Oral Administration of Qing-Shu-Yi-Qi-Tang Reduce Lung Cancer-Induced Cachexia in Mice

African Journal of Pharmacy and Pharmacology Vol. 6(2), pp. 84-91, 15 January, 2012 Available online at http://www.academicjournals.org/AJPP DOI: 10.5897/AJPP11.186 ISSN 1996-0816 ©2012 Academic Journals

Full Length Research Paper

Oral administration of Qing-Shu-Yi-Qi-Tang reduce lung cancer-induced cachexia in mice

Yen-Jung Chou 1, Cheng-Yi Kuo 4, Pei-Yi Chen 1, Lih-Lian Chen 1, Kun-Yun Yeh 2, Hsien-Shen Kuo 4 and Chin-Hsien Chang 1,2,3 *

1Center for Traditional Chinese Medicine, En Chu Kong Hospital No. 399, Fuxing Rd., Sanxia District, New Taipei City 23702, Taiwan. 2Division of Hemato-Oncology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, No. 222, Mai- Jin Road, Keelung, Taiwan. 3School of Traditional Chinese Medicine, Chang Gung University, No. 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan County, Taiwan. 4Seeing BioScience Co Ltd., 12F, No. 126, Sec. 1, San-Ming Rd., Banqiao District, New Taipei City, Taiwan.

Accepted 5 October, 2011

This study is to investigate anti-inflammatory and anti-cachectic effect of Qing-Shu-Yi-Qi-Tang (QSYQT) in RAW 264.7 cells and Lewis lung cancer cells bearing mice. We examined the effect of QSYQT on LPS-induced inflammatory activity in a murine macrophage cell line, Raw 264.7. We evaluated cachectic parameters, such as weight loss, food intake and tumor size in tumor-bearing and non-tumor-bearing mice treated with QSYQT decoction or a normal diet. Cytokine production in cell culture and in cachectic mice was quantified by ELISA. NF-kB expression was measured using real-time polymerase chain reaction (PCR). QSYQT significantly reduced the IL-1β, IL-6 and TNF-α production in LPS- stimulated RAW 264.7 cells. Treatment of QSYQT prevented weight loss in tumor-bearing mice without affecting food intake or tumor growth. Furthermore, the level of proinflammatory cytokines, IL-1β, IL-6 and TNF-α in sera were significantly reduced in tumor-bearing mice treated with QSYQT. NF-kB expression in spleen of LLC-derived mice was decreased in the presence of QSYQT. Our results revealed that QSYQT exerts an anti-cachectic effect on LLC-induced cachectic mice. The effect is conclusively associated with modulation of IL-6 production through NF-kB.

Key words: Chinese traditional medicine, cachexia, anti-inflammation, IL-6, NF-kB, palliative medicine.

INTRODUCTION

Cachexia is a syndrome characterized by progressive breast malignancies. The exact nature of mechanism loss in weight, anorexia, fatigue and aberrant immune underlying pathogenesis of cachectic multifactorial function (Esper and Harb, 2005). The disorder occurs in complication in cancer patients remains sketchy. up to 80% of patients with advanced cancer and However, it is evident that persistent inflammatory accounts for up to 20% death. Cancer cachexia is response of the host in association with cytokines and associated with the responsiveness to chemotherapy and catabolic factors produced by the tumor plays a critical correlated with survival time of cancer patients, leading to role in the pathogenesis. Current therapeutic poor quality of life (Brown, 2002). The disorder is interventions in cancer cachexia are of limited benefit commonly seen in subjects with gastrointestinal, lung and (Gagnon and Bruera, 1998). Drugs that modulate either prostate cancers, in contrast to haematological and immune responses or production of tumor-associated catabolic molecules represent promising candidates for anti-cachectic therapy. Herbal medicines serving as one arm of medication in Asian societies represent attractive *Corresponding author. E-mail: [email protected]. Tel: remedy for their immuno-modulating activity in the aspect +886-2-24313131 Ext.2127. of palliative supplement (Yap et al., 2010; Yang et al.

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2008; Engdal et al., 2008). supplemented with 10% fetal bovine serum (FBS) at 37°C in an Qing-Shu-Yi-Qi-Tang (QSYQT), a formula of Chinese atmosphere of 95% air and 5% CO 2. Cells were co-treated with medicine, has been traditionally used for treating fever LPS (1 µg/ml) and various concentrations of QSYQT for 24 h. and pulmonary disorders for centuries. The major ingredients of QSYQT have been individually investigated for their immunopharmacological action. Astragalus MTT assay membranaceus has been reported to effectively reduce Cell viability was determined by 3-(4,5-dimethythiazol-2-yl)-2,5- inflammatory responses through inhibition of NF-kB- diphenyl tetrazolium bromide (MTT) assay as previously described meditated transcription (Lee et al., 2005; Ryu et al., 2008). (Mantovani and Madeddu, 2009). Briefly, cells were seeded at a In a clinical trial, Astragali radix has been demonstrated density of 4 × 10 4 cells/well in a 24-well plate and cultured with to improve cancer-associated anoxia in patients with serum-free Dulbecco's Modified Eagle's Medium (DMEM) for 16 h. advanced cancer (Lee, 2010). Atractylodes Then, the cells were treated with serial concentrations of 6-gingerol macrocephala koidz , an ingredient of QSYQT, has been (0, 5, 10 and 15 g/ml) for 24 or 48 h. Treatment at each concentration was performed in triplicate. After treatments, the demonstrated to have anti-inflammatory effects using in medium was aspirated and cells were washed with phosphate vitro model (Dong et al., 2008; Li et al., 2007. The use of buffered saline (PBS). Cells were subsequently incubated with MTT Panax ginseng C. A. Mey inhibits the expression of solution (5 mg/ml) for 4 h. The supernatant was removed, and inflammation cytokines, including IL-6, IL-8 and TNF-α in formazan was solubilized in isopropanol and measured lipopolysaccharide (LPS)-stimulated lymphocytes (Lee et spectrophotometrically at 563 nm. The percentage of viable cells was estimated in comparison with untreated cells. al., 2008; Kim et al., 2007). Immuno-modulatory activity of Rhizoma Cimicifugae has been demonstrated in vitro and in vivo (Pan et al., 2009; Lin et al., 2006). Evaluation of cytokines production The present study was aimed to explore the effect of Chinese herbal decoction QSYQT on lung cancer Concentrations of IL-6, IL-1β and TNF-α in culture supernatants or induced cachexia. The anticachectic activity of QSYQT circulation of mice of each group were determined by the ELISA was investigated using a cachectic model established in method following the instructions of the manufacturer (R&D mouse with Lewis lung carcinoma cells (Matthys et al., Systems, Minneapolis, MN, USA). 1991). The physiological parameters, including body weight, food intake and tumor size were evaluated as RNA extraction and real-time reverse transcription-polymerase well as immunological factors, such as cytokine chain reaction (RT-PCR) production. Total RNA was extracted from harvested cells with the RNeasy Midi Kit (Qiagen) and treated with RNase-free DNase (Qiagen) MATERIALS AND METHODS according to the manufacturer’s instructions. The SuperScript II (Invitrogen) reagent set was used to convert 2 ug RNA to cDNA. All real-time PCR assays contained 10 mM Tris (pH 8.3), 50 mM KCl, 1 Decoction preparation U of Taq polymerase (Sigma-Aldrich), 200 ng/_L bovine serum albumin (MBI Fermentas), 3 mM MgCl 2, 0.3 mM dNTPs (Sigma- The decoction used in this study was prepared by Chuang Song Aldrich), 1:100,000 SYBR Green I (Molecular Probes) and 400 nM Zong Pharmaceutical Co. Ltd. (Ligang, Taiwan) as lyophilized polymerase chain reaction (PCR) primer each in 20 ul. The reverse powder of water extract from Astragalus membranaceus, Panax transcription and real-time PCR primers were designed using ginseng C. A. Mey, Atractylodes chinensis (DC.) Koidz, Cimicifuga Primer3. Real-time PCR was performed in a LightCycler (Roche foetida, L., A. macrocephala Koidz, Alisma orientale (Sam.) Juzep, Diagnostics) starting with 3 min of preincubation at 95°C, followed Citrus reticulata Blanco, Massa Medicata Fermentata. Briefly, the by 50 amplification cycles. The threshold cycle (Ct) was determined aforementioned materials were mixed and decocted three times by the use of the maximum-second-derivative function of the with boiling distilled water for 1 h. The decoction was filtered, LightCycler software. Formation of expected PCR product was collected, concentrated and lyophilized. The powder was dissolved confirmed by agarose gel electrophoresis (2%) and melting curve in distilled water and administered in a volume of 10 ml/kg. analysis.

Cell culture Animal model and experimental design

Vero and Lewis lung carcinoma (LLC) cell lines were obtained from Male C57BL/6 mice of 6 to 8 weeks old from National Laboratory Biosource Collection and Research Center (BCRC, Hsin-Chu, Animal Breeding and Research Center (Taipei, Taiwan) and were Taiwan) and maintained in Dulbecco’s Modified Eagle’s Medium housed as previously described. Animals were injected (Gibco, USA) supplemented with 10% fetal calf serum (Gibco, USA), subcutaneously into upper flank of mice with Lewis lung carcinoma penicillin (100 U/ml), streptomycin sulfate (100 µg/ml) and 2.0 (LLC) cells (1 × 10 5 tumor cells/animal) using a 27-gauge needle. mmol/L glutamine. Cells were incubated at 37°C in a humidified 5% Animals were orally administered with either distilled water or CO 2 atmosphere and subcultured by trypsinization with 0.05% decoctions once everyday after cell injection until the animals were trypsin to 0.02% ethylenediamine tetra-acetic acid when cells sacrificed. Food intake and body weight were measured every 2 became confluent. days after cell injection. Tumor volume was measured every 4 days For anti-inflammatory experiment, murine monocyte-macrophage throughout the experiment, and tumor volume was calculated as RAW 264.7 cells were obtained from BCRC and grown in DMEM (Height × Width 2)/2.

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120 LLC Vero

100

20 Cell viability (%; comparedto untreated)

0 0 0.04 0.08 0.16 0.32 0.625 1.25 2.5 QSYQT Concentration (%)

Figure 1. Effects of QSYQT on viability of Vero and Lewis lung carcinoma cells. MTT assay was performed after QSYQT treatment at various concentrations. The value of the cell viability is mean ± SD of five determinations.

Statistical analysis Anti-cachectic activity of QSYQT in LLC cancer cachexia model The data are expressed as mean ± S.D. Student's t-test or Dunnet t-test was used to compare the differences between treated groups and control groups, and differences were considered significant at According to the findings in cell-based model, we P < 0.05. performed in vivo study using LLC cancer cachexia model to evaluate anticachectic effect of QSYQT at final concentration of 2.5%. The effects of 2.5% QSYQT RESULTS treatment on body weight, tumor size and food intake in C57BL/6 mice bearing LLC are shown in Figure 3. Effect of Qing-Shu-Yi-Qi-Tang (QSYQT) on cell QSYQT significantly prevented weight loss in tumor- viability and cytokine production in vitro bearing mice without changing tumor growth or food intake (P < 0.05). No difference in body weight and food Cytotoxic effect of QSYQT was examined using Vero and intake was observed between control mice with or without LLC cell lines after treatment with serial concentrations of QSYQT treatment. QSYQT. As shown in Figure 1, there was no significant change in cell viability following the treatment at concentrations up to effective dose of 2.5%, as assessed Effect of QSYQT on inflammatory mediators in vivo by MTT assay. We further investigated the effect of QSYQT on the production of proinflammatory cytokine in To determine whether QSYQT modulates the level of LPS-stimulated RAW 264.7 macrophages. Concentra- inflammatory mediators in vivo including IL-1β, IL-6 and tions of TNF-α, ΙΛ−6ανδIL-1β) in culture medium of TNF-α, LLC-induced cachectic mice were orally activated macrophages in presence of QSYQT were administered with QSYQT at a concentration of 2.5% measured by ELISA. The results showed that concentra- (v/v). The cytokines concentration was measured using tions of LPS-induced proinflammatory mediators were ELISA. High levels of IL-1β, IL-6 and TNF-α were concentration-dependent and they decreased in the detected in the sera of tumor-bearing mice. Treatment of presence of QSYQT (Figure 2). QSYQT resulted in a significant decrease in concentration

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120 IL-6 IL-1 β TNF- α 100

40 Cytokine production (%) production Cytokine

0 0 0.04 0.08 0.16 0.32 0.625 1.25 2.5 QSYQT concentrations (%, v/v)

Figure 2. Effects of QSYQT on production of inflammatory mediators in RAW 264.7 cells. Cells (1 × 10 6 ml -1) were incubated with LPS (1 g/ml) for 24 h, in the presence or absence of QSYQT at the indicated concentrations. Cytokine production in the culture medium was determined as described in materials and methods. Each column represents the mean ± S.D. of three independent experiments. *P < 0.05 indicates a significant difference from the LPS treated control group.

serum IL-1β, IL-6 and TNF-α of LLC-derived cachectic et al., 2007). Currently, much research is focused on mice as compared to that of untreated tumor bearing exploring the mechanism of cachexia development in animals (Figure 4). cancer setting. It is quite clear that cancer cachexia is As production of IL-6 is regulated by several associated with a chronic systemic inflammatory transcription factors including NF-kB, we thereafter response and proinflammatory cytokines are linked to all determine the effect of QSYQT on NF-kB expression. As pathways that induce cachexia. Manipulation of cytokine shown in Figure 5, expression of NF-kB in mouse spleen production is currently of significant interest for managing was significantly inhibited in the presence of QSYQT at a cancer cachexia. Extracts of a variety of herbs have been concentration of 2.5% (v/v). shown to exert immunopharmacological activity. Since most of the medicinal herbs have low toxicity and minor side-effects, herbal formula is considered as a palliative DISCUSSION supplement for cancer patients with worsening physical condition.In the present study, the data revealed that Patients with advanced malignancies, such as lung QSYQT, a traditional Chinese medicine formula, can cancer, frequently develop cachexia that significantly reduce productions of pro-inflammatory cytokines in LPS- affects clinical course, quality of life and survival of the stimulated RAW 264.7 cells. The finding is consistent patients (Esper and Harb, 2005; Gagnon and Bruera, with previous researches in which the same herbal 1998; Mantovani and Madeddu, 2009). Therapeutic ingredients were examined. The results in vitro prompted strategies against cachexia have been developed and us to examine the anti-cachectic effect of QSYQT on examined in human trial and tumor-bearing animal Lewis lung carcinoma, a cachectic tumor that induced models based on the clinical symptoms (Brown, 2002; significant weight loss and remarkable change in Gagnon and Bruera, 1998). The treatments include biochemical factors (Bennani-Baiti and Walsh, 2011; appetite stimulants, non-steroid anti-inflammatory drug, Llovera et al., 1998). Using this model, we demonstrated anabolic and anti-catabolic drugs (Madeddu and that oral administration of QSYQT resulted in attenuation Mantovani, 2009). However, in clinical trials, most of the of cachexia symptoms. However, anorexia, other feature anti-cachectic therapies fail to meet expectation in terms of cachexia was not improved and tumor growth of Lewis of weight gain, nutritional status and quality of life (Topkan lung cancer cell was not inhibited in the presence of

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Tumor Tumor treated with QSYQT 26 Control treated with QSYQT Control a 24

20 Body Weight (g) Weight Body

16 0 2 4 6 8 10 12 14 16 18 20 22 24 Days post inoculation

Tumor Tumor treated with QSYQT 3.8 Control treated with QSYQT b Control 3.6

3.4

3.2

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2.8 Food intake (g/day) intake Food 2.6

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2.2 0 2 4 6 8 10 12 14 16 18 20 22 24 Days post inoculation

10000 Tumor Tumor treated with QSYQT c 8000 ) 3 6000

4000 Tumor size (mm size Tumor

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0 0 4 8 12 16 20 24 Days post inoculation

Figure 3. Effect of QSYQT on (a) body weight, (b) food intake and (c) tumor growth in mice bearing Lewis lung carcinoma cells. Values represent mean body weights, tumor volumes and food intakes for 6 mice in each group. Bars indicate SD. (a) QSYQT treatment significantly attenuated weight loss in tumor-bearing mice as compared to controls. (b, c) There were no statistical differences in tumor growth or food intake between the 2 experimental groups.

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600 Control Tumor 500 Tumor treated with QSYQT

400

300

200 Concentration (pg/mL)

100

0 IL-6 TNF-alpha IL-1 beta

Figure 4. Effects of oral administration of QSYQT on production of pro-inflammatory cytokine in LLC-derived cachexia mice. Data represent means ± SD of the control (C) group, tumor-bearing control and tumor-bearing groups after supplementation with 2.5% QSYQT.

500 NF-kB mRNA

400

300

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100 Relative expression change (% ofcontrol)

0 N.a.N. control Tumor Tumor treated with QSYQT

Figure 5. Effects of QSYQT on NF-kB mRNA level of splenocyte of cachectic mice. Data represent means ± SD of the control group, tumour-bearing control and tumor- bearing groups after supplementation with 2.5% QSYQT.

QSYQT. In cancer patients, cachexia development is tumor. The continuing presence of tumor, resulted in a attributed to the production of a combination of cytokines chronic inflammatory state, characterized by the and other cachectic factors by both the host and the tumor production of T helper 1 (Th1) cytokines, such as IL-1β,

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