Original Contributions |
From the Institutes of Traditional Medicine (Y.-J.W., C.-Y.H.) and Clinical Medicine (S.-J.L., C.-Y.H.), National Yang-Ming University; and the Departments of Medical Research and Education (M.-S.S.) and Internal Medicine (C.-Y.H., S.-J.L., P.W.), Veterans General Hospital, Taipei, Taiwan, ROC.
Correspondence to Ming-Shi Shiao, Department of Medical Research and Education, Veterans General Hospital-Taipei, 201, Section 2, Shih-pai Road, Taipei, Taiwan 11217, Republic of China.
| Abstract |
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Key Words: Salvia miltiorrhiza salvianolic acid B vitamin E atherosclerosis oxidized LDL
| Introduction |
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Antioxidants that prevent LDL from oxidative damage may interrupt the progression of atherosclerosis.4 Vitamins E and C protect LDL from oxidative damage in vitro9 10 and decrease the morbidity of coronary heart disease.11 12 13 14 Probucol inhibits atherosclerosis in nonhuman primates15 and rabbits.16 Recently, N,N'-diphenyl-phenylenediamine has been demonstrated to reduce atherosclerosis in cholesterol-fed rabbits and apoE-deficient mice.17 18 The ability of lipophilic antioxidants to reduce atherosclerosis and coronary heart disease is mainly due to the protection of LDL from oxidative modification.14 Since water-soluble antioxidants are unable to adhere to LDL particles, they are unable to protect LDL from oxidation in the subendothelial space. However, several studies suggest that water-soluble antioxidants, such as vitamin C, are effective in inhibiting LDL oxidation by the preservation of endogenous antioxidants in LDL.19 Recent studies have also shown that flavonoids, a class of water-soluble antioxidants, are useful in reducing the risk of coronary heart disease.20 Glabridin, a polyphenolic compound with medium polarity from licorice, protects LDL against lipid peroxidation in humans and reduces atherosclerotic lesion areas in apoE-deficient mice.21
Salvia miltiorrhiza Bunge (Labiatae), an eminent herb in the
treatment of cardiovascular disorder (called blood
stasis in traditional Chinese medicine), is widely used in China,
Japan, and Taiwan. Its nonpolar extracts contain tanshinones, which can
inhibit platelet aggregation22 and protect
myocardium against ischemia-induced
derangement.23 The aqueous extract of S
miltiorrhiza contains phenolic compounds that are effective in
protecting liver microsomes, hepatocytes, and erythrocytes
against oxidative damage.24 Among them, Sal B
(see Fig 1
) is a potent hepatoprotective
agent and water-soluble antioxidant.25 The
purpose of the present study is to elucidate the potential of Sal B
in the inhibition LDL oxidation and of a Sal Brich fraction of
S miltiorrhiza (SM) in the reduction of the severity of
atherosclerosis in hypercholesterolemic
rabbits.
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| Methods |
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-tocopherol,
retinyl acetate, Evans blue, Sudan IV, and hematoxylin were purchased
from Sigma Chemical Co. Sal B was a gift from the Institute of Materia
Medica, Chinese Academy of Medical Sciences at Beijing. Male NZW rabbits were obtained from the Animal Center of National Taiwan University. High fiber rabbit chow (as normal diet) was purchased from Purina.
Preparation of SM and Determination of Sal B Content
The dry roots of S miltiorrhiza were extracted with a
mixture of water and ethanol (4:1, vol/vol) at room temperature for 24
hours. After evaporation of solvent under reduced pressure, the extract
(SM) was stored under nitrogen at 4°C before use. The content of Sal
B in SM was determined by reversed-phase HPLC. The column
(5C18, 4.6x250 mm) was eluted with 25%
aqueous methanol at 1.0 mL/min for 6 minutes. The volume percentage of
methanol was increased to 35% linearly in the next 4 minutes and
maintained isocratically for 5 minutes. It was further increased to
40% linearly in the next 5 minutes and kept constant for 20 minutes.
During the entire elution, a low percentage of acetic acid was added to
suppress ionization of phenolic acids. Sal B was eluted at a retention
time of 24.9 minutes. Quantification of Sal B was based on peak area at
290 nm.25
DPPH Radical Scavenging and Inhibition of LDL Oxidation
The DPPH radicalscavenging activities of Sal B, SM, and
probucol were determined. In brief, 1 vol of acetate buffer (100
mmol/L, pH 5.5), 1 vol of ethanol, and 0.5 vol of freshly prepared DPPH
ethanolic solution (500 nmol/L) were mixed. After adding the test
compound, the mixture was incubated at 25°C for 90 minutes. The
change in absorption at 517 nm was then
determined.26
Fasting plasma samples were collected from healthy male adults not given vitamin supplements. LDL was obtained by ultracentrifugation from a density range of 1.019<d<1.063 (adjusted by NaBr).27 LDL was extensively dialyzed against PBS (5 mmol/L phosphate buffer and 145 mmol/L NaCl, pH 7.4) at 4°C under nitrogen for 24 hours. In vitro LDL oxidation was carried out in a 96-well microtiter plate at 37°C.28 Probucol stock solution (2.0 mmol/L) was prepared in ethanol. It was diluted to 50 µmol/L into 10% aqueous ethanol before use as a positive control. Sal B and SM were dissolved in PBS. A 50 µL aliquot of LDL (0.9 mg cholesterol per milliliter) in each well was preincubated with test compound for 1 hour. The final volume in each well was adjusted to 100 µL with PBS. LDL oxidation was initiated by adding CuSO4 to a final concentration of 10 µmol/L. After incubation, 150 µL EDTA (2 mmol/L) was added. A 100-µL portion of the mixture was then transferred to a minivial containing 0.9 mL of 2-propanol. The precipitates were removed by centrifugation. The concentration of conjugated dienes in the supernatant was determined by absorption at 234 nm.
Animal Treatment
Male NZW rabbits were randomly divided into four groups. Five
rabbits in the control group were fed a normal diet. Seven rabbits in
the high cholesterol group were fed a high
cholesterol diet (normal diet supplemented with 1%
cholesterol and 4% corn oil). Seven rabbits in the
probucol group were fed a high cholesterol diet plus 1%
(wt/wt) probucol.29 Seven rabbits in the SM group
were fed a high cholesterol diet plus 5% (wt/wt) SM. The
selection of SM dose was based on its antioxidant activity comparable
to that of probucol in Cu2+-induced LDL oxidation
(see Table 1
). Diets and drinking water
were provided ad libitum. Animals were bled periodically for
measurement of plasma cholesterol and liver function.
During the 12-week feeding period, we adhered to the guidelines for
care and use of laboratory animals.
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Plasma Cholesterol and Lipoprotein Analysis
Fasting plasma levels were obtained from animals after 0, 1, 3,
6, 9, and 12 weeks of feeding. Concentrations of plasma and lipoprotein
cholesterol were determined
enzymatically.30 Cholesterol exposure
was calculated as the area under the curve of plasma
cholesterol versus time. For lipoprotein analysis,
an aliquot of plasma was prestained with Sudan black for 20 minutes.
Electrophoresis was performed by using polyacrylamide gel
(Sebia) with a discontinuous gradient (2% in the upper layer and 3%
in the lower layer).
Susceptibility of LDL Oxidation Ex Vivo
Fasting blood samples were collected into evacuated tubes
(K3-EDTA) from rabbits after 12 weeks of feeding.
The LDL fraction (1.019<d<1.063) was collected by
ultracentrifugation and extensively dialyzed in PBS (pH
7.4). The concentration of dialyzed LDL was adjusted to 0.9 mg
cholesterol per milliliter. It was incubated with
CuSO4 (final concentration, 25 µmol/L) at
37°C. A subsequent assay was performed according to the procedure of
Puhl et al31 with modification. Formation of
malonaldehyde was determined as TBARS.28 In
brief, an aliquot of incubation solution was added with TBA solution
(0.6%, wt/vol) and heated at 95°C for 45 minutes. After
centrifugation, TBARS in the supernatant was measured
by absorption at 532 nm.
Vitamin E Content in LDL
Without dialysis, a 200 µL aliquot of LDL was added with an
equal volume of ethanol containing 7.5 µmol/L retinyl acetate as
an internal standard. The mixture was extracted with
n-hexane containing BHT (0.4 mg/mL) in darkness. The
hexane layer (1.5 mL) was dried under a stream of nitrogen, and the
residues were resuspended in 100 µL mobile phase
(acetonitrile/tetrahydrofuran, 70:30, vol/vol). After filtration
through glass wool, the content of vitamin E (as
-tocopherol) was determined by reversed-phase
HPLC.32
Endothelial Damage
Endothelial damage was determined in separate
animals after 6 weeks of an identical feeding schedule. Quantification
was based on the leakage of EBA conjugate as a macromolecular
tracer.33 Animals were anesthetized by a
mixture of ketamine and xylazine hydrochloride solution. The
right femoral artery, vein, and right carotid artery were cannulated.
Fifteen milliliters of EBA solution (200 mg BSA per milliliter) was
slowly injected into the femoral vein. Exactly 5 minutes after
injection, an overdose of pentobarbital was given. Shortly before
euthanasia of the animal, heparin (5000 USP units) was injected
intravenously through the femoral vein to prevent
intravascular blood coagulation. The arterial system was
perfused immediately with heparinized saline (2 U/mL) via the right
carotid artery at a pressure of 120 mm Hg. After the fluid was
drained from the femoral artery and the vein turned clear, the
perfusate was switched to a neutral-buffered 10% formalin
solution. Perfusion was continued at the same pressure for another 10
minutes as a preliminary perfusion fixation. For further fixation, the
thoracic aorta was excised and immersed in 10% formalin for 1 hour.
The adventitial tissue and branches were carefully removed. Each aortic
specimen was cut longitudinally and dissected into six pieces (100
mm2 per segment). The specimens were stained with
Harris' hematoxylin for 1 minute. An epifluorescence
microscope was used for detection and quantification of EBA leaky foci.
The EBA fluorescence was examined with green excitation at 546
nm.
Extent of Atherosclerosis and Cholesterol
Deposition
After 12 weeks of feeding, the animals were killed, and the
aortas, from aortic arch to iliac bifurcation, were collected and
cleaned of adhering tissue. Abdominal aortas were stained with a
solution of Sudan IV to visualize the lesion
area.17 Sudanophilic areas were photographed and
measured by computer-assisted planimetry. Thoracic aortas were weighed,
minced, and extracted with a mixture of chloroform and methanol (2:1,
vol/vol) for total lipids. Aliquots of the lipid extracts were
saponified in an ethanolic KOH solution. Cholesterol was
extracted into n-hexane, and levels were determined by using
a microscale method of Abell et al.34
Biochemical Measurement
Blood samples were collected before and 1 and 12 weeks after
feeding for measurement of plasma Na+,
K+, Cl-,
triglyceride, glucose, BUN, creatinine, AST,
and ALT. For the SM group, additional blood analysis was
carried out after 1 week of feeding for evaluation of acute
toxicity.
Statistical Analysis
Results were reported as mean±SEM. The differences in number of
EBA leaky foci between groups were analyzed by paired
t test. The other statistical analyses were obtained
by using unpaired t test or ANOVA. A value of
P<.05 was considered statistically significant.
| Results |
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There was no detectable change in wavelength
(
max) or molecular absorption (log
) of Sal
B at 50 µmol/L when coincubated with LDL (100 µg/mL) in PBS:
max (log
)=289 (4.16), 310 (4.10), and 330
(4.05). There was no indication of direct binding of Sal B with LDL
particles in solution. Similar observations were also found by using
fresh, extensively dialyzed human LDL preparations.
Animals
There were no differences in body weights at the end of the
12-week feeding period (normal, 3.0±0.2 kg; high
cholesterol, 3.1±0.3 kg; probucol, 2.9±0.2 kg; and SM,
3.1±0.2 kg). Hypertriglyceridemia and
hyperglycemia occurred in all groups of animals fed a high
cholesterol diet; neither probucol nor SM significantly
prevented the elevation of plasma triglyceride and glucose.
Probucol treatment caused an elevation of AST values (normal, 25±3
U/L; high cholesterol, 36±5 U/L; and probucol, 59±9 U/L).
The SM group had an AST value (10±4 U/L) lower than that of the high
cholesterol group (P<.05).
There were no significant differences in ALT, electrolyte, BUN, or creatinine values among the three cholesterol-fed groups. SM treatment did not cause any additional abnormality, as indicated by the biochemical parameters.
Plasma Cholesterol and Aortic Cholesterol
Exposure
Plasma cholesterol levels were increased during
the feeding period in rabbits fed a high cholesterol diet.
SM and probucol treatment attenuated the increase in plasma
cholesterol (see Fig 2
).
Cholesterol exposure, defined as the area under the curve
of plasma cholesterol versus time, was determined to
estimate the effect of cholesterol lowering on
atherosclerosis reduction. SM caused a 29% decrease
and probucol caused a 44% decrease in cholesterol exposure
compared with the high cholesterol group. Reduction of
plasma cholesterol by SM and probucol occurred
predominantly in ß-VLDL (d<1.019) (see Fig 3
). Probucol treatment decreased HDL
cholesterol levels at weeks 6 and 12 compared with levels
in the high cholesterol group (P<.005) and
levels before treatment (week 0 versus week 12, P<.0001).
Throughout the feeding, no difference in HDL cholesterol
between the SM and high cholesterol groups was
observed.
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Oxidative Susceptibility and Vitamin E Content in LDL
LDLs collected from SM- and probucol-treated groups were more
resistant to oxidation than those from the high
cholesterol group (see Fig 4
). Time required to achieve half-maximum
TBARS production was defined as antioxidativity. The
antioxidativity of probucol (34.8±1.1 hours) was the longest among the
three cholesterol-fed groups. The antioxidativity of the
SM-treated group (6.2±0.2 hours) was significantly higher than that of
the high cholesterol group (1.1±0.1 hour).
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Cholesterol feeding decreased vitamin E content in LDLs. In
the high cholesterol group, the value (9.6±1.8 nmol/µmol
cholesterol) was 32% less than that in the normal group
(14.1±1.6 nmol/µmol cholesterol) (P<.05)
(see Table 2
). Probucol treatment further
decreased vitamin E content in LDLs by 15%. Vitamin E content in LDLs
collected from the SM-treated group was 21.7±2.1 nmol/µmol
cholesterol, a value 2.3-fold higher than that in the high
cholesterol group (P<.005).
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Protection of Endothelial Damage
Endothelial damage, as determined by the number of
EBA leaky foci in the thoracic aortas, was increased by
cholesterol feeding. The number of leaky foci was
significantly increased in the high cholesterol group
(4.10±0.95 foci per square millimeter) compared with the normal group
(0.84±0.03 foci per square millimeter) (P<.01) (see Table 3
). Compared with the high
cholesterol group, endothelial damage was
reduced by 42% in the SM group (P<.01) and by 34% in the
probucol-treated group (P<.05). To reveal the protective
effect of SM against endothelial damage caused by
cholesterol feeding, the number of leaky foci was corrected
by subtracting the basal value of the normal group from the treatment
group value. SM treatment decreased cholesterol
feedinginduced endothelial damage by 53%
(P<.05).
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Reduction of Atherosclerotic Area and Cholesterol
Deposition
Severe atherosclerosis was developed in animals
after 12 weeks of a high cholesterol diet. The
atherosclerotic area in the abdominal aorta was 37.2±4.4% and the
cholesterol deposition in the thoracic aorta was 28.7±1.9
mg/g in the high cholesterol group (see Fig 5
). Probucol treatment resulted in a 74%
decrease in atherosclerotic area and a 56% decrease in
cholesterol deposition. SM treatment caused a 56% decrease
in atherosclerotic area and a 50% decrease in cholesterol
deposition. Both decreases were statistically significant
(P<.005) compared with the high cholesterol
group values.
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| Discussion |
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The content of SM in a high cholesterol diet was 5.0%. Since SM contained only 4.4% of Sal B, the actual concentration of Sal B in the chow was only 0.22%, a value much lower than that of probucol (1%). The DPPH-scavenging activity of a water-soluble antioxidant was dependent on its oxidizable functional group. Sal B and SM exerted radical-scavenging activities effectively in the DPPH system. However, antioxidant activity tested in the LDL system was further dependent on the interaction with LDL particles.35 Lipophilic antioxidants, such as probucol, bound to LDL and augmented the protective effects in LDL oxidation. It is interesting to notice that the relative potency of Sal B to SM remained unchanged in both assay systems. This is an indirect evidence that the antioxidant activity of SM predominantly came from Sal B. Being water-soluble and negatively charged, Sal B is less likely to bind to LDL through the Cu2+ binding sites. At a 40-fold higher concentration than its IC50 value, Sal B did not exhibit a detectable wavelength shift or absorption change when coincubated with LDL from the high cholesterol group (authors' unpublished data, 1997).
The severity of the atherosclerotic area in the abdominal aorta foretold the severity of cholesterol deposition in the thoracic aorta, and vice versa. There was a linear correlation (y=1.224x-1.54, r2=.807, P<.001) between atherosclerotic area and cholesterol deposition. Cholesterol exposure is a known risk factor of atherosclerosis in cholesterol-fed rabbits.17 To reveal the influence of factors other than elevation of plasma cholesterol, the atherosclerotic area was normalized by cholesterol exposure. Results showed that SM and probucol significantly reduced the atherosclerotic area per unit of cholesterol exposure. Atherosclerotic areas under similar amounts of cholesterol exposure were less in the SM-treated (-40%) and probucol-treated (-53%) groups than in the high cholesterol group. It is concluded that the antiatherosclerotic effects of SM and probucol rely not only on the cholesterol-lowering effects but also on their antioxidant activities.
Endothelial dysfunction is an early event in the pathogenesis of atherogenesis.4 The present study demonstrated that SM treatment significantly reduced endothelial damage. Antioxidants, including vitamin E and probucol, are reported to restore endothelial function in cholesterol-fed rabbits.36 37 This suggests that Sal B in SM may, on one hand, scavenge free radicals in the bloodstream and reduce their direct injury to aortic endothelium in hypercholesterolemic rabbits. On the other hand, the role of Sal B in resisting LDL oxidation in the subendothelial space could be the result of the preservation of vitamin E in LDL particles in the circulation.38 It has been reported that vitamin C, but not probucol, preserves lipophilic antioxidants in LDL during oxidative modification.10 19 A recent study in humans also indicates that probucol decreases serum concentrations of diet-derived lipophilic antioxidants, including vitamin E.39 Since the vitamin E content in LDL was higher in the SM-treated group than in the high cholesterol group and since the SM fraction did not contain vitamin E or C, we conclude that Sal B in SM may indirectly protect LDL from oxidative modification by scavenging free radicals in the bloodstream of cholesterol-fed rabbits and sparing the vitamin E in LDL from being oxidized.
| Selected Abbreviations and Acronyms |
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| Acknowledgments |
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Received March 4, 1996; accepted November 25, 1997.
| References |
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-tocopherol and carotenoids (lutein,
all-trans-lycopene,
- and ß-carotenes) in human plasma by
isocratic liquid chromatography. J
Chromatogr. 1994;645:129133.
-tocopherol and
ubiquinol in homogeneous solution and in aqueous
dispersions of lipids: unrecognized consequences of lipid particle size
as exemplified by oxidation of human low density lipoprotein.
Proc Natl Acad Sci U S A. 1993;90:4549.
-tocopherol improves and high-dose
-tocopherol worsens endothelial
vasodilator function in cholesterol-fed rabbits.
J Clin Invest. 1994;93:844851.
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