The current study deals with the effect of a dietary flavanoid quercetin on fibrotic lung tissue in rats. Bleomycin was administered by single intratracheal instillation to Wistar rats to induce lung fibrosis. The pathologies associated with this included significantly reduced antioxidant capacity, ultimately leading to protracted inflammation of the lung tissue. The hallmark of this induced fibrosis condition was an excessive collagen deposition in peribronchial and perialveolar regions of the lung. Oral quercetin treatment over a period of twenty days resulted in significant reversal of the pathologies. The antioxidant defense in lung tissue was revived. Moreover, activity of the collagenase MMP-7, which was high in fibrotic tissue, was seen restored after quercetin administration. Trichome staining of lung tissue sections showed high collagen deposition in fibrotic rats, which may be a direct result of increased mobilization of collagen by MMP-7. This was appreciably reduced in quercetin treated animals. These results point towards an important protective role of quercetin against idiopathic lung fibrosis, which remains a widely prevalent yet incurable condition in the present times. 1. Introduction Bleomycin is a commonly used chemotherapeutic agent which, however, induces dose-dependent pulmonary fibrosis upon long-term administration [1]. Interstitial pulmonary fibrosis is characterized by an altered cellular composition of the alveolar region with excessive deposition of collagen. However, lung inflammation is considered to be a major underlying factor for the induction of pulmonary fibrosis [2]. Reactive oxygen species such as superoxide anion, hydrogen peroxide, and hydroxyl radical are reported as major mediators of lung inflammatory processes [3]. Nevertheless, the direct linkage between reactive oxygen species formation and pulmonary fibrosis has not been established conclusively. Bleomycin-induced pulmonary injury and lung fibrosis have been documented in studies using several animal models [4, 5]. These models have been widely used for studying the mechanisms involved in the progression of human pulmonary fibrosis and the impact of various drugs on this progression [6, 7]. The bleomycin induces the genesis of reactive oxygen species upon binding to DNA and iron, which in turn causes DNA damage [8]. The interaction of bleomycin with DNA is postulated to initiate the inflammatory and fibroproliferative changes through a concerted action of various cytokines leading to collagen accumulation in the lung [5]. Further, it is reported that
References
[1]
K. Jules-Elysee and D. A. White, “Bleomycin-induced pulmonary toxicity,” Clinics in Chest Medicine, vol. 11, no. 1, pp. 1–20, 1990.
[2]
A. El-Medany, H. H. Hagar, M. Moursi, R. At Muhammed, F. I. El-Rakhawy, and G. El-Medany, “Attenuation of bleomycin-induced lung fibrosis in rats by mesna,” European Journal of Pharmacology, vol. 509, no. 1, pp. 61–70, 2005.
[3]
V. L. Kinnula, J. D. Crapo, and K. O. Raivio, “Generation and disposal of reactive oxygen metabolites in the lung,” Laboratory Investigation, vol. 73, no. 1, pp. 3–19, 1995.
[4]
A. Tzurel, M. J. Segel, R. Or, R. H. Goldstein, and R. Breuer, “Halofuginone does not reduce fibrosis in bleomycin-induced lung injury,” Life Sciences, vol. 71, no. 14, pp. 1599–1606, 2002.
[5]
Q. Wang, S. N. Giri, D. M. Hyde, and C. Li, “Amelioration of bleomycin-induced pulmonary fibrosis in hamsters by combined treatment with taurine and niacin,” Biochemical Pharmacology, vol. 42, no. 5, pp. 1115–1122, 1991.
[6]
A. S. El-Khatib, “Possible modulatory role of nitric oxide in lung toxicity induced in rats by chronic administration of bleomycin,” Chemotherapy, vol. 48, no. 4-5, pp. 244–251, 2002.
[7]
S. Yara, K. Kawakami, N. Kudeken et al., “FTS reduces bleomycin-induced cytokine and chemokine production and inhibits pulmonary fibrosis in mice,” Clinical and Experimental Immunology, vol. 124, no. 1, pp. 77–85, 2001.
[8]
L. Atzori, F. Chua, S. E. Dunsmore et al., “Attenuation of bleomycin induced pulmonary fibrosis in mice using the heme oxygenase inhibitor Zn-deuteroporphyrin IX-2,4-bisethylene glycol,” Thorax, vol. 59, no. 3, pp. 217–223, 2004.
[9]
A. E. Filderman, L. A. Genovese, and J. S. Lazo, “Alterations in pulmonary protective enzymes following systemic bleomycin treatment in mice,” Biochemical Pharmacology, vol. 37, no. 6, pp. 1111–1116, 1988.
[10]
L. Galvan, C. H. Huang, and A. W. Prestayko, “Inhibition of bleomycin-induced DNA breakage by superoxide dismutase,” Cancer Research, vol. 41, no. 12, pp. 5103–5106, 1981.
[11]
N. Sriram, S. Kalayarasan, and G. Sudhandiran, “Epigallocatechin-3-gallate augments antioxidant activities and inhibits inflammation during bleomycin-induced experimental pulmonary fibrosis through Nrf2-Keap1 signaling,” Pulmonary Pharmacology & Therapeutics, vol. 22, no. 3, pp. 221–236, 2009.
[12]
S. Soumyakrishnan and G. Sudhandiran, “Daidzein attenuates inflammation and exhibits antifibrotic effect against bleomycin-induced pulmonary fibrosis in Wistar rats,” Biomedicine & Preventive Nutrition, vol. 1, no. 4, pp. 236–244, 2011.
[13]
A. W. Boots, G. R. M. M. Haenen, and A. Bast, “Health effects of quercetin: from antioxidant to nutraceutical,” European Journal of Pharmacology, vol. 585, no. 2-3, pp. 325–337, 2008.
[14]
P. C. H. Hollman and M. B. Katan, “Dietary flavonoids: intake, health effects and bioavailability,” Food and Chemical Toxicology, vol. 37, no. 9-10, pp. 937–942, 1999.
[15]
S. Jagtap, K. Meganathan, V. Wagh, J. Winkler, J. Hescheler, and A. Sachinidis, “Chemoprotective mechanism of the natural compounds, epigallocatechin-3-O-gallate, quercetin and curcumin against cancer and cardiovascular diseases,” Current Medicinal Chemistry, vol. 16, no. 12, pp. 1451–1462, 2009.
[16]
C. F. Skibola and M. T. Smith, “Potential health impacts of excessive flavonoid intake,” Free Radical Biology and Medicine, vol. 29, no. 3-4, pp. 375–383, 2000.
[17]
C. Chen, J. Zhou, and C. Ji, “Quercetin: a potential drug to reverse multidrug resistance,” Life Sciences, vol. 87, no. 11-12, pp. 333–338, 2010.
[18]
M. Materska and I. Perucka, “Antioxidant activity of the main phenolic compounds isolated from hot pepper fruit (Capsicum annuum L.),” Journal of Agricultural and Food Chemistry, vol. 53, no. 5, pp. 1750–1756, 2005.
[19]
S. J. S. Flora, “Structural, chemical and biological aspects of antioxidants for strategies against metal and metalloid exposure,” Oxidative Medicine and Cellular Longevity, vol. 2, no. 4, pp. 191–206, 2009.
[20]
N. Walter, H. R. Collard, and T. E. King Jr., “Current perspectives on the treatment of idiopathic pulmonary fibrosis,” Proceedings of the American Thoracic Society, vol. 3, no. 4, pp. 330–338, 2006.
[21]
S. C. Gad and C. S. Weil, “Statistics for toxicology,” in Principles and Methods of Toxicology, A. W. Hayes, Ed., pp. 221–274, Raven Press, New York, NY, USA, 3rd edition, 1994.
[22]
K. C. Teixeira, F. S. Soares, L. G. C. Rocha et al., “Attenuation of bleomycin-induced lung injury and oxidative stress by N-acetylcysteine plus deferoxamine,” Pulmonary Pharmacology & Therapeutics, vol. 21, no. 2, pp. 309–316, 2008.
[23]
H.-D. Wang, M. Yamaya, S. Okinaga et al., “Bilirubin ameliorates bleomycin-induced pulmonary fibrosis in rats,” American Journal of Respiratory and Critical Care Medicine, vol. 165, no. 3, pp. 406–411, 2002.
[24]
Y. Tang, C. Gao, M. Xing et al., “Quercetin prevents ethanol-induced dyslipidemia and mitochondrial oxidative damage,” Food and Chemical Toxicology, vol. 50, no. 5, pp. 1194–1200, 2012.
[25]
C. A. Edwards and W. D. O'Brien Jr., “Modified assay for determination of hydroxyproline in a tissue hydrolyzate,” Clinica Chimica Acta, vol. 104, no. 2, pp. 161–167, 1980.
[26]
H. Ohkawa, N. Ohishi, and K. Yagi, “Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction,” Analytical Biochemistry, vol. 95, no. 2, pp. 351–358, 1979.
[27]
P. Kakkar, B. Das, and P. N. Viswanathan, “A modified spectrophotometric assay of superoxide dismutase,” Indian Journal of Biochemistry and Biophysics, vol. 21, no. 2, pp. 130–132, 1984.
[28]
H. Luck, “A spectrophotometric method for the estimation of catalase,” in Methods of Enzymatic Analysis, H. U. Bergmeyer, Ed., pp. 886–887, Academic Press, New York, NY, USA, 1963.
[29]
S. V. Szapiel, N. A. Elson, and J. D. Fulmer, “Bleomycin-induced interstitial pulmonary disease in the nude, athymic mouse,” American Review of Respiratory Disease, vol. 120, no. 4, pp. 893–899, 1979.
[30]
S. Sleijfer, “Bleomycin-induced pneumonitis,” Chest, vol. 120, no. 2, pp. 617–624, 2001.
[31]
R. K. Coker and G. J. Laurent, “Pulmonary fibrosis: cytokines in the balance,” European Respiratory Journal, vol. 11, no. 6, pp. 1218–1221, 1998.
[32]
M. P. Keane, J. A. Belperio, M. D. Burdick, and R. M. Strieter, “IL-12 attenuates bleomycin-induced pulmonary fibrosis,” American Journal of Physiology: Lung Cellular and Molecular Physiology, vol. 281, no. 1, pp. L92–L97, 2001.
[33]
J. A. D. Cooper Jr., “Pulmonary fibrosis,” American Journal of Respiratory Cell and Molecular Biology, vol. 22, no. 5, pp. 520–523, 2000.
[34]
X.-M. Zhou, G.-C. Zhang, J.-X. Li, and J. Hou, “Inhibitory effects of Hu-Qi-Yin on the bleomycin-induced pulmonary fibrosis in rats,” Journal of Ethnopharmacology, vol. 111, no. 2, pp. 255–264, 2007.
[35]
A. Gazdhar, P. Fachinger, C. van Leer et al., “Gene transfer of hepatocyte growth factor by electroporation reduces bleomycin-induced lung fibrosis,” American Journal of Physiology: Lung Cellular and Molecular Physiology, vol. 292, no. 2, pp. L529–L536, 2007.
[36]
L. Zhao, X. Wang, Q. Chang et al., “Neferine, a bisbenzylisoquinline alkaloid attenuates bleomycin-induced pulmonary fibrosis,” European Journal of Pharmacology, vol. 627, no. 1–3, pp. 304–312, 2010.
[37]
M. H. Daba, A.-A. H. Abdel-Aziz, A. M. Moustafa, A. A. Al-Majed, O. A. Al-Shabanah, and H. A. El-Kashef, “Effects of L-carnitine and ginkgo biloba extract (EGb 761) in experimental bleomycin-induced lung fibrosis,” Pharmacological Research, vol. 45, no. 6, pp. 461–467, 2002.
[38]
A. Pardo, V. Ruiz, J. L. Arreola et al., “Bleomycin-induced pulmonary fibrosis is attenuated in γ-glutamyl transpeptidase-deficient mice,” American Journal of Respiratory and Critical Care Medicine, vol. 167, no. 6, pp. 925–932, 2003.
[39]
A. Serrano-Mollar, D. Closa, N. Prats et al., “In vivo antioxidant treatment protects against bleomycin-induced lung damage in rats,” British Journal of Pharmacology, vol. 138, no. 6, pp. 1037–1048, 2003.
[40]
X. Liang, Q. Tian, Z. Wei et al., “Effect of Feining on bleomycin-induced pulmonary injuries in rats,” Journal of Ethnopharmacology, vol. 134, no. 3, pp. 971–976, 2011.
[41]
N. R. Grande, M. N. D. Peao, C. M. De Sa, and A. P. Aguas, “Lung fibrosis induced by bleomycin: structural changes and overview of recent advances,” Scanning Microscope, vol. 12, pp. 487–494, 1998.
[42]
S. Sogut, H. Ozyurt, F. Armutcu et al., “Erdosteine prevents bleomycin-induced pulmonary fibrosis in rats,” European Journal of Pharmacology, vol. 494, no. 2-3, pp. 213–220, 2004.
[43]
V. C. J. de Boer, A. A. Dihal, H. van der Woude et al., “Tissue distribution of quercetin in rats and pigs,” Journal of Nutrition, vol. 135, no. 7, pp. 1718–1725, 2005.
[44]
X. Wei, J. Han, Z.-Z. Chen et al., “A phosphoinositide 3-kinase-γ inhibitor, AS605240 prevents bleomycin-induced pulmonary fibrosis in rats,” Biochemical and Biophysical Research Communications, vol. 397, no. 2, pp. 311–317, 2010.
[45]
L.-K. Gong, X.-H. Li, H. Wang et al., “Effect of Feitai on bleomycin-induced pulmonary fibrosis in rats,” Journal of Ethnopharmacology, vol. 96, no. 3, pp. 537–544, 2005.
[46]
M. S. Razzaque and T. Taguchi, “Pulmonary fibrosis: cellular and molecular events,” Pathology International, vol. 53, no. 3, pp. 133–145, 2003.
[47]
R. Verma, M. Brahmankar, L. Kushwah, and B. Suresh, “Evaluating the inhibitory potential of sulindac against the bleomycin-induced pulmonary fibrosis in wistar rats,” Environmental Toxicology and Pharmacology, vol. 36, no. 3, pp. 769–778, 2013.
[48]
S. Kalayarasan, N. Sriram, and G. Sudhandiran, “Diallyl sulfide attenuates bleomycin-induced pulmonary fibrosis: critical role of iNOS, NF-κB, TNF-α and IL-1β,” Life Sciences, vol. 82, no. 23-24, pp. 1142–1153, 2008.
[49]
L. A. Ortiz, H. C. Champion, J. A. Lasky et al., “Enalapril protects mice from pulmonary hypertension by inhibiting TNF-mediated activation of NF-κB and AP-1,” American Journal of Physiology: Lung Cellular and Molecular Physiology, vol. 282, no. 6, pp. L1209–L1221, 2002.
[50]
J. S. Yoon, M. K. Chae, S. Y. Jang, S. Y. Lee, and E. J. Lee, “Antifibrotic effects of quercetin in primary orbital fibroblasts and orbital fat tissue cultures of graves orbitopathy,” Investigative Ophthalmology & Visual Science, vol. 53, no. 9, pp. 5921–5929, 2012.
[51]
I. O. Rosas, T. J. Richards, K. Konishi et al., “MMP1 and MMP7 as potential peripheral blood biomarkers in idiopathic pulmonary fibrosis,” PLoS Medicine, vol. 5, no. 4, article e93, pp. 0623–0633, 2008.
[52]
A. Pardo and M. Selman, “Role of matrix metaloproteases in idiopathic pulmonary fibrosis,” Fibrogenesis & Tissue Repair, vol. 5, article S9, supplement 1, 2012.
[53]
F. Zuo, N. Kaminski, E. Eugui et al., “Gene expression analysis reveals matrilysin as a key regulator of pulmonary fibrosis in mice and humans,” Proceedings of the National Academy of Sciences of the United States of America, vol. 99, no. 9, pp. 6292–6297, 2002.
[54]
H. M. M. Arafa, M. H. Abdel-Wahab, M. F. El-Shafeey, O. A. Badary, and F. M. A. Hamada, “Anti-fibrotic effect of meloxicam in a murine lung fibrosis model,” European Journal of Pharmacology, vol. 564, no. 1–3, pp. 181–189, 2007.
[55]
S. V. Jovanovic, S. Steenken, M. G. Simic, and Y. Hara, “Antioxidant properties of flavonoids: reduction potentials and electron transfer reactions of flavonoid radicals,” in Flavonoids in Health and Disease, C. R. Evans and L. Packer, Eds., pp. 137–161, Marcel Dekker, New York, NY, USA, 1998.
[56]
N. Kawada, S. Seki, M. Inoue, and T. Kuroki, “Effect of antioxidants, resveratrol, quercetin, and N-acetylcysteine, on the functions of cultured rat hepatic stellate cells and kupffer cells,” Hepatology, vol. 27, no. 5, pp. 1265–1274, 1998.
[57]
I. Huk, V. Brovkovych, J. Nanobash Vili et al., “Bioflavonoid quercetin scavenges superoxide and increases nitric oxide concentration in ischaemia-reperfusion injury: an experimental study,” The British Journal of Surgery, vol. 85, no. 8, pp. 1080–1085, 1998.
[58]
P. Kumar, S. Sharma, M. Khanna, and H. G. Raj, “Effect of quercetin on lipid peroxidation and changes in lung morphology in experimental influenza virus infection,” International Journal of Experimental Pathology, vol. 84, no. 3, pp. 127–133, 2003.
[59]
B.-Y. Ho, Y.-M. Wu, K.-J. Chang, and T.-M. Pan, “Dimerumic acid inhibits sw620 cell invasion by attenuating H2O2-mediated MMP-7 expression via JNK/C-Jun and ERK/C-Fos activation in an AP-1-dependent manner,” International Journal of Biological Sciences, vol. 7, no. 6, pp. 869–880, 2011.
[60]
S. K. Madala, S. Schmidt, C. Davidson, M. Ikegami, S. Wert, and W. D. Hardie, “MEK-ERK pathway modulation ameliorates pulmonary fibrosis associated with epidermal growth factor receptor activation,” American Journal of Respiratory Cell and Molecular Biology, vol. 46, no. 3, pp. 380–388, 2012.