Background
Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease, which finally results in damage of ligaments, peripheral joints and tendons. RA affects around 1% people in developed countries [
1‐
5]. RA is further defined as the inflammatory condition of joints, which produces the pain, immobility and inflamed condition with excess deposition of synovial fluid (accumulation of polymorphonuclear leukocytes) [
6,
7].. NSAIDs (Nonsteroidal anti-inflammatory drugs) are well established class of drugs used by many physicians on their patients as a first line antiarthritic drug, but they have side effects such as gastric erosion, ulceration, liver toxicity, inhibition of platelet activation and gastrointestinal hemorrhage, which consequently result in increased risk of hemorrhage [
8,
9]. A lot of drugs have been developed for the treatment of RA over the past two decades, but researchers are still in search for more specific drugs with minimum side effects. Researchers were able to explain the one of the herbal formulation piascledine, which is the mixture of avocado and soybean oils sfor relief of inflammatory arthritis symptoms. Several other small anti-inflammatory compounds isolated from natural sources have been scrutinized for the development of new lead molecule in the treatments for RA, but scientific data of their antiarthritic efficacy is still deficient and need more thorough study.
Melastoma malabathricum Linn. (Melastomataceae) (
MM), commonly known as Phutki in India, is a branched shrub available in subcontinent, especially in northeastern region. Traditionally, its leaves are chewed and applied to cuts and wounds for their coagulating properties. The leaves are used to treat hemorrhoid, dysentery, diarrhea and to prevent scarring from the pox. The shoots are used as a toothbrush for toothache,. Leaves and roots powder can be applied to pox scars and wounds to expedite the healing process or to alleviate the uneasiness of hemorrhoids. Flowers are used to treat stomach-ache [
10,
11,
12].
MM plant has been utilized in the treatment of inflammation and rheumatism by the local people in Dibrugarh district, Assam. The plant is rich source of different chemical constituents such as α-amyrin, patriscabatine and auranamide [
13], kaempferol-3-O-(2”,6”-di-O-p-trans-coumaroyl)glucoside, quercitrin, Mefloquine, (+) 3,4-Dehydroproline amide, 2-(3,5-Diphenyl-pyrazol-1-yl) benzothiazole, Kaempferol, Kaempferol-3-O-(2”, 6”-di-O-p-trans-coumaroyl)-β-glucopyranoside [
14,
52].
Researchers have proved the antinociceptive, anti-inflammatory, antipyretic [
15,
16], antidiarrhoeal [
17], antimicrobial [
18], antiproliferative and antioxidant [
19], antiulcer activity [
20], acute toxicity evaluation, antibacterial, antioxidant and immunomodulatory effects and hepatoprotective activity [
21,
22] of the plant. However, this plant is not scientifically explored for its antiarthritic activity. Hence, efforts were made by the authors to screen the antiarthritic potential of
MM.
Methods
Drugs and chemicals
CFA was procured from Sigma Chemical Company, USA and Indomethacin from Micro Lab Pvt. Ltd., India. Rest of the chemicals used in the experimental protocol was purchased as an analytical grade from the approved vendor.
Plant material
MM leaves were collected from the Herbal Garden, Dibrugarh University, Dibrugarh, Assam and authenticated by the Botanical Survey of India, Shillong and specimen voucher of plant sample was deposited for future reference.
MM leaves were thoroughly cleaned with tap water to eliminate extemporaneous matter and dried in the shade. The dried
MM (1 kg) leaves samples were exhaustively extracted with methanol in Soxhlet extractor for 72 h [
23,
24]. The extract was filtered using the Whatman filter paper and the filtrate was concentrated under reduced pressure at low temperature. The extract was stored at 4 °C until further use. Before experimentation,
MM extract was freshly prepared by dissolved in 1% carboxyl methyl cellulose (CMC) for experimental study.
Chromatography experiment
Pre-coated silica gel plate 60 F254 with a width (6 mm band) used for the HPTLC. Camag microliter syringe with a Linomat 5 applicator was used for injecting the sample over the plate under a flow of Nitrogen gas. The mobile phase {Hexane/ethyl acetate/formic acid (5:4:1, v/v/v)} was used in linear ascending development. The saturation time for mobile phase was about 20 min in saturation chamber to obtain the best results of tested and reference samples at room temperature (27 ± 20 °C) with 50% ± 2 relative humidity. Finally, the TLC (Thin layer chromatography) plate was dried at room temperature and the TLC plate image was developed at the distance of up to 80 mm length.
HPTLC study of
MM extract was carried out according to reported method of Kumar et al. with minor modification [
25]. Quercetin (10 mg) was dissolved in 10 mL of methanol for preparing the standard solution and
MM (2.0 g) extract solution was dissolved in 50 mL of methanol and was subjected to filtration using the Whatman filter paper. The filtrate was completely evaporated under reduced pressure and the obtained remains were re-dissolved in 1 mL of methanol. The prepared solution of quercetin and
MM extract was carefully spotted on the precoated TLC plates using Camag microliter syringe with constant application 150 nL/s.
Molecular docking studies
The molecular docking study was performed on cyclooxygenase 2 (3D structure) complex enzyme using Maestro 9.0 program (Schrodinger Inc. USA) by 64 bits operating systems under Windows 7 with an HCl computer [Intel (R) Core (TM) i5-2400 CPU @ 3.10 GHz, 8GB memory]. The molecular docking study was performed on enzymes cyclooxygenase, which was taken from the protein data bank (PDB ID: 1cx2). The protein is having the 96% similarity with the human cell enzyme with all the active site residues. Before performing the molecular docking, the enzyme structure was scrutinized for missing bonds, atoms and contacts. All residues and water molecules were manually removed from the structure. The grid box was used for the estimation of the active site of the protein. The minimum energy was selected and used an energy minimization.
Animals
Swiss albino adult Wistar rats (weighing 150–220 g; both sexes, kept six per cage) were obtained from the departmental animal house and were used according to departmental ethical committee and care of animals (National Institutes of Health). The animals were housed in the animal house under standard conditions (relative humidity (55 ± 10%), temperature (23 ± 1 °C), 12 h/12 h light/dark cycles) they received the standard pellet diet and water ad libitum.
Acute toxicity study of MM
Oral acute toxicity study of
MM extract was performed according to the reported method of Kumar et al. with minor modifications [
25]. Swiss albino Wistar rats of both sexes (weighing 100 to 220 g, body weight) were used for the experimental purpose. The rats were ravenous overnight and divided into the four groups (each group of rats contained three male and three female rats): Group I: (normal control) treated with vehicle only (1 mL water) and Group II (tested) received
MM (0.5 g/kg); Group III received
MM (1.0 g/kg, body weight (b.w.)) and Group IV received
MM (2.0 g/kg b.w.), respectively. All group animals were examined for 24 h, for the confirmation of signs and symptoms of autonomic, neurological and behavioral changes [
26].
Sub acute toxicity study of MM
Swiss albino Wistar rats (weighing 100 to 220 g; both male and female) were randomly selected randomly for the study. The animals were divided into four groups and each group contains animals (five male and five female): Group I- normal controls received vehicle (1 mL water); Group II- treated MM (500 mg/kg b.w.); Group III- treated MM (1000 mg/kg b.w.); Group IV- treated MM (2000 mg/kg b.w.). All animals treated with predetermined oral treatment and MM extract which was suspended in distilled water.
All group animals were observed for adverse reactions, side effects, mortality and any other changes at end of the sub acute toxicity study. The food consumption, water intake and body weight of all group animals were scrutinized at regular intervals. At the end of protocol nimals were sacrificed by cervical dislocation using the anesthesia condition, all the vital organs of animals were scrutinized visibly for evidence of any morphological deformity and blood samples of all group animals were collected and were used for the estimation of serum biochemistry like RBC (red blood cells), WBC (white blood cells), Hb (hemoglobin) and platelets levels and the biochemical parameters like AST (Aspartate aminotransferase), ALP (Alkaline phosphatase), ALT (Alanine transaminase), total cholesterol, LDL (Low-density lipoprotein), VLDL (Very low-density lipoprotein), HDL (High-density lipoprotein), triglyceride, bilirubin, albumin, creatinine, total protein and serum urea were also estimated [
53]. The vital organs such as kidney, heart and liver were excised, removed and weighed. Samples of extraneous tissues were removed, fixed in 10% formalin and dehydrated for histopathological examinations [
27].
Oral administration of drugs
The flexible metal rodent feeding tube was used for oral administration of tested and reference drugs. Mis-feeding of tested and reference drugs into trachea was perceived by signs of an irregular breathing pattern, irritation and choking. When the misfeeding transpired (less than 5% of all feedings), the rats were carefully observed for their revival [
28].
Complete Freund’s Adjuvant-induced arthritis in rats
The rats were divided into six groups (each group 6 rats). Group I was treated with vehicle (1% (
w/v) CMC); II received CFA; III received CFA +
MM (100 mg/kg); IV received CFA +
MM (250 mg/kg); V received CFA +
MM (500 mg/kg) and Group VI received CFA + indomethacin (10 mg/kg). CFA (0.5%
w/v) was inducted into the sup-planter region of left hind paws to induced the arthritis. All the animals received the predetermined treatment till 28 days [
29,
30] with paw edema of rats subjected to scrutinized at a regular interval using the screw gauge micrometer [
31].
Evaluation of arthritis swelling
The joint swelling (arthritis index) was evaluated by the reported method of Kumar et al. [
25] with minor modifications. The arthritic index was assessed on scale 0–4, 0: no change, 1: mild swelling and erythema of limb, 2: erythema of limb and moderate swelling, 3: erythema of limb and coarse swelling, 4: the inability of limb and gross deformity. The score of the four limbs was counted. Score more than one, confirmed arthritis and limited score of arthritis was set to 16. The arthritis score day of onset and frequency of arthritis was also recorded [
32].
Blood and tissue sampling
Rats of all groups were sacrificed on 29th day, and blood samples were collected in test tubes with anticoagulation agent. The collected blood samples were centrifuged at 15,000 rpm, and the serums were obtained for the estimation of biochemical parameters.
Estimation of proinflammatory and inflammatory mediators
The proinflammatory mediators such as interlukin-1β (IL-1β), interlukin-6 (IL-6) and tumor necrosis factor-α (TNF- α) inflammatory mediators such as cyclooxygenase 2 (COX- 2) were estimated using the manufacturer instructions of Enzyme Linked Immunosorbent Assay kits.
Histopathology examination
The left paw of all groups rats were cut above and below the 0.5 cm of joints. The muscle and skin of joints were trimmed away to leave the intact synovial membrane. All tissues were processed with the 3% hydrochloric acid (HCl) solution for 5–7 days, with periodic change of HCL on every 24 h for complete decalcification of joints. After that, the joints were fixed in the neutral buffered formalin (10%) for 2 days. Decalcified joints of rats were again dehydrated in different series of alcohol and joints were cleared and embedded in liquid paraffin. Decalcified joints were sliced g into 5 μm pieces with hematoxylin and eosin used for staining the tissue and preparing the slide. The slides were prepared for microscopic evaluation under light microscope (original magnification 40×, DXIT 1200, Nikon, Japan). H&E stained joint slides were examined for bone and cartilage destruction by synovial proliferation, cellular infiltration, and cartilage erosion by the following scoring system.
a.
Synovial proliferation
For the estimation of synovial proliferation, the following score system was used. No change = Score 0; mild proliferation with 2–4 layers of synoviocytes = Score 1; moderate proliferation with four or more layers of synoviocytes, absent synovial cell invasion of adjacent connective tissue and bone with enhanced mitotic activity = Score 2; provide proliferation distinguished by adjacent cartilage and effacement of joint space, connective tissue and bone.
b.
Cellular infiltration
Cellular infiltration: no changes: Grade 0; the small number of focal infiltrates: Score 1; extensive focal infiltration: Score 2; widespread infiltrates assaulting the capsules with combined formation: Score 3.
c.
Cartilage erosion
No changes: Score 0; localized cartilage ruin in more than one region: Score 1; cartilage ruin: Score 2; thick cartilage ruin different locations.
Statistical analysis
All the results were presented as mean ± SEM (standard error mean) using the one-way ANOVA {Graph Pad Prism 5.0 (Graph Pad Software, San Diego, CA, USA)}. The values of the result were considered to be significant, when the P value was p < 0.05, p < 0.01 and p < 0.001.
Discussion
Arthritis is a chronic painful inflammatory disease, affecting more than 1% population in developed countries. On the basis of biochemical markers, CFA-induced arthritis is clinically classified into four phases, initial phase developed during the first week after injecting the CFA with acute local inflammation and having some effects on liver; in the second week afterward, extend the reduction of acute inflammation and start the periarteritis; third-fourth week develops the arthritis with chronic inflammation, osteogenic and periarteritis activity, therefore, the fifth week onwards (forever), with permanent articular deformity and minimal inflammation [
33,
34].
Our study showed the credible protecting impact of this plant against the chronic inflammation induced by CFA. The results confirmed the use of MM extract as an antiarthritic agent in Indian folk medicine on the scientific basis. The conclusion of this study clearly explains that the MM extract is a potent antiarthritic remedy against chronic phases of inflammation. Topical and systemic application of MM is commonly observed for the treatment of inflammation, predominantly, arthritis (ama vata) which has been pursued for many years in the practice of Indian system of medicine (Ayurveda).
MM extract is a rich source of the flavonoids (quercetin). Flavonoids play an important role to inhibit the inflammation via apoptotic mechanism (calcium dependent) or cyclin-dependent kinase inhibitors; modify the cell cycle capture at the G1/S phase (Extracellular growth signals stimulate progression through the first gap phase G1, and into S, where genomic DNA is replicated); inhibit the cell-survival kinase and the inflammatory transcription factors; down-regulate the antiapoptotic gene products [
34,
35].
The CFA-induced arthritis model is the most extensively use model to investigate the clinical and pathogenic changes, which are similar to human arthritis [
25]. Further this method helps in determining the correlation between efficacy of therapeutic agents and RA model [
36,
37]. The adjuvant-induced inflammatory process involves fenestration of microvasculature, leakage of element into the interstitial space and passage of macrophages, lymphocytes into inflamed tissue; where adjuvant inoculation releases the number of inflammatory mediators like cytokines, histamine, 5 hydroxytryptamine, bradykinin, various chemotactic factor, interferons and prostaglandin into inflamed area. These mediators are liable for demolition and destruction of bone, cartilage and associated with pain, which can lead to several disabilities. Other mechanisms involves leukocytes and phagocytes, preparing a complex with the mediators, releasing the lysosomal enzymes and causing the injury of cartilage and other tissue. CFA affected the soft tissue and created the swelling near the ankle joints confirm the expansion of arthritis which was measured as edema of the particular tissues [
38,
39]. In the current study, the efficacy of
MM treated rats was evaluated in the proliferative phase of inflammation, showing the minimization of the chronic swelling induced by CFA. The first indication of the antiarthritic effect of
MM was observed when the administered extract (100, 250 and 500 mg/kg) showed a significant dose-dependent reduction of paw edema with 59.17%, 74.16%, and 87.72%, as compared to AC rats respectively. However,
MM received rats did not show enhancement of joint diameter, which suggests that mechanisms involved, is inhibition of inflammatory autacoids. The most likely mechanism for
MM extract may be inhibition of proinflammatory mediators, which could have lead to an alteration in the immunological situation during the delayed phase of the response. The determination of body weight and foot thickness of CFA-induced arthritis animals has been used to evaluate the antiarthritic effect of drug treatment. We found increased body weight of rats with decreased thickness of rat paw as compared to AC rats.
AC rats confirmed the decline level of RBC, Hb and increased levels of WBC, ESR. WBC is an important component of an immune system which is associated with induction of inflammation and is related to other infectious diseases [
40]. During the arthritic condition, 1 L-1β mediated increase in WBCs, cause the growth of colony stimulating factors and production of inflammatory macrophages and granulocyte [
41].
MM treated rats significantly suppressed the migration of inflammatory macrophages and granulocytes in dose dependent manner. On the other hand, increased ESR levels start the generation of endogenous proteins (fibrinogen, α/β globulin) and indicate the disease progression [
42]. During the arthritic condition, decreased levels of RBC and Hb, associated with anemic condition due to erythrocyte deformability (shorten the life span of erythrocytes), which result in declined level of RBC during arthritis [
43,
44]. It is projected that the declined levels of Hb during arthritis, results in reduction of erythropoietin level (decreased the level of bone marrow erythropoietin level) and premature destruction of RBCs [
28,
45]. Restoration of hematological parameters to normal by MM extracts supports its anti-arthritic effect.
ROS/RNS/free radical incessantly formed inside the body as a consequence of exposure to many endogenous and exogenous chemicals. There is equilibrium between the antioxidants and generated ROS/RNS, as the generation of ROS/RNS is stabled by endogenous antioxidants. Any disparity among the inactivation and production of ROS/RNS species leads to cellular dysfunction and unwanted pathological conditions including RA [
46]. The ROS/RNS species start the deprivation of synovial fluid and induce the depolymerization of hyaluronic acid which turns the loss of viscosity in joints [
47]. The human body has an efficient mechanism to avoid and deactivate the free radical generation/production damage caused by endogenous antioxidants such as SOD, GSH, GPx and CAT. SOD is metalloprotein that is the first line antioxidant marker involve in antioxidant defense. Decreased levels of RBCs in arthritic conditions increase the production of superoxide (O
2) and hydrogen peroxide radicals (H
2O
2) due to accumulation of inflammatory macrophages and granulocytes in the inflamed area [
47,
48]. Lipid peroxidation (LPO) is a common feature of rheumatic arthritis. MDA (as an indicator of lipid peroxidation) is used to evaluate the LPO. MDA is a pro-oxidant factor which determines the oxidative stress present in the rats [
48]. AC rats showed increased levels of MDA as compared to NC rats, due to elevated d level, it also started the accumulation of neutrophils in the inflamed area. CFA-induced arthritic rats that received
MM significantly (
P < 0.001) declined the levels of MDA. GSH and SOD are the first line antioxidants against scavenging the free radicals. SOD coverts the superoxide radical to H
2O
2 and is widely used to protect the cell damage during the toxic effects of O
2 anion. First line antioxidants catalytically scavenge the hydrogen peroxide (H
2O
2) and superoxide (O
2-) molecules. Endogenous antioxidant GPx reduced the H
2O
2 in the presence of GSH to form oxidized glutathione and water [
49]. CFA-induced arthritic rats that received
MM had significantly (
P < 0.001) modulated the level of an antioxidant enzyme as compared to AC rats.
Many researchers have shown that the proinflammatory mediators play a crucial role in the pathogenesis of arthritis [
50]. TNF-α (pleiotropic inflammatory cytokines) plays a crucial role in pathogenesis of acute and chronic inflammation, associated with the neutrophils and lymphocytes in endothelial cells via inflamed tissue. TNF-α, present in sera and synovial fluid of arthritic patients is a laboratory and clinical marker for estimation/confirmation of RA disease [
51‐
53]. It also promotes the generation of macrophage chemotactic protein-1 (MCP-1), IL-6 and IL-1β, which are involved in increasing the inflammatory reaction. Macrophages release the proinflammatory IL-1β, which enhances the inflammatory reaction. Both inflammatory cytokines (IL-1β and TNF-α) activated through the osteoclasts and nuclear factor are responsible for re-absorption and obliteration of bones. The generation of proinflammatory cytokines such as IL-6 starts through the T-cells, fibroblasts and monocytes, which initiate the induction of osteoclast discrimination and stimulates the MCP-1. All these proinflammatory cytokines are also involved in enhancing the clinical sign of arthritis and expansion of arthritic symptoms as well as body weight loss and joint swelling [
25,
27]. In the current study, we observed a considerable enhancement of serum TNF-α, IL-1β and IL-6 concentrations in AC group as compared to NC group. Treatment with
MM decreased the serum levels of IL-1β, TNF-α and IL-6 without disturbing other inflammatory mediators.
Acknowledgment
The present research was supported by the Department of the Pharmaceutical Sciences, Faculty of Health Sciences, SHIATS-Deemed University.