65μM against 57.34 ± 3.76μM (P < .01), 2 days after the onset of diarrhea. After 6 days of treatment, NO production in colon was significantly reduced (P < .01) by 20 mg/kg BW norfloxacin and by 50 and 100 mg/kg BW aqueous extract of
3.5Blood parameters
Red blood cells, Ht, PC, MCV, MCH, and MCHC did not significantly change in norfloxacin‐treated diarrheic rats compared to NC. However, in
Group | NC | DC | Nor 20 mg/kg | WOb 50 mg/kg | WOb 100 mg/kg |
---|---|---|---|---|---|
WBC × 103/mm3 | 10.7 ± 0.5 | 6.5 ± 0.4** | 10.4 ± 0.4b | 6.8 ± 0.3** | 5.4 ± 0.2** |
Hb, g/dL | 17.6 ± 0.7 | 14.6 ± 0.7* | 16.2 ± 0.5 | 13.9 ± 0.7** | 17.1 ± 0.2 |
Ht, % | 49.6 ± 2.4 | 41.8 ± 2.8** | 46.3 ± 1.9 | 40.5 ± 2.9** | 51.0 ± 0.7 |
RBC × 106/mm3 | 8.0 ± 0.3 | 7.1 ± 0.2* | 7.6 ± 0.1 | 7.1 ± 0.3* | 7.7 ± 0.3 |
PC × 106/mm3 | 84.6 ± 5.4 | 68.1 ± 2.0* | 80.9 ± 1.4 | 86.7 ± 3.3 | 86.2 ± 3.1 |
MCV, μm3 | 61.7 ± 1.2 | 58.9 ± 3.5 | 60.6 ± 2.6 | 57.0 ± 2.2 | 66.7 ± 2.1 |
MCH, ρg | 21.9 ± 0.0 | 20.6 ± 0.8 | 21.3 ± 0.8 | 19.6 ± 0.7 | 22.3 ± 0.9 |
MCHC, ρg/dL | 35.6 ± 0.8 | 35.2 ± 0.8 | 35.2 ± 0.5 | 34.5 ± 1.0 | 33.5 ± 0.4 |
Data are the mean ± SEM (n = 5 per group). Significant difference: *P < .05. **P < .01 compared with NC. bP < .01 compared with DC.
3.6Effects ofO barrelieri water extract on the microhistology of colon in diarrheal rats
The control rat colon (Figure 7A) showed normal mucosa. In untreated diarrheal rats, colon histology showed destruction of the mucosa (Figure 7B). However, in rats treated with norfloxacin 20 mg/kg (Figure 7C), with 50 mg/kg (Figure 7D) or 100 mg/kg (Figure 7E)
4DISCUSSION
The purpose of this study was to provide scientific support for the traditional use of
In vitro antimicrobial study showed an inhibitory activity of extract against Sd1 growth. Minimal inhibitory concentration and MBC values of
In untreated diarrheic rats, destruction of the colonic mucosa and significant NO production were due to the pathogenic effects of Shigella. However, the protection of the colonic mucosa and the significant decrease in NO production in the colon and in the blood appear to be a direct result of treatment with the extract. The pathogenesis of Shigella is multifactorial and includes the production of shiga‐toxin and its ability to penetrate and destroy host tissues that largely induces an inflammatory response. Shigella would penetrate the intestinal epithelial barrier through M cells that cover the lymphoid follicles and reach the basolateral layer of the intestine where it can invade. Shigella, once in the cells, multiplies rapidly and spreads to adjacent cells.4 As a result of this pathogenesis, severe tissue damage in sigmoid colon and rectum, responsible for the severe dysenteric syndrome, occurs.42 High levels of NO in DC rats might result from the lipopolysaccharides or the enterotoxins (shiga toxin) produced by Sd1, which is very often implicated in the inflammation associated with diarrhea. Bacterial lipopolysaccharides or Sd1 enterotoxins induce the expression of the inducible NO synthase gene in different inflammatory and tissue cells for the production of NO.43, 44 High bacterial load (high concentration of enterotoxins) would be responsible for the high NO level in the colon and in the blood. The extract reduced the bacterial load, causing a decrease in enterotoxins, which would lead to a decrease in NO production.
CONFLICT OF INTEREST
None declared.
AUTHOR CONTRIBUTIONS
Conceptualization: René Kamgang, Michel Archange Fokam Tagne
Formal Analysis: Michel Archange Fokam Tagne
Funding Acquisition: René Kamgang
Investigation: Michel Archange Fokam Tagne, Paul Aimé Noubissi, Gaëtan Olivier Fankem
Methodology: René Kamgang, Michel Archange Fokam Tagne
Project Administration: René Kamgang, Michel Archange Fokam Tagne
Resources: René Kamgang, Michel Archange Fokam Tagne
Supervision: René Kamgang
Validation: René Kamgang
Writing—Original Draft Preparation: Michel Archange Fokam Tagne
Writing—Review & Editing: Michel Archange Fokam Tagne, Paul Aimé Noubissi, Gaëtan Olivier Fankem, René Kamgang.
ACKNOWLEDGEMENTS
This work was financially supported by the Institute of Medical Research and Medicinal Plants Studies (IMPM). Authors are very grateful to the Centre Pasteur of Yaoundé, Cameroon, for providing Shigella dysenteriae type 1 strain (088‐1A).
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