Croton urucurana Baill. is a native Brazilian tree, popularly known as “sangra-d’água” or “sangue-de-dragão,” based on the red resinous sap of the trunk. Its use has been transmitted through generations based on popular tradition that attributes analgesic, anti-inflammatory, and cardioprotective properties to the tree. However, its cardioprotective effects have not yet been scientifically investigated. Thus, the present study investigated the pharmacological response to an ethanol-soluble fraction from the leaves of C. urucurana in Wistar rats exposed to smoking and dyslipidemia, two important cardiovascular risk factors. The extract was evaluated by high-performance liquid chromatography. Wistar rats received a 0.5% cholesterol-enriched diet and were exposed to cigarette smoke (9 cigarettes/day for 10 weeks). During the last 5 weeks, the animals were orally treated with vehicle (negative control group), C. urucurana extract (30, 100, and 300 mg/kg), or simvastatin (2.5 mg/kg) + enalapril (15 mg/kg). One group of rats that was not exposed to these risk factors was also evaluated (basal group). Electrocardiograms and systolic, diastolic, and mean blood pressure were measured. Blood was collected to measure total cholesterol, triglycerides, urea, and creatinine. The heart and kidneys were collected and processed for oxidative status and histopathological evaluation. The phytochemical analysis revealed different classes of flavonoids and condensed tannins. The model induced dyslipidemia and cardiac and renal oxidative stress and increased levels of urea and creatinine in the negative control group. Treatment with the C. urucurana extract (300 mg/kg) and simvastatin + enalapril decreased cholesterol and triglyceride levels. In contrast to simvastatin + enalapril treatment, the C. urucurana extract exerted cardiac and renal antioxidant effects. No alterations of electrocardiograms, blood pressure, or histopathology were observed between groups. These findings indicate that C. urucurana exerts lipid-lowering, renal, and cardioprotective effects against oxidative stress in a preclinical model of multiple risk factors for heart disease.
1. Introduction
Because of the high risk of morbidity and mortality associated with cardiovascular disease, finding ways to mitigate such risk has become paramount in public healthcare. The presence of classic risk factors, such as hypertension, dyslipidemia, obesity, sedentary lifestyle, smoking, diabetes, and family history, increases the risk of developing cardiovascular disease. Dyslipidemia is an important cardiovascular risk factor. Low-density lipoprotein cholesterol (LDL-c) is the most relevant modifiable risk factor for coronary artery disease [1]. Ample evidence indicates that low LDL-c levels are associated with a proportional reduction of cardiovascular outcomes, including myocardial infarction, stroke, and cardiovascular-related death [2].
Another cardiovascular risk factor is smoking, a disease that is caused by nicotine addiction. An estimated 1.25 billion smokers worldwide are at risk of early death from smoking [3]. The health consequences of smoking are disastrous, given long-term exposure of the body to harmful components in cigarettes. The long-term continued use of tobacco and its derivatives leads to the appearance of cardiovascular, oncological, and respiratory diseases, making it one of the main causes of preventable death worldwide [4].
Despite the high morbidity and mortality of cardiovascular disease, animal models that combine its main risk factors are scarce. Despite the existence of effective and low-cost pharmacological therapies, some new drugs that are recommended by recent guidelines are expensive or unavailable in public healthcare systems [5]. Thus, the search for new therapeutic agents that are less expensive and safe and act effectively for the management of cardiovascular risk factors is essential. Plants remain an important source of potential medicines and the development of new therapies.
One important native tree in Brazil is Croton urucurana Baill. (Euphorbiaceae), popularly known as “sangra-d’água” or “sangue-de-dragão.” This species is widely used by the Brazilian native population as a natural source of medicines. The leaves and bark of C. urucurana are popularly used to treat various conditions, including rheumatism, wounds, gastric ulcers, liver disorders, diarrhea, cancer, and cardiovascular diseases [6, 7]. The main active constituents of C. urucurana are tannins, lignans, and alkaloids [8]. Preclinical studies have shown that C. urucurana has antifungal [9], antibacterial [8], anti-inflammatory [10], antinociceptive [6, 11], antitumoral [12, 13], wound healing [12, 14], antiulcerogenic [15, 16], antidiarrheal [17, 18], and antihemorrhagic [19] effects. Toxicological studies reported that C. urucurana is potentially nontoxic, with an oral lethal dose 50 (LD50) above 5 g/kg in mice [9].
However, despite the popular use of C. urucurana for the treatment of cardiovascular diseases [7], the cardioprotective actions of this species have not yet been pharmacologically investigated. Thus, the present study investigated the lipid-lowering and antioxidant effects of an ethanol-soluble fraction obtained from leaves of C. urucurana in Wistar rats in a model of a combination of risk factors (exposure to tobacco smoke and dyslipidemia) for heart disease.
2. Material and Methods
2.1. Drugs
Bovine serum albumin, 5,5′-dithiobis(2-nitrobenzoic acid), reduced glutathione (GSH), xylenol orange, K2HPO4, KH2PO4, 1 M Tris, 5 mM ethylenediaminetetraacetic acid, Tris HCl (all from Sigma, St. Louis, MO, USA), pyrogallol, absolute ethanol, absolute methanol, ferrous ammonium sulfate, trichloroacetic acid, formaldehyde (all from Vetec, Rio de Janeiro, Brazil), and ultra-pure water from a Milli-Q system were used for eluent preparation.
2.2. Extract Preparation and Phytochemical Profile
Leaves of Croton urucurana Baill. were collected in May 2020 at Dourados, Mato Grosso do Sul (″22°20.9299′ south, 54°83.7713 west), and a voucher specimen (no. 5536) was deposited in the Herbarium of the Federal University of Grande Dourados. The plant was dried in an oven at 50°C for 5 days and pulverized. The extract was prepared by infusion using the methodology of Barbosa et al. [20], in which the pulverized material (100 g) was subjected to the extraction process by infusion with 1 L of boiling water. The resulting infusion was kept in an amber flask for 5 h, filtered, and then treated with 95% ethanol (1 : 3, v/v) to precipitate proteins and polysaccharides, giving rise to the heterogeneous phase that was removed by filtration. The ethanol-soluble fraction was concentrated on a rotary evaporator and lyophilized. The final yield of the dried extract of C. urucurana was 11.31%. Phytochemical characterization was performed using high-performance liquid chromatography (HPLC) with a diode-array detector (DAD; Shimadzu, Prominence LC-20A). Chromatography was conducted in the reverse-phase on a C18-PCP column (Ascentis Express; 150 × 4.6 mm, 2.7 μm particle size) using mobile phases that were composed of (A) 0.1% formic acid in water and (B) 0.05% formic acid in acetonitrile. The separation was obtained by a gradient of B that increased from 5% to 30% in 15 min then to 80% in 20 min, with a return to 5% in 21 min and then 5 min at the initial condition for solvent reequilibration. The flow rate was 0.5 ml/min. The column temperature was held at 40°C. Compound detection was accompanied by ultraviolet (UV) light at 190–400 nm.
2.3. Animals
Wistar rats, weighing 150–200 g, were obtained from the central vivarium of the Federal University of Grande Dourados. The animals were housed in the vivarium of the Laboratory for Pre-Clinical Research of Natural Products, Paranaense University, with free access to food and water. The animals were housed under controlled environmental conditions (20° ± 2°C temperature, 50% ± 10% relative humidity, and 12 h/12 h light/dark cycle) with environmental enrichment. The total number of animals in the experiment was 48 (n = 8/group). The animals were weighed weekly on an analytical balance. The experimental protocol was approved by the Ethics Committee on the Use of Animals of Paranaense University (protocol no. 1000/2020). All national and international guidelines on animal welfare were followed. The reporting of animal investigations conformed to Animal Research Reporting of In Vivo Experiments (ARRIVE) guidelines [21].
2.4. Experimental Design
The choice of the animal species, sample size, and extract doses was based on Mendes et al. [22]. For 10 weeks, the animals received standard commercial food that was enriched with 0.5% cholesterol ad libitum. They were exposed to smoke from nine commercial cigarettes (0.8 mg nicotine, 10 mg tar, and 10 mg carbon monoxide) for 1 h daily, 5 days weekly, for 10 weeks, as proposed by Mendes et al. [22]. During the last 5 weeks of the experiment, the animals were treated orally by gavage with vehicle (0.1 ml of filtered water/100 g body weight; negative control [C−] group), the ethanol-soluble fraction of Croton urucurana (30, 100, and 300 mg/kg), or enalapril (15 mg/kg) + simvastatin (2.5 mg/kg) once daily. Nondyslipidemic and nonsmoke-exposed Wistar rats were treated with vehicle (filtered water) and served as the basal group (n = 8). The final groups were the following: (1) basal (rats not exposed to any risk factor and treated with vehicle), (2) negative control (C−; dyslipidemic rats exposed to cigarette smoke and treated for 5 weeks with vehicle), (3) C. urucurana 30 (dyslipidemic rats exposed to cigarette smoke and treated with 30 mg/kg C. urucurana extract for 5 weeks), (4) C. urucurana 100 (dyslipidemic rats exposed to cigarette smoke and treated with 100 mg/kg C. urucurana extract for 5 weeks), (5) C. urucurana 300 (dyslipidemic rats exposed to cigarette smoke and treated with 300 mg/kg C. urucurana extract for 5 weeks), and (6) simvastatin + enalapril (dyslipidemic rats exposed to cigarette smoke and treated with 2.5 mg/kg simvastatin plus 15 mg/kg enalapril for 5 weeks).
2.5. Electrocardiography and Heart Rate and Blood Pressure Measurements
On the last day of the experiment, the rats were intramuscularly anesthetized with ketamine (100 mg/kg) + xylazine (20 mg/kg). A bolus injection of heparin (15 IU) was administered subcutaneously. Electrocardiography (ECG) was recorded using a 12-lead ECG recorder (WinCardio, Micromed, Brasília, Brazil) according to Romão et al. [23]. Electrocardiographic waves were recorded for 5 min. After ECG, the left carotid artery was isolated, cannulated, and connected to a pressure transducer that was coupled to a PowerLab recording system. Chart 4.1 software (ADI Instruments, Castle Hill, Australia) was used to record heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). After 15 min of stabilization, changes in heart rate and blood pressure were recorded for 5 min.
2.6. Blood Collection and Biochemical Analysis
Blood samples were collected from the left carotid artery using heparinized syringes. Plasma was separated by centrifugation at 1,500 × g for 10 min and stored at −80°C for biochemical analyses. Total cholesterol, triglyceride, creatinine, and urea levels were measured using commercial kits and an automated analyzer (Quick Lab).
2.7. Euthanasia and Organ Collection
The rats were euthanized by puncture of the diaphragm while under anesthesia. The heart and left kidney were removed, carefully dissected, and weighed on an analytical balance. The weights of the heart and kidney were multiplied by 100 and divided by the animal’s body weight before euthanasia to obtain the relative organ weight (%). A sample of the heart and kidney was rapidly separated and frozen in liquid nitrogen to evaluate oxidative stress. Other organ samples were stored in a 10% formalin solution for further histological analysis.
2.8. Tissue Redox Status
To investigate the tissue antioxidant system, the heart and kidney samples were homogenized in a 1 : 10 dilution of potassium phosphate buffer (0.1 M, pH 6.5). Afterward, 100 μl was separated, suspended in 80 μl of trichloroacetic acid (12.5%), vortexed, and centrifuged at 6000 × g for 15 min at 4°C. Reduced glutathione levels were measured according to Sedlak and Lindsay [24]. The remaining homogenate was centrifuged at 9000 × g for 20 min at 4°C for the determination of superoxide dismutase (SOD) activity and lipoperoxidation (LPO) levels according to Gao et al. [25] and Jiang et al. [26], respectively.
2.9. Histopathological Analysis
Samples of the heart and kidney were fixed in buffered 10% formalin solution (distilled water, 35–40% formaldehyde, and monobasic and dibasic sodium phosphate), dehydrated with alcohol and xylene, embedded in paraffin, sectioned at 6 μm, and stained with hematoxylin/eosin. The slides were analyzed by optical microscopy (Leica DM 2500) to evaluate cellular alterations.
2.10. Statistical Analysis
The data were analyzed for homogeneity of variance and a normal distribution. Differences between means were determined by one-way analysis of variance (ANOVA) followed by the Newman–Keuls post hoc test. The level of significance was set at 95% . The data are expressed as the mean ± standard error of the mean (SEM).
3. Results
3.1. Phytochemical Profile
The phytochemicals in the ethanol-soluble fraction from the leaf extract of Croton urucurana are described in Table 1. C. urucurana was previously investigated for the chemical composition of its leaves and stem bark. Different compounds were reported in this plant, including flavan-3-ols, proanthocyanidins (condensed tannins), flavonols, O-glycosides, hydroxyflavones, C-glycosides [14, 27], alkaloids, terpenes, and phenolic acids [10], which were obtained with different extraction solvents. In the present study, comparisons with authentic standards identified some main compounds in the extract of the leaves of C. urucurana, despite the lack of information to confirm the identification of some low-abundance peaks (e.g., 1, 2, 3, and 4). Other compounds were tentatively identified based on UV spectra, supported by previous reports, but some compounds were not observed in the current extract. Alves et al. [27] performed a more comprehensive phytochemical analysis of the leaves of C. urucurana. They identified different classes of flavonoids, such as condensed tannins (e.g., proanthocyanidins). In the current extract, we identified peaks 5, 6, and 7 with UV spectra which were consistent with these compounds, with λmax at 277–279 nm. Condensed tannins have been reported in all investigated parts of C. urucurana [10, 14, 27].
Peak
Rt
UV λmax
Tentative identification
Reference
1
2.58
264
n.i.
—
2
2.81
200, 280
n.i.
—
3
3.31
261
n.i.
—
4
3.45
254, 278 (Sh)
n.i.
—
5
8.06
277
Condensed tannin
[27]
6
9.07
279
Condensed tannin
[27]
7
9.66
278
Condensed tannin
[27]
8
10.26
279
Condensed tannin
[27]
9
11.39
221, 268, 301
n.i.
—
10
14.36
255, 353
Flavonol-O-glycoside
[27]
11
14.51
255, 353
Rutin
Std. [27]
12
14.75
269, 337
Apigenin-C-glycoside
[27]
13
14.83
269, 337
Apigenin-C-glycoside
[27]
14
15.13
255, 353
Isoquercitrin
Std. [27]
15
15.33
265, 346
Flavone C-glycoside
[27]
16
15.81
265, 346
Flavone C-glycoside
[27]
17
16.46
245, 333 (Sh), 348
n.i.
—
18
20.35
229, 266, 316
n.i.
—
19
20.53
229, 266, 316
n.i.
—
20
20.87
254, 366
Quercetin
Std.
21
22.06
254, 366
Kaempferol
Std.
n.i.: not identified; Std.: compound confirmed by a comparison with authentic standard.