Background
Treatment of infectious diseases is becoming more challenging due to the development of resistance to multiple classes of antibiotics by bacteria. This is especially true for infections caused by
Pseudomonas aeruginosa.
P. aeruginosa is a frequent causative pathogen in nosocomial infections. The Gram-negative bacterium is associated with nosocomial pneumonia, and is frequently implicated in hospital-acquired bloodstream and urinary tract infections [
1]. In an attempt to counteract resistance to antibiotics, a number of studies now focus on the search for new antimicrobials. Plants are one of the main targeted sources in the search for novel antimicrobials.
Constituents of plant origin provide a good source of antimicrobial compounds [
2,
3], as plants have evolved a variety of diverse chemical strategies to combat attack from pathogens. The secondary metabolites of medicinal importance include alkaloids, flavonoids, tannins, terpenes, and phenolic compounds. These active constituents possess effective pharmacological activity [
4].
Triumfetta w
elwitschii Mast. belonging to the Tilicea family is an important medicinal plant largely used in the Southern African countries as traditional medicine. Its roots are crushed and used in the form of decoction to treat symptoms of diarrhoea [
5]. A mixture of milk and roots of
T.
welwitschii is used as an oral antipyretic agent [
6]. Root extracts of
T. welwitschii has been reported to possess antiplasmodial activity [
7] and antiproliferative activity against Jurkat cells [
8]. Antibacterial activity against
Escherichia coli,
Bacillus cerus [
9] and antimycobacterial activity against
Mycobaterium aurum and
Myocobacterium smegmatis has been reported from root extracts of
T.
welwitschii [
10]. The current study shifts from investigating antimicrobial activity of the roots and focuses on the leaves of
T.
welwitschii. The leaves from the same family (Tilicea) of plants have been reported to possess analgesic and antimicrobial activity [
11‐
13], indicating the potential for antimicrobial activity in leaves of
T.
welwitschii. The main classes of secondary metabolites found in
T.
welwitschii are flavonoids, phenols and coumarins (unpublished data from BIA laboratory). The primary objective of the current study was to investigate the antibacterial properties of the leaf extracts of
T.
welwitschii against six of some of the common nosocomial pathogens [
14]. The secondary objectives were to evaluate the possible mode of action and cytotoxicity of the crude extracts.
Discussion
The search for new antimicrobials is frequently based on ethnobotany and ethnopharmacology [
25].
T.
welwitschii was selected based on its ethnomedicinal use in the Southern parts of Africa [
5,
6]. Since work had already been done on the roots [
7‐
9] this study focused on the leaves of the plant as there is a knowledge gap pertaining the pharmacological value of the leaves of the plant. Solvents of varying polarities were used to prepare extracts from leaves of
T.
welwitschii. Different solvents extract different phytochemical groups; therefore, serial exhaustive extraction was used to enhance the isolation of phytochemicals from the complex crude mixture [
26]. The DCM: methanol solvent mixture gave the highest percentage yield (8.06%). The solvent mixture constitute of a polar and non-polar solvent which must have facilitated the extraction of both polar and non-polar phytochemicals. Polar solvents with the exception of water gave yields of more than 2% while non-polar solvents gave yields of less than 2%. Martini and Eloff [
27] showed that the polar solvents have higher extracting potential than the non-polar solvents.
Leaf extracts from
T. welwitschii possessed varying potential of antibacterial activity against
P. aeruginosa,
S. aureus,
K. pneumoniae,
S. pneumoniae,
S. pyogenes and
B. subtilis (Fig.
2)
. Of the eight test isolate,
P. aeruginosa ATCC was the most inhibited by the majority of extracts. It is worth noting that the Gram-negative
P. aeruginosa was inhibited by most of the extracts more than the Gram-positives
S. aureus,
B. subtilis,
S. pneumoniae and
S. pyogenes. Gram negatives possess two cellular membranes, with the outer membrane covered with lipopolysaccharides, making it a formidable barrier for molecules to penetrate [
28] which deviates from the expected results. In this study, the disruption of membrane integrity was shown to be the mode of action of the three extracts. The penetration of the outer membrane of the Gram-negative
P. aeruginosa by the extracts may have been achieved through the pre-disruption of the membrane.
The acetone, ethanol and DCM: methanol leaf extracts from
T. welwitschii were the most active extracts against the ATCC strain of
P. aeruginosa. Acetone, ethanol and methanol (in the DCM: methanol mixture) are polar solvents known to extract a wide range of phytochemicals [
27]. Antibacterial activities shown by these extracts may be attributed to phenols, flavonoids [
29] and coumarins [
30] the common secondary metabolites in
T.
welwitschii. A total of six and two extracts showed more than 50% growth inhibition against the ATCC and clinical strains of
P. aeruginosa respectively. The inhibition of growth of the clinical strain of
P. aeruginosa by most of the extracts was lower compared to that of the ATCC strain. Laboratory strains have been sub-cultured for years since they were first isolated. A diversity of genotypes subsequently changes over time [
31] hence the different responses noted for the clinical and laboratory strains. These findings on the antibacterial activity of extracts from
T. welwitschii plant make the plant a possible source of compounds to explore for novel lead compounds for drug development against
P. aeruginosa.
A wide range of mechanisms provide bacteria with resistance to antibiotics; these include target-site modification and antibiotic inactivation among others. The expression of efflux pumps by some human pathogenic bacteria confers multidrug resistance (MDR). A single pump may provide bacteria with resistance to an extensive range of chemically and structurally different compounds. Natural products are a possible source of efflux pump inhibitors [
32‐
34]. The R6G efflux assay was carried out to determine the potential use of the acetone, ethanol and DCM/methanol leaf extracts from
T.
welwitschii as efflux pump inhibitors. The R6G assay involves preloading the cell with a fluorescent substrate (R6G) prior to the efflux assay. After the loading step, R6G accumulates within the cells. Cells are then washed to remove R6G on the outer surface of cells. Subsequently, glucose is added to the culture as a source of energy, and the efflux of R6G is measured by fluorimetry [
35]. A known EPI (e.g reserpine) is included as a positive control for inhibition of the efflux of R6G. Results from the R6G efflux (Fig.
3) showed that there was increased efflux of R6G in the presence of plant extracts compared to cells in glucose. The plant extracts stimulated efflux. Thus, the extracts used in this study lacked efflux pump inhibitory activity. While inhibition of efflux pumps seems to be a worthy approach for improving the efficacy of antibiotics which are substrates of such pumps, it is important to identify antibiotics and target bacteria for which this approach would be the most applicable [
36].
Antibacterial agents, usually act on the membranes of bacteria by causing disruption and permeabilisation [
37]. The antibacterial mode of action of the acetone, ethanol and DCM: methanol leaf extracts from
T.
welwitschii on the membrane integrity of
P. aeruginosa was determined using propidium iodide a fluorescent nucleic acid stain. Live bacterial cells are impermeable to propidium iodide, but upon membrane disruption or permeabilisation, propidium iodide can enter the cells [
18]. The exposure of
P. aeruginosa to the three leaf extracts resulted in bacterial cell membrane disruption as evident from the increased uptake of propidium iodide in comparison to the unexposed cells (Fig.
4). The increased fluorescence of propidium iodide by cells showed that there was disruption of the cell membrane since propidium iodide exclusively bind to nucleic acids of dead cells with damaged membranes only and not live cells. It has been reported in other studies that some extracts cause membrane damage leading to nucleic acid leakage [
38], and induce cell damage [
39]. Among extracts that cause membrane damage causing leakage of cell materials can be found also the
Plumbago zeylanica root [
37],
Trianthema portulacastrum leaf [
40], and
Ocimum basilicum [
41].
For a plant extract to be useful, it has to possess bioactive properties and exhibit non-cytotoxic profile. Some plants possessing bio-active components may show toxicity thus it is important to investigate the primary toxicity of plant extracts. Several researchers have used erythrocytes as a model system for determining the interaction of drugs with mammalian membranes [
42‐
45]. The erythrocyte model has been commonly used in toxicity profiling as it provides a direct indication of toxicity of injectable preparations in addition to a general indication of membrane toxicity [
46]. Haemolysis is a result of the destruction of the erythrocyte caused by the lysis of the membrane lipid bilayer. The lysis of erythrocytes can cause anaemia, an increase in plasma haemoglobin leading to nephrotoxicity and vasomotor instability [
47]. In the haemolytic assay, when the erythrocyte suspension was diluted in Drabkin’s, the reagent haemolysed the erythrocytes. The haemolysis released haemoglobin into the solution. The Fe
2+ of the haemoglobin molecules were oxidised by potassium ferricyanide to Fe
3+. This oxidation resulted in the formation of methaemoglobin which combined with the cyanide ions to form cyanmethemoglobin, a stable compound colour pigment read calorimetrically at 590 nm [
48]. The acetone, ethanol and DCM: methanol leaf extracts from
T.
welwitschii showed haemolytic activity of 10–16% (Fig.
5). According to Vidhya and Udayakumar [
49], a 10–49% haemolytic activity is rated as slightly toxic. Therefore, the 10–16% haemolytic activity obtained for the three leaf extracts from
T.
welwistchii is an indicator of non-significant toxicity to erythrocyte membrane, consequently favouring further study of the plant species.
Macrophages are highly phagocytic and considered to be essential immune effector cells that participate in innate and adaptive immune responses. Since the functioning of macrophages can be altered depending on their surrounding environment and the stimuli they are exposed to [
50], they were used as a typical model to study the cytotoxicity of plant extracts. The potential of plant extracts to inhibit the growth or viability of murine macrophages can, therefore, be used as an indication of toxicity. Viability of mouse peritoneal cell was determined using the MTT assay. The yellow tetrazolium MTT salt was reduced by metabolically active cells by the action of dehydrogenase enzymes giving a purple colour. The intensity of the purple colour was used to calorimetrically measure viable cells [
51]. The results of the mouse peritoneal cells exposed to the acetone, ethanol and DCM: methanol extracts from
T.
welwistchii (Fig.
6) showed that cell survival increased with increasing extract concentration. The proliferative effect of the three extracts on the mouse peritoneal cells was an indication that the leaf extracts were not toxic towards the mouse peritoneal cells. Similar results were reported by Ragupathi., et al [
52], saponins isolated from
Quillaja saponaria tree bark stimulated the production of immune cells. Sun et al., [
53], showed that most plant polypeptides promote the proliferation of macrophages among other immune cells. Therefore, the results of this study provide evidence that the acetone, ethanol and DCM/methanol leaf extracts are not toxic to mouse peritoneal cells but may stimulate their growth. The extracts may boost growth of the immune cells which are vital in fighting some bacterial infections.
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