Cognitive impairment (CI) is among the leading causes of disability in humans. It is estimated that over 35.6 million people are suffering from Alzheimer’s disease- (AD-) associated cognitive deficits globally with these statistics projected to rise over 115.4 million by the year 2050. There is no specific etiology for this cognitive impairment; however, various contributing factors including advancing age (>60 years old), oxidative stress, cerebral injuries, infections, neurologic disorders, and cancer have been implicated. Despite various attempts to manage CI, no curative medicines are yet available. The current drugs used to manage symptoms of AD-associated CI including Donepezil and Rivastigmine among others are only palliative rather than therapeutic. Furthermore, these agents have been associated with undesirable side effects. This calls for alternative and complementary approaches aimed at either preventing or reverting AD-related CI in a curative way without causing adverse events. It is estimated that over 80% of the world’s population utilize herbal medicines for basic healthcare as it is considered safe, affordable, and easily accessible as opposed to conventional healthcare. Various parts of P. thonningii are used in traditional medicine to manage various conditions including CI. However, empirical and scientific data to validate these uses is lacking. In this study, the Morris water maze (MWM) experiment was adopted to evaluate the cognitive-enhancing effects of the studied plant extracts. The malondialdehyde (MDA) profiles in the brains of experimental mice were determined using the thiobarbituric acid reactive substances (TBARS) test. Moreover, qualitative phytochemical profiling of the studied plant extracts was performed using standard procedures. The results showed remarkable cognitive-enhancing activities which were reflected in significantly shorter transfer latencies, navigation distances, longer time spent in platform quadrant, and lower MDA levels compared with those recorded for the negative control mice (). Phytochemical screening of the studied plant extracts revealed the presence of antioxidant phytocompounds, which may have played key roles in the extracts’ potency. Based on the findings herein, P. thonningii extracts, especially the aqueous ones have a promising potential for the management of AD-associated CI. Further studies aimed at isolating and characterizing specific active compounds for CI from P. thonningii are recommended. Additionally, specific mode(s) of action of active principles should be elucidated. Moreover, toxicity studies should be done on the studied plant extracts to ascertain their safety.
1. Introduction
Cognitive impairment is the overarching phenomenon referring to a continuum of diseases and mental impairments of the brain tissue, which cause abnormalities in learning, memory, and communicative and intellectual abilities of the affected subject. Cognitive impairment is a complex presentation of continuous degeneration of intellectual functions characterized by a plethora of symptoms caused by diseases/disorders affecting the brain [1, 2]. It is estimated that 35.6 million people are affected with AD and associated cognitive deficits, with over half (58%) living in low- and middle-income countries. Annually, 7.7 million new cases are reported and these figures are expected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050 [3].
Cognitive impairment is one of the major causes of mental disability and dependency among older people and those suffering from AD and other dementias globally. It is not only debilitating to the affected subjects but also to their caregivers and families. There is often a lack of awareness and understanding of cognitive disorders, resulting in stigmatization and barriers to diagnosis, treatment, and management. The impact of cognitive impairment on caregivers, family, and society in general can be physical and psychological [4].
Recent research has shown that oxidative stress, which is the excessive generation of free radicals or their ineffective attenuation, drives cognitive impairment by damaging brain cells [5]. The high concentration of polyunsaturated fatty acids (PUFAs) in the brain increases its vulnerability to free radicals attack, which, in turn, damage brain cells leading to CI [6, 7]. Lipid peroxidation is thought to be a destructive form of oxidative degradation that impairs cell membranes, thereby generating several secondary products including reactive oxygen metabolites (ROMs) that cause neurotoxicity [8]. An increase in the levels of malondialdehyde (MDA), which is one of the ROMs, has been recognized as an important lipid peroxidation indicator and a marker of oxidative stress [9, 10].
Oxidative damage to proteins causes impairment to endogenous enzymes, which play important roles in proper functioning of the neural and glial cells in the brain. Damage to critical enzymes in the brain may lead to the downregulation of energy metabolism, which in turn triggers cell damage. Moreover, protein oxidation in the central nervous system exacerbates hyperphosphorylation of the tau proteins with aggregations of β-amyloids, which are hallmark features in cognitive-impaired brains of AD-affected patients [11, 12].
Even though pharmacotherapies seem to slow cognitive impairment events, the advantages are mostly marginal and unreliable [13]. Conventional medicines prescribed for the management of cognitive impairment are only palliative and do not cure the disease as they only manage the symptoms and improve quality of life without altering the result of the underlying condition [13, 14]. Furthermore, due to the diverse constellation of neuropsychiatric and behavioral symptoms associated with cognitive impairment, there may be potential undesirable side effects of conventional drugs, where improving one symptom worsens another symptom, thus rendering the management of this condition an uphill task. As a result, there is an urgent need for arsenal therapeutic agents for the management of AD-associated CI, and medicinal plants’ phytocompounds are a potential source [12, 15–17].
Plants have been used since antiquity for the management of cognitive deficits [18–20]. Various plant secondary metabolites that are responsible for their biological activities have been identified [21]. Some of them include terpenoids, phenolic compounds (flavonoids, phenolic acids, quinones, coumarins, lignans, stilbenes, and tannins), nitrogen-containing phytocompounds (alkaloids, amines, and betalains), and carotenoids. Phenolics have been demonstrated to possess the widest spectrum of bioactivity by acting as potent antioxidants [16, 21, 22]. The beneficial properties exerted by these bioactive components of medicinal plants include the inhibition of acetylcholinesterase (AChE), modification of Aβ processing, protection against apoptosis, and attenuation of oxidative stress [12, 15, 16]. Therefore, utilization of antioxidants offers a promising potential in the prevention and treatment of AD-associated cognitive deficits as well as other associated neurologic conditions [5, 8, 23].
Various parts of P. thonningii are used in African traditional medicine for the treatment of diverse conditions and diseases. Briefly, P. thonningii is used for the treatment of malaria, leprosy, ulcers, fever, wounds, arthritis, dizziness, coughs, and dementia and memory enhancement among others [24]. Some of the isolated bioactive compounds from P. thonningii include D-3-O-methylchiroinosital which possess antioxidant, analgesic, antidiabetic, antilipidemic, and antipyretic activities. Additionally, C-methyl flavanols, which have anti-inflammatory and antibacterial activities, have been isolated from this plant [25]. Furthermore, other antioxidant compounds with broad spectra of activities like β-amyrin (7) [25], quercetin (11), and quercitrin (12) [26], among many others (1-6, 8-10, and 13-15), have so far been isolated and identified [25]. Therefore, this study was aimed at investigating in vivo cognitive enhancing, ex-vivo MDA profile lowering and qualitative phytochemical composition of the aqueous and methanolic stem bark extracts of P. thonningii in the quest for better, safe, cost-effective, and potent novel drugs for the treatment of AD-associated cognitive deficits.
2. Materials and Methods
2.1. Plant Material and Processing
Fresh stem barks of P. thonningii were collected from Cianyi village, Muchomoke sublocation, Gitiburi location, Siakago division, Mbeere North Subcounty in Embu County, Kenya, where the plant grew naturally. This plant was chosen for this study based on its ethnomedical information and use among the locals. The plant was identified primarily by its local name (“Mukuura”) and diseases it treats by the help of a reputable local herbalist. Voucher specimen was prepared, identified, and authenticated (GM001/2017) by a taxonomist at the Department of Plant Sciences, Kenyatta University, and the specimen was deposited for future reference. The collected barks of the plant were then cut into small pieces and spread evenly to dry under shade at room temperature for a period of 14 days. Regular grabbling was done to ensure uniform drying. The dried material was then ground into a coarse powder with the help of an electric plant mill and stored in a well-labeled khaki envelope awaiting extraction.
2.2. Preparation of Methanolic and Aqueous Extracts
Approximately 200 grams of the powdered material- of P. thonningii barks were macerated in 750 ml of methanol (AR grade) in 1-liter conical flask, with regular shaking for 48 hours. The methanolic mixture was carefully decanted and filtered through Whatman No. 1 filter paper. The filtrates were concentrated in vacuo with the help of a rotary evaporator set at 50°C, transferred into preweighed, clean, dry, and labeled universal glass bottles. They were then kept in a hot-air oven set at 35°C for 5 days to allow for complete drying. The aqueous extract was obtained by boiling 50 g of powdered P. thonningii bark in distilled water for five minutes. The extracts were then cooled to room temperature, filtered, and transferred into clean freeze-drying flasks. The flasks were then fitted into a freeze dryer for lyophilization for a period of 48 hours. The dry and lyophilized extracts were transferred into clean, dry, preweighed, and labeled universal glass bottles. The actual weights of the extracts were calculated by subtracting the weight of the empty bottle from that of the bottle containing the extract. The percentage yields of respective extracts were calculated using the formula described by Harborne (1976) and modified by Afolayan et al. [25] and Truong et al. [27]. The respective extracts were then sealed and stored in a refrigerator at 4°C awaiting biological and chemical assays.
2.3. Determination of In Vivo Cognitive-Enhancing Effects
2.3.1. Experimental Animals
In this study, Swiss-Albino mice (white) aged 4-5 weeks with an average weight of were obtained from the animal breeding house of Kenya Medical Research Institute (KEMRI) Nairobi, Kenya. The mice were kept in standard conditions and housed in polypropylene rectangular cages measuring with soft wood shavings as bedding material. They were randomly selected and housed in groups of 3 males and 2 females in separate home cages, provided with standard laboratory animal food (rodent pellets) and tap water ad libitum. They were maintained at a natural 12-hour-day/12-hour-night cycle in a room maintained at , 360 lux lighting, and 65% humidity. They were acclimatized for 72 hours before experimentation. Humane handling and standard protocols/guidelines for laboratory animal care and use were followed in this study according to the National Research Council [25], after Kenyatta University ethical approval and National Commission for Science, Technology and Innovation authorization (NACOSTI/P/19/2080).
2.3.2. Preparation of Drugs and Administration
The methanolic and aqueous stem bark extracts of P. thonningii for administration at dose levels of 200 mg/kg bw, 100 mg/kg bw, and 50 mg/kg bw were prepared freshly each day in normal saline according to the guidelines described by [26]. The positive control (Donepezil) was also prepared at a dose level of 1 mg/kg bw in normal saline using the same guidelines. All the drugs were orally administered (p.o) to respective experimental groups of mice at 0900 hrs during the experimentation period. Hyoscine hydrobromide (scopolamine) was prepared in normal saline at a dose of 1 mg/kg bw in the same manner as for extracts and Donepezil. It was administered intraperitoneally (i.p) during the experiment.
2.3.3. Morris Water Maze Setup
The Morris water maze method described by Morris [27–29] was used in this study for determination of in vivo cognitive-enhancing effects of the two medicinal plant extracts. The water maze comprised a white circular tank that formed a pool measuring 110 cm in diameter and 45 cm in height with a featureless inner surface. The circular pool was filled with water, in which 750 g of powdered fat-free milk was mixed, to a height of 30 cm to make the pool opaque. The temperature of the maze was monitored using a calibrated mercury bulb thermometer and maintained at . A white escape platform measuring 10 cm in diameter and 29 cm in height was centered in the northwest (NW) quadrant of the pool. The water level was adjusted to 1 cm below the top surface of the escape platform and later to 1 cm above the escape platform. On the walls of the maze, manila papers of blue, green, pink, and yellow colors were mounted to the west (W), north (N), south (S), and east (E) quadrants, respectively, as local visual cues before introducing the mice. The continuous location of each swimming mouse, from the start position to the top of the platform, was monitored with the help of a digital Sony video camera that was mounted 1.5 meters above the maze linked to Any-Maze tracking software version 6.05 installed in Windows 10 Pro PC [27–29].
2.3.4. Swim Training
In this study, the day prior to the experimentation day was dedicated to training each of the experimental mice to swim for 60 seconds in the presence of the visible escape platform followed by another training session in the absence of the escape platform, with an intertraining break of 20 minutes to allow the mice to rest and recover. This was followed by another training session with the invisible platform in the same manner as the preceding trainings, where each mouse could explore the maze, searching for the hidden platform so as to help it create a spatial map of the surroundings and for proper orientation. The location of the escape platform was in the northwest (NW) quadrant and remained unchanged throughout the training session. The specific starting points were predetermined (the boundaries of each quadrant) as north (N), south (S), east (E), and west (W), respectively, and were changed in every trial and session of experiment.
2.3.5. Acquisition
In the acquisition days, the water level in the maze was adjusted to 1 cm above the escape platform, which was centered in the northwest (NW) quadrant to make it invisible at water level. Mice were subjected to three sessions each day for three consecutive days with an intertrial break of 20 minutes. The starting points were predetermined in the same manner as during the training session and were alternated throughout the experiment.
During each trial, mice were held and gently placed in the water maze facing the wall away from the escape platform. Each mouse could explore the pool, searching for the hidden escape platform for a maximum period of 60 seconds. Once the mouse located the platform, it could remain on it for 10 seconds for further examination of the surroundings. If the mouse did not locate the platform within 60 seconds, it was gently guided to the platform and allowed to rest there for 15 seconds as it explored the surroundings. It was then gently removed from the pool and placed in a holding cage that contained paper towels to dry. This parameter was averaged for each session of trials and for each experimental mouse. Transfer latency (time taken to search for and locate the hidden platform with 60 s cutoff) and the navigation distance (distance covered during the MWM task) for each experimental mouse were recorded by a digital video recorder.
2.3.6. Probe Trial
To assess learning and memory retention, the experimental mice were subjected to a single probe trial on the last day of experimentation (Day 4) by introducing each of them into the maze without the escape platform. This helped assess whether the experimental mice had learnt the task and if they were able to remember the location of the hidden escape platform. They were allowed to explore and search for the escape platform as during the acquisition phase, and the respective times spent in the NW quadrant for each mouse were recorded.
2.3.7. Induction of Cognitive Impairment
Cognitive impairment was induced during the last day of experimentation (Day 4) by an intraperitoneal (i.p) injection of 200 μl of hyoscine hydrobromide (scopolamine) at a dose of 1 mg/kg bw to all the experimental mice except for the normal control mice, to which 200 μl of normal saline was administered intraperitoneally.
2.3.8. Experimental Design
A controlled randomized, laboratory-based study design was adopted, from which an experimental design was drawn. For each of the studied plant extracts, thirty (30) experimental mice were randomly assigned to six treatment groups each consisting of five mice (3 males and 2 females). The grouping protocol was as presented in Table 1.
Treatment groups
Treatment
I
Normal control
Normal saline only (10 ml/kg bw; i.p)
II
Negative control
Normal saline+scopolamine (1 mg/kg bw; i.p)
III
Positive control
Donepezil (1 mg/kg bw; p.o)+scopolamine (1 mg/kg bw; i.p)
IV
Experimental group 1
Extract (50 mg/kg bw; p.o)+scopolamine (1 mg/kg bw; i.p)
V
Experimental group 2
Extract (100 mg/kg bw; p.o)+scopolamine (1 mg/kg bw; i.p)
VI
Experimental group 3
Extract (200 mg/kg bw; p.o)+scopolamine (1 mg/kg bw)
All the administered drugs were prepared in normal saline (0.9% NaCl). Extract: aqueous/methanolic stem bark extracts of P. thonningii; p.o: oral administration; i.p: intraperitoneal administration.