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Nephroprotective Effect of Coenzyme Q10 Alone and in Combination with N-Acetylcysteine in Diabetic Nephropathy

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Nephroprotective Effect of Coenzyme Q10 Alone and in Combination with N-Acetylcysteine in Diabetic Nephropathy Eur. Pharm. J. 2021, 68(1), 30-39. ISSN 1338-6786 (online) and ISSN 2453-6725 (print version), DOI: 10.2478/afpuc-2020-0020 EUROPEAN PHARMACEUTICAL JOURNAL Nephroprotective Effect of Coenzyme Q10 alone and in Combination with N-acetylcysteine in Diabetic Nephropathy Original Paper Mahajan Manojkumar S., Upaganlawar Aman B., Upasani Chandrashekar D. Shri Neminath Jain Brahmacharyashram Trust’s Shreeman Sureshdada Jain College of Pharmacy Nashik, Maharashtra, India Received 3 November, 2020, accepted 29 March, 2021 Abstract Aim: Oxidative stress due to chronic hyperglycaemia is a key factor in the development and progression of various microvascular complications including diabetic nephropathy (DN) and associated renal injury. Treatment with antioxidants is one of the strategies to protect the kidney from oxidative tissue damage to improve renal physiology during DN. The investigation, therefore, was designed to assess the nephroprotective effect of coenzyme Q10 (CoQ10) and N-acetylcysteine (NAC), either alone or in combination in streptozotocin (STZ)-nicotinamide (NAD) induced diabetic nephropathy (DN) in rats. Methods: T2DM induced by STZ (55 mg/kg, i.p.)-NAD (110 mg/kg, i.p.) in Sprague-Dawley rats (220–250 g) was confirmed by the elevated blood glucose level and glycated haemoglobin. DN was assessed by renal function tests. The diabetic rats were treated with CoQ10 (10 mg/kg, p.o.) and/or NAC (300 mg/kg, p.o.) for 8 weeks after confirmation of DN. Oxidative tissue damage due to STZ-NAD was estimated by malondialdehyde (MDA), superoxide dismutase (SOD) and catalase (CAT), reduced glutathione (GSH), myeloperoxidase (MPO) and nitric oxide (NO) in the renal homogenate. Results: Data showed significant alteration in serum and urinary creatinine, total protein, albumin, serum urea, blood urea nitrogen (BUN) and uric acid in diabetic animals as compared to the control rats. CoQ10 and/or NAC effectively alleviated the disturbances in renal function. Diabetic rats showed increased MDA, decreased SOD and CAT activities and decreased GSH along with a significant increase in MPO activity and nitrite content. Treatment with the aforementioned antioxidants and their combination ameliorated the kidney damage as indicated by the reduced OS with improved renal function. Conclusion: The investigation suggests that the chronic hyperglycaemia-induced OS leads to the development and progression of DN. The combined treatment with CoQ10 and NAC has shown a remarkable nephroprotective effect suggesting that combined antioxidant therapy with CoQ10 and NAC may be useful in the attenuation of DN. Keywords Diabetic nephropathy – oxidative stress – streptozotocin – coenzyme Q10 – N-acetylcysteine INTRODUCTION Diabetes mellitus (DM) is a group of heterogeneous disorders neuropathy and diabetic retinopathy (Pal et al., 2014; Geraldes characterized by hyperglycaemia linked to insulin deficiency et al., 2009). or decreased tissue sensitivity (Maitra, 2015; Masharani, DN is the foremost cause of chronic kidney disease (CKD) 2008). The two types of DM are type 1 DM (T1DM) and type and end-stage renal disease (ESRD). It is a progressive and 2 DM (T2DM). irreversible loss of renal function involving glomerular T2DM or non-insulin-dependent diabetes mellitus (NIDDM), hyperfiltration, incipient nephropathy, microalbuminuria, a multifactorial disorder develops as a result of insulin overt proteinuria and ESRD (Mogensen et al., 1983). DN resistance with relative insulin deficiency and is most common induces renal structural changes like an accumulation of among adults. T2DM features a strong genetic component in extracellular matrix and glomerular mesangial expansion, addition to the acquired pathogenic causes associated with interstitial fibrosis and basement membrane thickening (Vora secretion and resistance to insulin (Kohei, 2010). & Ibrahim, 2003). Premature deaths due to DM are associated with macro and Hyperglycaemia plays a crucial role in the development of DN. microvascular complications. The primary microvascular It has been shown that persistent hyperglycaemia in DM can complications of DM are diabetic nephropathy (DN), diabetic induce OS by several mechanisms that involve, glucose auto- * E-mail: [email protected] Open Access. © 2021 European Pharmaceutical Journal, published by Sciendo. This work is licensed under the Creative Commons Attribution-NonCommercial- NoDerivatives 3.0 License. OR 30 Eur. Pharm. J. 2021, 68(1), 30-39 Nephroprotective Effect of Coenzyme Q10 alone and in Combination with N-acetylcysteine ... Mahajan Manojkumar S., Upaganlawar Aman B., Upasani Chandrashekar D. oxidation, activation and acceleration of polyol pathway, reduced glutathione (GSH) and nitric oxide (NO) content protein glycation through non-enzymatic means and reduced were acquired from Elabscience Biotechnology Inc. (Houston, antioxidant defense. Hyperglycaemia is believed to act by USA). Kits for estimation of total protein and albumin were activation of Protein kinase C (PKC) pathway, generation obtained from Arkray Healthcare Pvt. Ltd. (Mumbai, India). of reactive oxygen species (ROS) and over-expression of Determination of serum and urinary creatinine, serum urea, transforming growth factor-β (TGF-β) (Schena & Gesualdo, BUN and uric acid was carried by using the biochemical kits 2005; Brownlee, 2001). purchased from Tulip Diagnostics Pvt. Ltd. (Mumbai, India). All The normal kidney owing to its high metabolic activity the other chemicals and reagents used in the study were of generates substantial OS that is stabilized by an antioxidant analytical grade. defense system. Uncontrolled blood glucose level shifts this equilibrium to a pro-oxidant state resulting in tissue injury and Animals vascular anomalies It has been shown that the mechanisms involved in the development of the DN induce considerable Forty healthy male Sprague-Dawley rats (SD, 8 weeks, OS by one or other means (Vasavada & Agarwal, 2005). 220–250 g) were obtained from the National Institute of At present, none of the therapies used for DN have proved Bioscience, Pune. Rats were acclimated for 1 week before the efficacious due to the involvement of diverse etiologic factors commencement of the study. Animals were housed under in the progression of DN. Therefore, it is difficult to select the a controlled environment of temperature (18–22ºC) and best possible treatment approach and therapeutic agent. light (12 hr light/dark cycle, lights on 07:00–19:00). All the Consequently, effective and novel therapeutic strategies are rats were provided ad libitum access to water and standard required in the treatment of DN. Studies have demonstrated food. All the experimental procedures in this study were the beneficial effects of antioxidant therapies in DN (Mahajan carried out following the guidelines issued by the Committee et al., 2019). for the Purpose of Control and Supervision of Experiments CoQ10 (ubiquinone) is an endogenous, vitamin-like lipophilic on Animals (CPCSEA) for the care and use of animals. The substance serving as a natural antioxidant. CoQ10 plays a Institutional Animal Ethics Committee (IAEC) approved the key role in the mitochondrial electron transport chain and protocol of the study bearing the reference number SSDJ/ scavenges free radicals to protect the β cells from the harmful IAEC/2016/02. effects of OS by its antioxidant properties (Hodgson et al., 2002; Rosenfeldt et al., 2007). Studies have also shown that Induction of Diabetic Nephropathy CoQ10 is effective for glycaemic control among individuals with T2DM and reduces HbA1c levels (Maheshwari et al., 2014). T2DM was induced in overnight fasted male SD rats using NAC is a glutathione precursor and a powerful antioxidant. STZ (55 mg/kg) as a single intraperitoneal (i.p.) injection. STZ NAC has been shown to impart protection to the β-cells was dissolved in freshly prepared cold citrate buffer (pH 4.5) against cellular damage. NAC attenuates hyperglycaemia and and administered immediately. STZ was injected 15 min. improves glucose intolerance. This action of NAC is linked to after the administration of nicotinamide (110 mg/kg, i.p.) glucose-induced insulin release (Haber et al., 2003; Ahmad et dissolved in normal saline (Ghasemi et al., 2014; Badole et al., 2012; Shimizu et al., 2005). al., 2013). Hyperglycaemia was determined at 72 h and then So far, no earlier studies have reported the synergistic effect at the end of the first week post-treatment with STZ-NAD of CoQ10 and NAC in the treatment of DN. Hence, we have using a glucometer (AlereG1, Korea). Blood glucose level was selected these antioxidants and an effort was taken to estimated in the samples collected from the end part of tails. study their combined effect in nephroprotection against Animals showing elevated blood glucose level greater than experimentally induced DN. Therefore, the current research 250 mg/dL were served as diabetic and were included in the was aimed to explore the nephroprotective effect of CoQ10 nephropathy studies. and NAC alone and in combination in STZ-NAD-induced DN. Experimental Design METHODS Rats were divided into the following five groups with six Drugs and Chemicals animals each. Group I: Normal rats (control, negative control without any CoQ10 was obtained as a gift sample from Zydus Cadila, treatment) Ahmedabad, India. NAC was purchased from Loba Chemie Group II: Diabetic control rats (STZ-NAD DN, positive control (Mumbai, India). STZ and NAD were purchased from Sigma- without any treatment) Aldrich (USA). Spectrophotometric kits
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