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Curcuma longa in Helicobacter pylori

Curcuma longa in Helicobacter pylori
Curcuma longa in Helicobacter pylori

Preliminary report

Investigation of the anti-in ?ammatory effect of Curcuma longa in Helicobacter pylori -infected patients

Chuchart Koosirirat a ,Sukanya Linpisarn b ,Don Changsom b ,Kriangkrai Chawansuntati b ,Jiraprapa Wipasa b ,?

a Uttaradit Hospital,Ministry of Public Health,Uttaradit 50300,Thailand

b

Research Institute for Health Sciences,PO Box 80CMU,Chiang Mai University,Chiang Mai 50202,Thailand

a b s t r a c t

a r t i c l e i n f o Article history:

Received 19March 2010

Received in revised form 26April 2010Accepted 26April 2010Keywords:Interleukin-8

Helicobacter pylori infection Curcumin

Triple therapy regimen In ?ammatory cytokine

Helicobacter pylori infection of the lining of the stomach induces an array of in ?ammatory cytokine production leading to gastritis and peptic ulcer disease.The aim of this study was to investigate the effect of curcumin on the production of interleukin (IL)-8,IL-1β,tumor necrosis factor (TNF)-αand cyclooxygenase (COX)-2in gastric mucosa from H.pylori -infected gastritis patients.Patients were randomly assigned to receive either OAM (Omeprazole,Amoxicillin and Metronidazole)treatment or a course of curcumin.Gastric biopsies were collected before and after treatment and were examined for the level of in ?ammatory cytokines mRNA by semi-quantitative reverse transcription polymerase chain reaction.The eradication rate of H.pylori in patients that received OAM treatment was signi ?cantly higher than the patients that received curcumin (78.9%versus 5.9%).The levels of IL-8mRNA expression in the OAM group signi ?cantly decreased after treatment,but no changes of other cytokines were found.This emphasizes an important role of IL-8in H.pylori infection.The decreases of cytokine production were not found in the curcumin group.We concluded that curcumin alone may have limited anti-bactericidal effect on H.pylori ,and on the production of in ?ammatory cytokines.Nevertheless,other studies have reported that patients treated with curcumin had relieved symptoms.Further investigation should be carried out as the use of curcumin in combination with therapeutic regimens may be bene ?cial as an alternative treatment.

?2010Elsevier B.V.All rights reserved.

1.Introduction

Helicobacter pylori is a helix-shaped gram-negative bacterium that infects the lining of the stomach.The host responds to the infection by producing antibody and a variety of cytokines,including interleukin (IL)-1,tumor necrosis factor (TNF)-α,inducible nitric oxide (iNOS),and cyclooxygenase (COX)-2which are correlated with the severity of symptoms [1–4].In addition,H.pylori infection induces the secretion of IL-8through the transcription factor nuclear factor kappa-B (NF-kB)activation [5,6].Enhanced gastric mucosal IL-8production leads to the recruitment of neutrophils to the site of infection [7].Enzymes released from neutrophils lead to in ?ammation of gastric tissue.Chronic in ?ammation may eventually cause gastric cancer [8].H.pylori is,therefore,classi ?ed as carcinogen.

According to the Maastricht III consensus and the American College of Gastroenterology Guideline (2007)on the management of H.pylori infection,the treatment includes two or more antibiotics and a proton pump inhibitor and/or bismuth for one or two weeks.However,there

is limitation of using this regimen in certain individuals.Failure of the treatment also occurs in some patients and the eradication rate with the triple therapy regimen is decreasing [9].Previous study has reported that treatment with either triple therapy regimen or histamine-2-antagonist alone can similarly improve symptoms of dyspeptic patients with H.pylori infection to some extent [10].It has also been demonstrated that H.pylori -infected patients treated with Curcuma longa (Turmeric)in combination with other drugs had relieved symptoms despite the eradication of H.pylori succeeded or failed [11–13].

C.longa has long been used widely as herbal medicine for peptic disease.Previous study has shown that curcumin inhibits NF-kB which regulates IL-8production [14].Curcumin extracts suppress the expression of COX-2and iNOS mRNA [15,16]and signi ?cant reduction of serum TNF-αlevel was observed in rats with experimental nephrotoxicity treated with curcumin [17].Curcumin and its extract have also been demonstrated to be able to inhibit H.pylori growth in vitro [18].However,the mechanism by which curcumin can reduce symptoms in H.pylori -infected patients is not clear,in particular,whether it has effects on in ?ammatory cytokine production.We,therefore,have conducted a pilot study to investigate the effect of curcumin on the production of in ?ammatory cytokines in chronic H.pylori -infected gastritis patients.

International Immunopharmacology 10(2010)815–818

?Corresponding author.Tel.:+6653945055;fax:+6653221849.E-mail address:jwipasa@chiangmai.ac.th (J.

Wipasa).1567-5769/$–see front matter ?2010Elsevier B.V.All rights reserved.doi:

10.1016/j.intimp.2010.04.021

Contents lists available at ScienceDirect

International Immunopharmacology

j o u r na l h o m e p a g e :w w w.e l s ev i e r.c o m /l o c a t e /i n t i m p

2.Materials and methods

2.1.Subjects

Study subjects were patients with chronic gastritis who were referred for gastrointestinal endoscopy at the Department of Internal Medicine,Uttaradit Hospital,Thailand.Patients were diagnosed positive to H.pylori if two of the three tests were positive;rapid urease test(CLO test,Ballard Medical Products,Draper,Utah,USA), pathology or culture.The patients were randomly assigned to receive either a one-week course of Omeprazole-based triple regimen(20mg of Omeprazole,1g of Amoxicillin,and800mg of Metronidazole,each given orally twice a day;OAM—manufactured by The Government Pharmaceutical Organization,Bangkok,Thailand)or a four-week course of turmeric tablet(Khaolaor Laboratory;Bangkok,Thailand, 700mg orally three times a day).The dose of turmeric tablets used in this study has proven safe and well tolerated in H.pylori-infected patients[12,13].Each turmeric tablet contained the average of40mg curcumin(as determined by UV-spectrophotometry at the Regional Medical Science Center10,the Ministry of Public Health).The erad-ication was considered successful if all three tests were negative at six weeks after the treatment end.

Four pieces of gastric antrum biopsies were taken at recruitment and at six weeks after the treatment completed and kept in RNA stabilization solution at4°C.All subjects in the curcumin group were given triple drug regimen at the end of study.Cytokine analysis was performed at the Research Institute for Health Sciences,Chiang Mai University.Ethical approval for the study was obtained from the Research Institute for Health Sciences,Chiang Mai University,and from the Ministry of Public Health,Thailand.

2.2.RNA preparation and reverse transcription polymerase chain reaction(RT-PCR)

Gastric biopsy specimens were homogenized by using QIAshredder (QIAGEN)and total RNA was isolated using RNeasy mini spin column (QIAGEN)and subjected to semi-quantitative RT-PCR.Ten nanograms of total RNA was reversed transcribed and RT-PCR was performed using One-Step RT-PCR kit(QIAGEN)to detect IL-8,IL-1β,TNFαand Cox-2mRNA.Total RNA was reverse transcribed at50°C for30min,and 30cycles of45s denaturation at94°C,45s of annealing at64°C and 1min extension at72°C were employed.Primer sequences are shown in Table1.PCR reaction products were electrophoresed on2%agarose gel,stained with ethidium bromide and quanti?ed by UV translumi-nator image documentation system using GeneSnap program.The levels of PCR products speci?c to cytokines were normalized relative to glyceraldehydes3-phosphate dehydrogenase(GAPDH)amplicon.2.3.Statistical analysis

Statistical analysis was performed using Fisher's exact test and t-test(paired and unpaired).

3.Results

3.1.Characteristics of the study subjects

A total of36chronic gastritis patients who con?rmed positive to H.pylori were studied.Seventeen individuals were assigned to receive curcumin and nineteen subjects assigned to receive OAM regimen (Table2).The two groups did not differ in age and sex.Six weeks after the treatment was completed,15of19patients(78.9%)receiving triple drug regimen were found to have successful eradication,whereas only one subject(5.9%)in the curcumin group had successfully eradicated the bacteria.The percentage of eradication rate in the OAM treatment group was signi?cantly higher than in the curcumin group(p b0.0001; Fisher's exact test).

3.2.Cytokine mRNA levels at recruitment

To determine IL-8,IL-1β,TNFαand Cox-2mRNA levels at recruitment,gastric biopsies were subjected to semi-quantitative RT-PCR as described in Materials and methods.Cytokine mRNA expression was normalized to GAPDH mRNA and presented as cytokine mRNA/ GAPDH mRNA ratio.There were no differences in the levels of cytokines at recruitment between the two study groups(Fig.1).

3.3.Effect of treatment on cytokine mRNA levels

Among the seventeen individuals who received curcumin,70.6%, 52.9%,47.1%and52.9%showed increased levels of IL-8,IL-1β,TNFαand Cox-2mRNA,respectively(Fig.2A–D),whereas29.4%,47.1%, 52.9%and47.1%had decreased levels of cytokine mRNA.There was no statistically signi?cant difference in the levels of cytokines before and after treatment.

Among the nineteen subjects in the OAM regimen group,26.3%, 31.6%,36.8%and26.3%had higher level of IL-8,IL-1β,TNFαand Cox-2 mRNA after treatment,whereas73.7%,68.4%,63.2%and73.7%showed a reduction of cytokine production.There were tendencies towards reduction of cytokine production in the OAM treatment group but statistical signi?cance was found with IL-8only(Fig.2E–H).

The proportion of individuals in the OAM regimen group who had a reduction of IL-8production after treatment were signi?cantly higher than in curcumin group(73.7%versus29.4%,p=0.018; Fisher's exact test)and no statistically signi?cant differences in the production of other cytokines were found.

3.4.Cytokine mRNA levels after treatment

Overall,the mean(±SD)of fold decrease in IL-8,IL-1β,TNF-αand COX-2mRNA expression after treatment in individuals that received

Table1

Nucleotides sequences used for detection of cytokine mRNA expression by RT-PCR. GAPDH

Sense(5′–3′)TGAAGGTCGGAGTCAACGGATTTGGT Antisense(5′–3′)CATGTGGGCCATGAGGTCCACCAC

IL-8

Sense(5′–3′)ATTTCTGCAGCTCTGTGTGAA

Antisense(5′–3′)TGAATTCTCAGCCCTCTTCAA

IL1-β

Sense(5′–3′)CAGAGAGTCCTGTGCTGAAT

Antisense(5′–3′)GTAGGAGAGGTCAGAGAGGC

TNFα

Sense(5′–3′)ATGAGCACTGAAAGCATGATC

Antisense(5′–3′)TCACAGGGCAATGATCCCAAAGTAGACCTGCCC COX-2

Sense(5′–3′)GGTCTGGTGCCTGGTCTGATGATG

Antisense(5′–3′)GTCCTTTCAAGGAGAATGGTGC Table2

Characteristics of chronic gastritis patients with H.pylori infection as assigned to receive curcumin or OAM regimen.

Curcumin OAM regimen

Total subjects—no.1719

Sex—no.(%)

Male7(41.2)10(52.6)

Female10(58.8)9(47.4) Age—yr.

Mean±SD48.1±10.0346.7±10.96 Range23–6518–61 Treatment success cases—no.(%)1(5.9)15(78.9)

816 C.Koosirirat et al./International Immunopharmacology10(2010)815–818

curcumin were 1.4±0.46,1.5±0.25,1.9±0.38and 1.8±0.40re-spectively.The expression of cytokine mRNA at the end of study in the OAM treatment group decreased by 9.1±1.93,1.5±0.14,37.2±

34.06and 8.6±3.04fold respectively.The average fold decreases of IL-8and COX-2expression in subjects received OAM treatment regimen were signi ?cantly higher than subjects treated with curcu-min (Fig.3).4.Discussions

Curcumin,the major component of C.longa which is stable at acidic pH has been long used in therapeutics worldwide.Curcumin can interact with a variety of target molecules that regulate the expression of several genes and activities of several enzymes [19,20].Its effects include anti-in ?ammatory,anti-carcinogenic and anti-bacterial.Never-theless,the mechanism of anti-in ?ammatory effect of curcumin in vivo is not clear,particularly whether it affects cytokine production in gastric tissue of patients with H.pylori infection.

In the present study,the eradication rate of subjects in the OAM treatment group was signi ?cantly higher than subjects in the curcumin group.Therefore,it is unlikely that curcumin alone has strong anti-bactericidal effect on H.pylori .Treatment with the triple therapy regimen resulted in a signi ?cant reduction of IL-8mRNA expression,whereas other cytokines were not affected.This data emphasizes the important role of IL-8in H.pylori infection.We did not ?nd an inhibitory effect of curcumin on the expression of cytokine mRNA in the gastric biopsies of H.pylori -infected patients.This differs from a study by Cho,et al.which demonstrated that Zedoarondiol extracted from C.heyneana reduces expression of iNOS,COX-2,TNF α,and IL-1βmRNA of lipopolysaccharide-stimulated RAW 264.7cells through the suppres-sion of NF-κB [21].It is conceivable that the amounts of active ingre-dients in curcumin extracts used in the in vitro studies were more than that contained in our curcumin tablets and the effects of curcumin on cytokine production in vitro may be different from in vivo .It is known that the bioavailability of curcumin in vivo is generally low [19].The possibility of low anti-in ?ammatory effect in our study might partly be due to poor distribution of the crude curcumin tablets.Further investi-gation to enhance its distribution and bioavailability is warranted.It should also be noted that a single dose of curcumin was investigated in this study.Whether a higher dose of curcumin would have an effect on the production of in ?ammatory cytokines in vivo remains to be determined.

It has been demonstrated that H.pylori infection activates NF-κB [22]which regulates the production of several cytokines such as IL-8and IL-1β[6,23].We found that patients treated with OAM

regimen

Fig.1.Expression of cytokine mRNA normalized to GAPDH mRNA at baseline before treatment.Patients were assigned to receive either curcumin (triangles)or OAM regimen (circles).The differences between groups were compared by unpaired t -test.Each symbol represents the data of one individual.Solid lines show the mean±95%con ?dence interval of each

group.

https://www.doczj.com/doc/154922000.html,parison of cytokine mRNA expression before and after treatment in patients that received curcumin (left column)or OAM treatment (right column).The pre-and post-treatment data were compared by paired t

-test.

Fig.3.Changes of expression of cytokine production after treatment with turmeric tablet (triangles)or OAM regimen (circles).The differences between groups were compared by unpaired t -test.Each symbol represents the data of one individual.Solid lines show the mean±95%con ?dence interval of each group.

817

C.Koosirirat et al./International Immunopharmacology 10(2010)815–818

had a signi?cant reduction of IL-8mRNA expression only,whereas expression of other cytokines did not alter.Our results suggest that the triple therapy regimen did not inhibit NF-κB directly.The reduction of IL-8is likely due to the removal of cytokine cascade after H.pylori eradication.This is concurrent with a study by Uemura et al.which reported a decline of neutrophils in gastric mucosa after treatment with Omeprazole and antibiotics[24].

The relief of symptoms after curcumin use has been reported previously[11–13].It is,therefore,conceivable that curcumin relieves symptoms through other mechanisms such as inhibition of gastric acid secretion by blocking H2histamine receptor[25].

Curcumin is a natural plant product that has been used for numerous purposes.Although treatment of H.pylori-infected patients with cur-cumin did not alter levels of in?ammatory cytokine mRNA expression and had limited anti-bactericidal effect,it improved common symptoms in the patients.Further investigation for a better understanding of its mechanisms should be carried out.The use of curcumin in combination with therapeutic regimen may bene?t patients in terms of better compliance or may be used as an alternative treatment in drug resistant H.pylori-infected cases.

Acknowledgments

We are grateful to all subjects of this study for their participation. We would like to thank the staff of the microbiology laboratory and the Department of Internal Medicine,Uttaradit Hospital,Thailand for technical assistance.

This study was supported by the Thailand Research Fund(TRF), grant number MRG5080110.TRF had no involvement in study design, analysis of data or writing the manuscript.

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JOIN IN 学生用书1 Word List Starter Unit 1.Good afternoon 下午好 2.Good evening 晚上好 3.Good morning 早上好 4.Good night 晚安 5.Stand 站立 Unit 1 6.count [kaunt] (依次)点数 7.javascript:;eight [eit] 八 8.eleven [i'levn] 十一 9.four [f?:] 四 10.five [faiv] 五 11.flag [fl?g] 旗 12.guess [ges] 猜 13.jump [d??mp] 跳 14.nine [nain] 九 15.number ['n?mb?] 数字 16.one [w?n] 一 17.seven ['sevn] 七 18.six [siks] 六 19.ten [ten] 十 20.three [θri:] 三 21.twelve [twelv] 十二 22.two [tu:] 二 23.your [ju?] 你的 24.zero ['zi?r?u] 零、你们的 Unit 2 25.black [bl?k] 黑色26.blue [blu:] 蓝色 27.car [kɑ:] 小汽车 28.colour ['k?l?] 颜色 29.door [d?:] 门 30.favourite [feiv?rit]javascript:; 特别喜爱的 31.green [gri:n] 绿色 32.jeep [d?i:p] 吉普车 33.orange ['?:rind?] 橙黄色 34.pin k [pi?k] 粉红色 35.please [pli:z] 请 36.purple ['p?:pl] 紫色 37.red [red] 红色 38.white [wait] 白色 39.yellow ['jel?u] 黄色 Unit 3 40.blackboard ['bl?kb?:d] 黑板 41.book [buk] 书 42.chair [t???] 椅子 43.desk [desk] 桌子 44.pen [pen] 钢笔 45.pencil ['pensl] 铅笔 46.pencil case [keis] 笔盒 47.ruler ['ru:l?] 尺、直尺 48.schoolbag [sku:l] 书包 49.tree [tri:] 树 50.window ['wind?u] 窗、窗口 Unit 4 51.brown [braun] 棕色 52.cat [k?t] 猫

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Join In剑桥小学英语.doc

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