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Overload
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Keywords: Curcumin, Oxidative Stress, iron overload, liver toxicity, spleen toxicity.
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ABASTRACT
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Background: Iron overload (IO) is now being recognized as a health problem in industrialized countries
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where cultural practices encourage acquisition of excess iron from diets. Excess iron is highly toxic for
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vital organs especially liver and spleen. Curcumin, a superb nature's medicine with still unfolding health
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benefits, has been shown to possess iron chelation property that has not been studied in nutritional IO.
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Objective: A three-year field study was conducted by our team on the impact of environmental excess
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iron in drinking water and its health hazard on liver diseases. Here, we evaluate the efficacy of curcumin
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as nutritional supplement to alleviate the hepatospleno-disorders and their sequelae on IO-induced rats.
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Design/Results: Initial studies revealed that the treatment of iron-overloaded rats with curcumin
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resulted in marked decreases in iron accumulation within liver/spleen. To further assess the role of
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curcumin, we studied its effects on iron overload-induced oxidative stress, protein loss, and anti-oxidant
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depletion. Iron-overloaded rats had significantly more TBARS, NO and OH radicals in liver and spleen
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compared with control group. These effects of IO were all reduced by intervention treatment with
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curcumin. Following this further, the bulk protein content in liver and spleen as well as their endogenous
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anti-oxidants (SOD, CAT, GSH, and ASA) were highly significantly decreased in chronic iron
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intoxication. Inversely, the administration of curcumin improved the alterations in these biochemical
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parameters.
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Conclusions: These findings implicate the therapeutic potential of the multifunctional, nutritional iron
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INTRODUCTION
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Iron, one of the most abundant metals on earth, is an integral part of many proteins and enzymes that
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maintain good health (1). However, excess amounts of iron has a destructive nature if not properly
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diagnosed and treated (2). Undiagnosed iron overload can lead to hemochromatosis, in which the excess
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iron stored in body organs causing serious tissue damage that leads to life-threatening conditions.
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Nevertheless, the majority of public are unaware of the problem and unconcerned due to the mistaken
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idea that the majority of hemochromatosis cases are genetic in origin, which affects only about 1 million
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of the estimated 275 million Americans. In fact, the potential threat of iron overload is universal and
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comes with advancing age regardless of genetic factors (3). Badria et al. reported the impact of
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environmental excess iron on human health among Egyptians who are inhabitants an area with high iron
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The content of body iron is regulated primarily by absorption since humans have no
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physiological mechanism by which excess iron is excreted. The quantity of dietary iron and the
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composition of the diet significantly influence iron absorption. Prolonged intake of high doses of iron
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leads to the accumulation of excess iron (5). This phenomenon has been well demonstrated in the
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episode of siderosis among the Bantu tribe in Africa who ingested excessive amounts of iron from their
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diet and beer. Their use of iron pots for cooking and brewing beer increased the iron content (6).
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Another important factor in iron absorption relates to the form of iron present in a diet. Herne iron and
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nonheme iron are the two major sources of iron. Heme iron, that is found in meat, fish, and poultry, is
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more effectively absorbed because this iron is associated with the porphyrin ring (7). A large population
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survey from Australia showed that normal volunteers have average iron storage is about twice as much
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as the optimal iron store for normal adults. Heavy ethanol intake and high meat consumption are
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believed to be the critical factors (8). Such practices have occurred in industrialized countries where
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alcohol intake as well as red meat consumption are high, and the use of iron fortification is widespread
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(9). Hepatotoxicity and spleen dysfunction are the most common findings in patients with iron
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overloading and in severe cases, iron is found within the Kupffer cells in the liver and the macrophage
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cells of the spleen (10). The etiology of these multiple organ dysfunctions has been attributed to the
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presence of excess non-protein bound free iron released to spark uncontrolled oxidation via generation
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of reactive oxygen species (ROS) through Fenton and Haber-Weiss reactions (11). ROS react directly
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with proteins, lipids, and nucleic acids and induce oxidative stress by depleting cellular stores of
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antioxidants (12). Consequently, it is of utmost importance to maintain iron homeostasis to ensure iron
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In all iron-overload-induced diseases, iron removal by iron chelation therapy is an effective life-
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saving strategy. The currently available iron-chelating agents used clinically are deferoxamine, and
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deferasirox. However, such compounds show several side effects and limitations (13) that direct towards
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the finding of a more effective and safe drug which may rise the therapeutic benefits for patients. As
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there is still no safe oral iron chelator agent, the use of nutritional therapy in the area of drug discovery
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proved to be an efficient, safe, and economic tool in the area of health care. Curcumin, Figure 1A (14),
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has been reported to be among the most efficient and safe chemopreventive agents investigated in
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recent years and is currently in human trials to prevent cancer (15). The mechanism of action of
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curcumin is complex and likely multifactorial (16). Previously, Curcumin has shown antioxidant and
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iron-chelating properties in vitro (16, 17). However, the pre-clinical effects of curcumin on hepatic and
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splenic sequelae during nutritional iron overload toxicity have not been investigated in depth.
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Accordingly, the present study aimed to evaluate the ability of the iron chelator, curcumin, to attenuate
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excessive dietary iron intake-induced hepatic and splenic oxidative stress. Furthermore, this study
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pursues to gain insight into the mechanistic basis behind this effect.
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Materials
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Na2HPO4, KH2PO4, p-phenylenediamine.HCl, and NaNO2 were purchased from Merck Company
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(Darmstadt, Germany). Nitroblue tetrazolium (NBT), phenazine methosulfate (PMS), NADH, 5,5\-
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dithiobis(2-nitrobenzoic acid) [DTNB], thiobarbituric acid (TBA) were from Sigma (St Louis, MO,
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USA).
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Animals
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All procedures with animals were performed in accordance with the National Institutes of Health Guide
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for the Care and Use of Laboratory Animals and Mansoura University guideline. Adult male rats with
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average body weight of 120 150 g were divided into the following groups (five animals each; n=5):
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2. Rats treated with iron (100 M FeSO4 in a drinking water for 90 days) and treated with or
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The dose of curcumin (100 mg/kg, b.w.) was selected for hepatoprotective studies by referring the
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published report (18). In various animal studies, a dose range of 100 200 mg/kg body weight exhibited
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good antiinflammatory activity and seemed to have negligible adverse effect on human systems. Oral
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LD50 in mice was found to be more than 2.0 g/kg body weight (18).
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Samples Collection:
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All these rat groups were under experiment for (3 months), then were anesthetized and scarified. Liver
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and spleen were collected immediately, dissected, rinsed with isotonic saline and dried between two
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pieces of filter papers and then stored at 20 C in plastic vials containing 0.5 ml of ice cold sterile
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isotonic saline.
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Preparation of homogenates
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An accurately weighed piece of each organ (1g tissue in 10 ml homogenate buffer) was homogenized in
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ice cold homogenate buffer (0.3 M sucrose and 0.1 mM potassium dihydrogen phosphate; pH 7.0) using
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a Teflon pestle connected to a Braun Homogenizer Motor (25 strokes/min at 1000 rpm). The
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homogenate was centrifuged at 30,000x g for 30 min at 4oC to remove cell debris and nuclei. The
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Methods
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Enzymesassays
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The activity of superoxide dismutase (SOD) was assessed spectrophotometrically by the procedure of
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Nishikimi et al. (19). The results were expressed as percentage of inhibition of formazane formation per
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g wet tissue. The SOD-like activity of curcumin was assessed by the same method and its activity was
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expressed as percent of inhibition of formazan (19). Catalase (CAT) activity was measured according to
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the method described by Bergmeyer (20). The results were expressed as unit per g wet tissue. The CAT-
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like activity of curcumin was determined by using the same method and its activity was determined as
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unit/min. The activity of ceruloplasmin (Cp) was assayed as described by Henry et al. (21). The results
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Biochemical analysis
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using DTNB as a color reagent (22). The results were expressed as mg GSH per g wet tissue. The level
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of total ascorbic acid (AsA) in tissue homogenates was determined spectrophotometrically according to
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the method of Zebrowski et al., (23). The results were expressed as mg ascorbic acid per g wet tissue.
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Lipid peroxidation (LPO) in liver and spleen homogenates was estimated by measuring the formation of
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thiobarbituric acid reactive substance (TBARS) (24). Nitric oxide (NO) concentration was determined
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spectrophotometrically according to the method of Hortelano et al., (25). The results were expressed as
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nmol nitrite level per g wet tissue. The level of hydroxyl radicals (.OH) was determined by Abou-Seif
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and Elgendy (26). The results were expressed as nmol of thiobarbituric acid reactive substance
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Protein content of homogenized samples was performed according to Lowry et al., method (27). The
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Iron and copper concentrations in liver and spleen homogenates were determined using an Atomic
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acetylene flame.
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Statistical analysis
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All analyses were performed with the GraphPad Prism 3 package. Data were checked for skewness, and
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an unpaired t-test was performed if the distribution of the values was Gaussian. If the distribution was
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not normal, a Mann-Whitney test was used. P-values less than 0.05 were considered to be statistically
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significant.
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RESULTS
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Iron overload-induced oxidative stress in the liver as well as in the spleen and the protective effect
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Numerous pathological alterations in liver and spleen have been reported in cases with primary or
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secondary iron overload. Furthermore, it has been well established that iron-catalyzed free radical-
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mediated lipid peroxidation plays a significant role in these abnormal events. Therefore, the iron-
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overloaded rats were used in this study to investigate whether curcumin, a potential iron chelator, could
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ameliorate hepatic and splenic oxidative stress induced by excess dietary iron intake and the underlying
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mechanisms involved therein. To test this, we first sought to verify the potential of curcumin as an iron
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chelator in this preclinical study. This necessarily entails to get a more exact measure of iron overload.
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Measurement of hepatic or splenic iron concentration is the most quantitative, specific, and sensitive
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method for determining the body iron burden (28). Accordingly, these tissues were removed to
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determine how much iron is present. Employing this measurement, the organ iron concentrations for the
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liver and spleen are shown in Figure 1 B and C, where the chronic supplementation with iron led to
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about a 2.6- and 3.9-fold, respectively, elevation of total hepatic and splenic iron content over control
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pair-fed values. Treatment with curcumin resulted in a highly significant decrease in iron concentration
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After
having shown the iron chelating properties of curcumin, we proposed its natural
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implementation in preventing metal-catalyzed prooxidative effects. Thereby we next aimed to assess the
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effect of curcumin on iron overloadinduced MDA, a terminal compound of lipid peroxidation that is
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commonly used as an index of oxidative stress status. As expected from excessive iron deposition in the
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liver, lipid peroxidation was induced locally as reflected by the significant increase in MDA in the
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untreated iron-overloaded group compared with the normal group, and that increase in tissue MDA level
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Furthermore, the generation of hydroxyl radical (HO), the highly reactive and cytotoxic free
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radical, is facilitated by iron, which catalyzes the interaction of superoxide (O2) and hydrogen peroxide
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(H2O2) by Fenton or Haber-Weiss reactions (11). Consequently, hepatic or splenic hydroxyl radical
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level was evaluated in iron-overloaded rats. The results showed that hepatic and splenic hydroxyl radical
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levels were (11.75-fold and 10.5-fold, respectively) higher in iron-overloaded rats compared to non-
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iron-overloaded. The curcumin treatment resulted in a significant decrease in hydroxyl radical level
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(approximately 62%) compared to untreated iron-overloaded rats (Figure 2C and D). Following this
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further, the hepatic and splenic iron overload was accompanied by a marked elevation of tissue nitric
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oxide (NO) concentrations up to 3.5- fold in both liver and spleen (Figure 2E and F). NO is an
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inorganic free-radical gaseous molecule that contributes to the oxidative burden and its concentrations
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were reduced significantly by the curcumin treatment (Figure 2E and F). These observations are
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consistent with the less severe lipid peroxidation phenotype observed in curcumin-treated rats, as free
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Given the oxidative stress nature of iron overload-induced toxicity and the fact that free radicals
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signaling cascade plays a pivotal role in initiating protein loss (12), we finally examined the bulk
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degradation of proteins in liver and spleen under the chronic iron intake condition. As the continuation
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of the work, we hypothesized that curcumin may also be effective in attenuation of iron overload-
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induced hepatic and splenic oxidative damage and protein loss. To test this, the effect of oral ingested
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curcumin on hepatic and splenic protein levels were determined. Iron-overload significantly (P< 0.001)
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promoted protein loss in liver and spleen to be 137.174.1 g/wet liver tissue versus 164 8.28 g/wet
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liver tissue in control rats and 1504.1 g/wet spleen tissue versus 185.32 3.65 g/wet spleen tissue in
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control rats. Curcumin intervention resulted in a significant inhibition of iron overload-induced hepatic
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and splenic protein loss to be 1504.6 g/wet tissue and 171.56.76 g/wet tissue, respectively.
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In vitro antioxidant properties of Curcumin per se in scavenging harmful free radicals seen in
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iron overload
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In light of the aforementioned curcumins iron chelating property and anti-lipid peroxidation effects,
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interest in its mechanisms of action has been expanded to investigate whether curcumin per se has a free
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radical scavenging capability against the most potent reactive species, which has been implicated in the
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pathogenesis of liver and spleen dysfunction seen in iron overload. To address this point, the capacity of
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curcumin to scavenge hydroxyl, H2O2, and superoxide radicals was evaluated, respectively, by
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thiobarbituric acid reactive substance (TBARS), catalase-like, and the superoxide dismutase-like
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reaction in vitro assays. The efficiency curcumin in inhibition of hydroxyl radical generation was
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quantified as the amount of TBARS formed, and the results are depicted in Figure 3A. Furthermore,
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The ability of curcumin to scavenge H2O2 (catalase-like activity) and its ability to scavenge O2- (SOD-
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like activity) were measured. As shown in Figure 3B and C, respectively, the rate of H2O2 and
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superoxide degradation was significantly enhanced by curcumin in all doses tested. Collectively, these
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results implied that curcumin limits iron-overload induced oxidative stress both by chelating excess iron
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Curcumin boosts levels of endogenous antioxidants that excessive dietary iron-intake depletes
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The induction of oxidative stress in iron overloaded model can be caused by increased free-radical
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generation, antioxidant depletion, or both. Given the fact that cells are armed with a variety of
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antioxidants acting as a multilevel defenses against free radical damage, we next sought to determine
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whether curcumin alleviation of the oxidative stress associated with iron accumulation is also mediated
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by restoring endogenous antioxidant defenses. These defense systems include glutathione (GSH),
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ascorbic acid (ASA), and enzymes such as SOD, and catalase (29).
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As shown in Figure 4A and B, chronic iron intake was clearly associated with a significant
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depletion of hepatic and splenic GSH when compared to non-iron overloaded rats. The curcumin
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supplementation resulted in a great improvement of liver and spleen levels of GSH by approximately
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65% and 90%, respectively. Moreover, the storage of ASA in livers of rats fed with excessive iron
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intake for 12 weeks was 66% less, and spleen ascorbic acid was 70% less than that of the controls fed a
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diet with normal iron level (Figure 4C and D). The administration of curcumin to rats receiving
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excessive dietary iron intake has been shown to increase liver and spleen content of ascorbic acid as it
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Furthermore, excess iron in liver lowers the activity of catalase in homogenates of both liver and
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spleen of chronic iron intoxication group by 40 and 50%, respectively, compared to the corresponding
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values of normal control group, whereas the treatment with curcumin arrested the iron-induced depletion
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Similarly, treatment with curcumin dramatically boosted activity of hepatic and splenic Cu-
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SOD activity by approximately 2.4- and 2.2-fold, respectively, in chronic iron overloaded rats, whereas
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a significant decrease in SOD activity has been observed in chronic iron overloaded rats (Figure 5C and
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D). In practice, the most common cause of poor SOD activity in rats with chronic dietary iron overload
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appears to be copper deficiency. At this stage, it is unclear whether the enhancement of liver and splenic
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SOD activity seen after curcumin treatment was also achieved through modulation of organ
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copper content and its antioxidant protein (ceruloplasmin). To delineate this preclinical association,
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Figure 6 demonstrates the average levels of copper and ceruloplasmin in both liver and spleen
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homogenates of iron intoxication rats either were treated with curcumin or served as non-treated controls
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group. Compared to the corresponding values of the control rat group, the administration of curcumin
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significantly restored the average of copper (Figure 6A and B) as well as ceruloplasmin levels (Figure
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DISCUSSION
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Iron overload is seen in increased absorption from diets, hereditary hemochromatosis, iron loading
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anemias, chronic liver disease, porphyria cutanea, congenital defects associated with iron overload,
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transfusions and therapeutic injections (30). In this study, we put forward a new pre-clinical evidence for
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introducing curcumin, an abundant and cheap micronutrient, as a multi-target therapeutic agent for
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treating hepatosplenic complications associated with excessive dietary iron intake. Curcumin has a wide
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therapeutic index with very low toxicity (31) and its efficacy has been demonstrated in different animal
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models of multiple diseases associated with oxidative injury (32, 33). The most interesting feature of
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curcumin is the lack of gastrointestinal side effects despite being an anti-inflammatory agent (18).
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Excess iron in liver is potentially detrimental to the cell because of its propensity to participate in
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oxidation-reduction reactions that promote tissue injury by catalyzing lipid peroxidation (34, 35). Iron
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initiates peroxidation by producing highly reactive hydroxyl radicals from hydrogen peroxide via Fenton
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type reactions or by complexing with oxygen directly to yield reactive perferryl and ferryl ions (12, 36).
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The role of iron in lipid peroxidation has been well studied both in vivo and in vitro (37, 38). In
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addition, it is also thought that a chronic increase in tissue iron level leads to depletion of antioxidants
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which, if not restored, can by itself lead to further ROS elevation and provide a mechanism for further
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dysfunction (12). Given the crucial participation of oxidative stress in liver and spleen failure seen in
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chronic iron overload, an iron chelator represents an important player in modulating these pathogeneses.
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This input has originated partly from histopathologic studies that show collagen fibrils were
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demonstrated immediately adjacent to the hepatocytes in the iron-overloaded animals but not the
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controls (39). These initial observations have been supported in postmortem human liver
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specimens
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(40) and reinforced by additional studies showing that oral iron loading induced
that was associated with selective decreases
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in microsomal hemoprotein concentrations and cytochrome P450-dependent enzymes (41, 42). The
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treatment with curcumin or antioxidants has demonstrated beneficial effects in the prevention of iron
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induced liver toxicity (43, 44). Moreover, the in vitro studies on cultured hepatocytes with high dose of
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iron have shown that iron induced free radical generation that kills liver cells (45).
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All of this seemingly overwhelming evidence has sculpted the concept of iron overload-mediated
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oxidative stress as a major contributing factor in the pathogenesis of its associated liver injury.
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Consistent with these previous studies, we observed similar findings regarding the oxidative stress and
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bulk protein degradation of liver and spleen under the chronic iron intake condition. However, this study
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is the first to show the preclinical utility and translational relevance of the specific curcumins iron-
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chelating potency during excessive iron intake. This notion was strengthen by the observation that the
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decrease in liver and spleen iron deposition induced by curcumin treatment was associated with
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The specific metal chelator effect of curcumin against iron which was established previously in
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vitro (46) might be attributed to the presence of chemical groups such as -diketonate group. This
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assertion is supported by using spectrophotometry to quantify curcumin affinity for copper, zinc, and
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iron ions. Zn2+ showed little binding, but each Cu2+ or Fe2+ appeared to bind at least two curcumin
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molecules. The interaction of curcumin with copper exhibited positive cooperativity, with Kd
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approximately 0.5-1.6 M (47). A recent study reported with the intracellular free copper tracer
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indicates that curcumin brings copper into the cells and releases it thereafter, resulting in an elevated
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intracellular free copper level. The dissociation of copper ions from curcumin in the cells supports the
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previous finding that the binding affinity of curcumin for copper is relatively moderate (48).
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Because excess iron is known to be responsible for the functional abnormalities associated with
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chronic iron overload, any beneficial effects of curcumin might be secondary to its action as a an iron
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chelator. Nevertheless, the demonstration that curcumin reduces the oxidative stress in other diseases
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(49, 50) has raised the possibility of multi-target properties beyond its role as an iron-chelating agent.
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An alternative mechanism of these effects is the possession of antioxidant properties. These properties
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were endorsed by the presence of chemical groups like hydroxyl, methoxy and 1,3-diketone conjugated
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diene system (51). In the context of chronic iron overload, these two effects of curcumin cannot be
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separated. Therefore, we studied the redox properties of curcumin against different reactive species
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generated in vitro. From these experimental results it can be derived that curcumin is also able to reduce
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oxidative stress during iron overload by scavenging, and/or neutralizing free radicals (such as hydroxyl
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radical, superoxide anions and H2O2 (52) known to participate in the pathogenesis of liver and spleen
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dysfunctions during iron overload. Accordingly, the hepato- and splenic-protective potential of
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curcumin comes from its iron chelating property as well as its antioxidant effect.
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Further, besides curcumins ability to chelate iron and its antioxidant potential other reported
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effects might have contributed to our finding of curcumins salutary effects, such as restoring activities
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of endogenous antioxidants (53). In agreement, the oxidative stress in our experimental model due to
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chronic iron intake resulted in the depletion of putative non-enzymatic (GSH, ASA) and enzymatic
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(CAT and SOD) antioxidants in target tissues. This depletion of antioxidants was significantly restored
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after curcumin treatment. Thus, curcumin significantly helping revival from hepatic and splenic
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oxidative stress associated with excessive dietary iron intake both directly or indirectly via mending the
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Taken together, because curcumin has an attractive safety profile and appreciable iron chelating
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property as well as anti-oxidant activity, it may represent a potential therapeutic agent for managing
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excessive dietary iron intake sequelae long before the occurrence of hepatic and splenic failure among
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Disclosures
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Author contributions: All the authors contributed to the researched data as well as the discussion,
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FIGURE LEGENDS
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Figure 1. The potential of curcumin as an iron chelator in damping iron accumulation in liver and
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spleen. A) Structural characteristic of curcumin as an iron chelator. B, C) Level of iron (g/g wet tissue)
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in liver and spleen, respectively, from iron-overloaded rats treated or untreated with curcumin. Data
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Figure 2. Iron overload-induced oxidative stress in the liver as well as in the spleen and the
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protective effect of curcumin. A, B) Level of MDA (N mol/g wet tissue) in liver and spleen,
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respectively, in iron overloaded rats with or without curcumin treatment. Levels of MDA in these tissues
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are significantly increased in iron overloaded rats than control rats. Curcumin treatment significantly
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decreased MDA levels in iron overloaded rats. C, D) Level of hydroxyl radical (N mol/g wet tissue) in
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liver and spleen, respectively, in iron overloaded rats with or without curcumin treatment. Levels of
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hydroxyl radical in these tissues are significantly increased in iron overloaded rats than control rats.
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Curcumin treatment significantly decreased hydroxyl radical levels in iron overloaded rats. E, F) Level
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of NO (N mol/g wet tissue) in liver and spleen, respectively, in iron overloaded rats with or without
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curcumin treatment. Levels of NO in these tissues are significantly increased in iron overloaded rats than
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control rats. Curcumin treatment significantly NO levels in iron overloaded rats. Data shown are the
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meanSD, (n = 5).
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Figure 3. In vitro antioxidant properties of Curcumin per se in scavenging harmful free radicals
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Figure 4. Curcumin improves levels of endogenous non enzymatic antioxidants that excessive
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dietary iron-intake depletes. A, B) Levels of glutathione (GSH; mg/g wet tissue) in liver and spleen,
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respectively; C, D) Levels of ascorbic acid (ASA; mg/g wet tissue) in liver and spleen, respectively; in
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iron overloaded rats with or without curcumin treatment. Levels of GSH and ASA in these tissues are
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significantly decreased in iron overloaded rats than controls. Curcumin treatment significantly increased
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GSH and ASA levels in iron overloaded rats. Data shown are the meanSD, (n = 5).
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Figure 5. Curcumin boosts activities of endogenous enzymatic antioxidants that excessive dietary
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iron-intake depletes. A, B) Activity of catalase (CAT; U/Min g wet tissue) in liver and spleen,
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respectively; C, D) Activity of Superoxide dismutase (SOD; U/Min g wet tissue) in liver and spleen,
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respectively; in iron overloaded rats with or without curcumin treatment. Activities of CAT and SOD in
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these tissues are significantly decreased in iron overloaded rats than controls. Curcumin treatment
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significantly boosted activities of both CAT and SOD in iron overloaded rats. Moreover, Activities of
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CAT and SOD of curcumin-treated iron overloaded rats remained higher than those of control rats. Data
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Figure 6. Curcumins modulation of organ copper content and its antioxidant protein
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(ceruloplasmin). Levels of copper (A, B) and ceruloplasmin (C, D) in both liver and spleen
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homogenates of iron intoxication rats either were treated with curcumin or served as non-treated controls
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group. Compared to the corresponding values of the control rat group, the administration of curcumin in
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iron overloaded rats significantly enhance the average of copper as well as ceruloplasmin levels in both
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liver and spleen homogenates. Data shown are the meanSD, (n = 5).
Figure 1
A
Figure 2
A
Figure 3
A
Figure 4
A
Figure 5
A
Figure 6
A