Published online Sep 21, 2020. doi: 10.3748/wjg.v26.i35.5272
Peer-review started: April 1, 2020
First decision: April 25, 2020
Revised: April 29, 2020
Accepted: August 25, 2020
Article in press: August 25, 2020
Published online: September 21, 2020
Ulcerative colitis (UC) has high incidence worldwide and is characterized by unintentional weight loss, abdominal pain, mucous and bloody diarrhea, and anemia. Generally, the recommended therapies for UC include anti-inflammatory drugs, antibiotics, immunosuppressants, and anti-tumor necrosis factor-alpha antibodies. Sulfasalazine, a drug composed of 5-aminosalicylic acid and sulfapyridine, has been prescribed as a standard-of-care in UC treatment. Otherwise, it can produce a variety of side effects upon long-term and high-dose intakes. Hence, an alternative approach for a safer, cheaper, and more efficacious management or treatment of UC is needed.
UC is chronic and complex autoimmune inflammatory disorder. The incidence of UC has grown worldwide over the recent decades and the quality of life for patients suffering from UC has been falling quickly, in tandem. The findings from our research will give essential help towards dealing with the problems of these patients, with sulfasalazine with Citrus unshiu peel and Bupleuri radix mixture (referred to as SCPB), one of more safe and effective herbal medicine mixtures, contributing to improving their quality of life.
The present study was conducted to evaluate the pharmacological effect of sulfasalazine alone and as the SCPB combination using an experimentally-induced UC mouse model.
Ulcerative colitis was induced by 5% dextran sodium sulfate in drinking water for 7 d. The pharmacological effect of sulfasalazine alone and SCPB was evaluated using serum analysis, histological exam, and western blotting. The colon tissue was selected as the region of interest for data analysis. One-way ANOVA followed by Least-significant differences (LSD) test were used for statistical inference.
The SCPB treatment significantly inhibited the induction of COX-2 and iNOS expressions and the production of the proinflammatory cytokines TNF-α and IL-1β. Moreover, the SCPB treatment remarkably down-regulated the MCP-1 chemokine and attenuated the adhesion molecule ICAM-1. The SCPB treatment exerted anti-apoptotic effect though a considerable down-regulation of Bax and caspase-3 upon SCPB treatment.
The SCPB supplementation showed enhanced therapeutic effect compared to that of the standard sulfasalazine treatment. Accordingly, SCPB may represent a promising alternative therapeutic against ulcerative colitis without inducing adverse effects.
A single dose of sulfasalazine cannot provide satisfactory therapeutic results because of a spectrum of side effects after long-term and high-dose intake. However, when we used in combination with Citrus unshiu peel and Bupleuri radix mixture in an experimentally-induced ulcerative colitis mouse model, its inflammation was alleviated significantly. SCPB therapy may be more efficious for symptom improvement of patients with ulcerative colitis in future.