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Protective Effects of Sodium Ferulate on Flap Transplantation Via Anti Brazilian Journal of Medical and Biological Research (2021) 54(7): e10520, https://doi.org/10.1590/1414-431X2020e10520 ISSN 1414-431X Research Article 1/6 Protective effects of sodium ferulate on flap transplantation via anti-inflammatory modulation and oxidative stress inhibition Y.D. Sun1* 00 , Y.S. Gao1* 00 , L.W. Xu1* 00 , Y.F. Zhang1 00 , C. Cheng1 00 , K.C. Wei1 00 , Jian Lin4 00 , G. Chen2 00 00, C.Y. Liu1,3 00 , and Q.F. Li1 00 1Department of Plastic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 2Department of Plastic Surgery, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, China 3Department of Plastic Surgery, Changzheng Hospital of Navy Medical University, Shanghai, China 4Department of Orthopedics, Xinhua Hospital (Chongming) Affiliated to Medical College, Shanghai Jiao Tong University, Shanghai, China Abstract Ischemia-reperfusion injury (IRI) has brought attention to flap failure in reconstructive surgery. To improve the prognosis of skin transplantation, we performed experimental IRI by surgical obstruction of blood flow and used sodium ferulate (SF) to prevent IRI in rats. After SF treatment, the morphological and histological changes of the skin flaps were observed by H&E and Masson’s trichrome staining. We also detected the expression levels of COX-1, HO-1, and Ki67 by immunohistochemical and western blot analysis. Moreover, enzyme-linked immunosorbent assay was used to identify the content of tumor necrosis factor (TNF)-a, myeloperoxidase (MPO), malondialdehyde (MDA), and nitric oxide (NO) in peripheral blood and skin tissue. Compared with the model group, SF treatment significantly improved the recovered flap area (%) and promoted collagen synthesis. Cyclooxygenase-2 (COX-2) expression was significantly inhibited by heme oxygenase-1 (HO-1) induction after SF treatment. Furthermore, SF significantly inhibited the levels of TNF-a in peripheral blood, MPO and MDA in the skin tissue, and the increased synthesis of NO. Our results showed the protective effects of SF on IRI after flap transplantation and we believe that the protective effects of SF was closely related to the alleviation of the inflammatory response and the inhibition of the oxidative stress injury. Key words: Sodium ferulate; Flap transplantation; Ischemia-reperfusion injury; Inflammation; Oxidative stress Introduction Flap transplantation is the main modality in wound (6). Among them, angelica has been shown to improve repair and reconstructive surgery, and partial ischemia blood circulation and eliminate stasis (7). Studies have and necrosis of the flap is the most common complication shown that angelica has good therapeutic effects on in reconstructive surgery (1). Inadequate hemoperfusion hypoxia and ischemia injury (8). Studies have proven that and ischemia-reperfusion injury (IRI) after transplantation sodium ferulate (SF, the brand name is Angelicone) is one are considered to be the major cause of flap necrosis and of the effective components of angelica extract, which is a failure (2,3). Therefore, an effective way to improve the type of new non-peptide endothelin receptor antagonist. recovery of skin transplantation is important (4,5). With the SF has beneficial effects in microcirculation through deepening of research on mechanisms of ischemia and activating the anti-inflammatory system, enhancing anti- hypoxia injury, IRI prevention and treatment are becoming coagulation modulation, increasing the synthesis of nitric the promising tools for us to explore. oxide (NO), and preventing lipid peroxidation injury (8–11). Traditional Chinese Medicine (TCM) encompasses a SF has been widely used in the treatment of angina wide range of practices and has gained excellent feed- pectoris, cerebral infarction, and renal ischemic lesions. It back from Asian people in their physiological restoration was also proven to be effective in the treatment of diabetic Correspondence: C.Y. Liu: <[email protected] | G. Chen [email protected]> *These authors contributed equally to this work. Received October 13, 2020 | Accepted February 2, 2021 Braz J Med Biol Res | doi: 10.1590/1414-431X2020e10520 Protective effects of sodium ferulate on flap transplantation 2/6 foot and chronic skin ulcers (12,13). However, the effects model group were given the same amount of saline of SF on flap transplantation remain unknown. In this intraperitoneally according to the same procedure. study, we investigated the effects of SF on the percent- age of the recovered flap area after IRI by establishing Indicators an animal model of skin flap transplantation in rats. In each group, 6 rats were randomly selected for We explored the related mechanism of SF effects and observation at 8, 24 h, and 3 and 7 days after IRI surgery. provided an experimental basis for its subsequent clinical The percentage of the recovered flap area was calculated application. by the recovered area compared to the total skin flap area, and the total surface area of the flaps was traced. We Material and Methods analyzed the areas using the ImageJ software (NIH, USA). The flap tissue was equally divided along the Experimental animals central point of the flap (the diagonal intersection was the Male Sprague Dawley rats (6–8 weeks, 230–270 g) center), fixed with morphological method, and made into were purchased from the Experimental Animal Center of tissue homogenate to detect the levels of MPO, NO, and General Hospital of Nanjing Military Region and were MDA by enzyme-linked immunosorbent assay (ELISA) subjected to experimental IRI. The animals were fed with and the nitro blue tetrazolium (NBT) method. At the same mixed feed, given natural light exposure in a single cage time, the peripheral blood of rats was collected, and with the temperature being controlled at about 25°C. The ELISA was used to detect the level of TNF-a in serum. animals were adapted for one week before the experi- ment. At 8–10 weeks of age, the rats were randomly Histological and immunohistochemical assessments divided into 3 groups as follows: sham surgery (n=24), After the experiment, the rats were killed under isoflu- model group with experimental IRI (n=24), and SF treat- rane anesthesia and the flap tissue was washed in PBS. ment group (n=24). All animal procedures performed in Skin tissue was fixed with 4% paraformaldehyde (PFA) this study were in accordance with the ethical standards and embedded in paraffin. Serial longitudinal sections of the Ethics Committee and ARRIVE guidelines. The were cut with a thickness of 5 mm, then deparaffinized, approval number of Ethics committee is IACUC-2003125. rehydrated, and antigen retrieved. Nonspecific immuno- reactivity was blocked by incubation with normal BSA Experimental reagents serum for 1 h at room temperature, and sections were SF was purchased from Nanjing Simcere (China, incubated with anti-COX2, anti-HO-1, and anti-Ki67 National Medicine Permit No. H20065557). Myeloperox- antibodies (1:1000), incubated overnight at 4°C, followed idase (MPO), NO, and malondialdehyde (MDA) detection by treatment with the streptavidin-peroxidase kit according kit were purchased from Nanjing Jiancheng Biotech Corp to the manufacturer’s instructions (Sangon Biotech, (China). The antibody of cyclooxygenase (COX-2), heme China). The sections were also stained with hematoxylin oxygenase (HO-1), and Ki67 were purchased from the and eosin (H&E) to evaluate the morphological changes of British Abcam company. The ELISA test kit for tumor the flap. As a control, a subset of sections was incubated necrosis factor (TNF)-a in rats was purchased from with PBS instead of the primary antibody. The expression Shanghai JiaTai Biotech Corp. (China). of COX2, HO-1, and Ki67, represented by the staining intensity under Â400 magnification, was assessed by Experimental IRI in rats double-blind evaluation. Experimental IRI was induced by surgical intervention of the blood flow of the flap and the sham-operated rats Western blot analysis were used as control. Briefly, we used 3% sodium Skin samples were homogenized in RIPA lysis buffer pentobarbital for intraperitoneal anesthesia (0.15 mL/100 with 1% phosphatase and protease inhibitor cocktail g body weight). In the sham group (CTL group), the flap (Sigma-Aldrich, USA). The mixture homogenates were was sutured in situ and no other treatment was performed. centrifuged (12,000 g, 15 min, 4°C) and the supernatants In the model and SF treatment groups, we used inferior were collected. Protein concentration was measured epigastric artery skin flap as a flap ischemia-reperfu- following Bradford’s colorimetric method. Furthermore, sion injury model, with the area of the axial flap about the supernatants were mixed with a 5Â SDS/PAGE 3 Â 6cm2. Thereafter, we blocked the blood flow with a sample buffer. Equal amounts of proteins (20 mg) were microvascular clamp immediately after the establishment separated by a 10% SDS/PAGE gel and then transferred of the superficial epigastric flap for 8 h. After that, surgical to PVDF membranes (Merck Millipore, USA). After microscopy was performed to confirm the recovery of blocking in a 5% BSA buffer for 1.5 h, membranes were blood supply. In the SF group, SF was administered into incubated at 4°C overnight with specific primary anti- the abdominal cavity at 80 mg/kg per day on the day bodies for COX2, HO-1, and GAPDH at a dilution of 1:000 before surgery, and for 7 days after surgery (the concen- (Cell Signaling Technology, USA). After washing with tration of SF solution was 1%, 2.5 mL). The rats in the TBST three times, membranes were incubated with a Braz J Med Biol Res | doi: 10.1590/1414-431X2020e10520 Protective effects of sodium ferulate on flap transplantation 3/6 secondary antibody (Cell Signaling Technology). For formed on the distal end of the flaps (Figure 1A). In visualization of the bands, all membranes were incu- contrast, after SF treatment, the necrosis area of the skin bated with Immobilon Western Chemiluminescent HRP in the SF group was significantly less than that in the substrate (Millipore) for desired durations.
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