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Kinkan orange protects hypercholesterolemic rats against dyslipidemia and oxidative stress

Abstract

We investigated the effect of dietary supplementation with kinkan orange on growth, adiposity, metabolic parameters, and oxidative stress in rats with diet-induced hypercholesterolemia. Female Wistar rats (6-8 weeks) were fed a AIN-93M diet (Control); AIN-93M diet containing 5% kinkan orange (CTkinkan); Hypercholesterolemic diet, containing 1% cholesterol and 25% fat (Hyper); or Hypercholesterolemic diet containing 5% kinkan orange (Hyperkinkan). Hypercholesterolemic diet increased body weight, adiposity, serum alanine transaminase (ALT), creatinine, cholesterol and triglycerides, hepatic total lipids, cholesterol, and triglycerides, and hepatic oxidative stress. Supplementation with kinkan reduced the serum and hepatic lipid content, decreased serum ALT, besides improving the antioxidant status in liver tissue of hypercholesterolemic animals. Moreover, HDL-cholesterol increased in both groups supplemented with kinkan orange (CTkinkan and Hyperkinkan). Our data suggest that diet supplementation with kinkan orange may consist of a valid strategy to prevent or reduce dyslipidemia and oxidative stress in hypercholesterolemic rats.

Key words
citrus; dyslipidemia; high-fat diet; oxidative stress

INTRODUCTI ON

Hypercholesterolemia is the major risk factor for cardiovascular diseases (CVD) that enhance reactive oxygen species (ROS) generation in blood and tissues (Baldissera et al. 2017BALDISSERA MD, SOUZA CF, GRANDO TH, DOLESKI PH, BOLIGON AA, STEFANI LM & MONTEIRO SG. 2017. Hypolipidemic effect of beta-caryophyllene to treat hyperlipidemic rats. Naunyn Schmiedebergs Arch Pharmacol 390: 215-223., El-Tantawy 2015EL-TANTAWY WH. 2015. Biochemical effects, hypolipidemic and anti-inflammatory activities of Artemisia vulgaris extract in hypercholesterolemic rats. J Clin Biochem Nutr 57: 33-38.).

Nutritional intervention can be one of the major strategies to prevent CVD. Studies suggest that citrus fruits intake is associated with prevention of CVD development, for promoting reduction in serum levels of cholesterol and triglycerides (Zheng et al. 2017ZHENG J, ZHOU Y, LI S, ZHANG P, ZHOU T, XU DP & LI HB. 2017. Effects and Mechanisms of Fruit and Vegetable Juices on Cardiovascular Diseases. Int J Mol Sci 18: 555.). The health benefits of citrus fruits can be attributed to their high amounts of phytochemicals and bioactive compounds (Toth et al. 2016TOTH PP ET AL. 2016. Bergamot Reduces Plasma Lipids, Atherogenic Small Dense LDL, and Subclinical Atherosclerosis in Subjects with Moderate Hypercholesterolemia: A 6 Months Prospective Study. Front Pharmacol 6: 299., Zou et al. 2016ZOU Z, XI W, HU Y, NIE C & ZHOU Z. 2016. Antioxidant activity of Citrus fruits. Food Chem 196: 885-896.). Among the various possible mechanisms, regulation of lipid metabolism, reduction of oxidative stress and attenuation of inflammation are reported (Zou et al. 2016ZOU Z, XI W, HU Y, NIE C & ZHOU Z. 2016. Antioxidant activity of Citrus fruits. Food Chem 196: 885-896., Zhao et al. 2017ZHAO CN, MENG X, LI Y, LI S, LIU Q, TANG GY & LI HB. 2017. Fruits for Prevention and Treatment of Cardiovascular Diseases. Nutrients 9: 598., Zheng et al. 2017ZHENG J, ZHOU Y, LI S, ZHANG P, ZHOU T, XU DP & LI HB. 2017. Effects and Mechanisms of Fruit and Vegetable Juices on Cardiovascular Diseases. Int J Mol Sci 18: 555.).

Previous studies have associated orange intake with beneficial effects on lipid metabolism and oxidative stress. Deyhim et al. (2007)DEYHIM F, VILLARREAL A, GARCIA K, RIOS R, GARCIA C, GONZALES C, MANDADI K & PATIL BS. 2007. Orange pulp improves antioxidant status and suppresses lipid peroxidation in orchidectomized male rats. Nutrition 23: 617-621. have shown that 2.5, 5.0 or 10% orange pulp intake increased antioxidant plasma levels, hepatic antioxidant enzymes activity (superoxide dismutase and catalase) and improved the lipid profile in orchidectomized rats. Another study showed that orange juice consumption provided a protection of mononuclear blood cells against oxidative DNA damage in healthy subject (Guarnieri et al. 2007GUARNIERI S, RISO P & PORRINI M. 2007. Orange juice vs vitamin C: effect on hydrogen peroxide-induced DNA damage in mononuclear blood cells. Br J Nutr 97: 639-643.). Giglio et al. (2016)GIGLIO RV ET AL. 2016. The effect of bergamot on dyslipidemia. Phytomedicine 23: 1175-1181. related that Citrus bergamia Risso (family Rutaceae), protects against free-radical damage, raises high density lipoprotein cholesterol (HDL-C), and reduces triglycerides accumulation in the liver, in studies involving animals and humans.

Kinkan orange (Fortunella japonica), originally from China, is a source of dietary fiber and bioactive compounds, including ascorbic acid, terpenoids, carotenoids, flavonoids, and essential oils (Choi 2005CHOI HS. 2005. Characteristic odor components of kumquat (Fortunella japonica Swingle) peel oil. J Agric Food Chem 53: 1642-1647., Lim 2012LIM TK. 2012. Citrus japonica ‘Marumi’. In: Edible Medicinal And Non-Medicinal Plants. Springer, Dordrecht, p 647-650., Sadek et al. 2009SADEK ES, MAKRIS DP & KEFALAS P. 2009. Polyphenolic composition and antioxidant characteristics of kumquat (Fortunella margarita) peel fractions. Plant Foods Hum Nutr 64: 297-302.). A previous study of our group showed that kinkan orange has chemical characteristics similar to those found in Brazilian citrus fruits, such as pH (4.22±0.03), soluble solids (21.1± 0.10 ºBrix), titratable acidity (1.14±0.16 g/100ml), vitamin C (86.45±6.65 mg/100ml), total phenolic contents (0.09 ± 0.0010 mg/g), and antioxidant capacity (52.99 ± 8.83 %) (Oliveira & Diniz 2015OLIVEIRA DR & DINIZ AB. 2015. Chemical composition of kinkan orange and citrus fruits. Demetra: Alimentação, Nutrição & Saúde 10: 835-844.). Kinkan orange is eaten whole as its rind is extremely sweet, fragrant and pleasant. It can also be processed into candies, preserves, marmalade, and jelly, or it can be sliced and added to salads (Choi 2005CHOI HS. 2005. Characteristic odor components of kumquat (Fortunella japonica Swingle) peel oil. J Agric Food Chem 53: 1642-1647.).

It is believed that kinkan orange consumption may protect against cardiovascular risk factors, such as dyslipidemia and oxidative stress. Therefore, the objective of this study was to evaluate the effect of kinkan orange consumption on weight parameters, lipid profile, oxidative stress and adiposity in rats receiving control or hyperlipidemic diet.

MATERIALS AND METHODS

Experimental Design

Forty female Wistar rats aged from 6-8 weeks were randomly distributed according to their weight into four groups of 10 animals to receive for 4 weeks AIN-93M diet (calorie density 3.95 kcal/g - Control group); AIN-93M diet containing 5% kinkan orange (calorie density 3.98 kcal/g - CTkinkan group); Hypercholesterolemic diet, containing 1% cholesterol and 25% fat (calorie density 4,81 kcal/g - Hyper group); or Hypercholesterolemic diet containing 5% kinkan orange (calorie density 4,84 kcal/g - Hyperkinkan group). Whole oranges excluding seeds were sliced, dried at 60 °C and ground before being added to the diets. Diets were offered ad libitum in pellet form.

The animals were maintained in controlled conditions of temperature (22 ± 3 °C) and light (12 h light/dark cycle), with free access to water and diet. After four weeks and 12 hours fasting, animals were anesthetized intraperitoneally with ketamine/xylazine (100 and 12 mg/kg body weight respectively), and blood collected from the axillary artery. Serum was separated by centrifugation (12 000g) for 10 minutes, adipose tissue (epididymal, peritoneal, and mesenteric), and liver tissue were collected. The experimental protocol was carried out according to the guidelines of the Ethics Committee on Animal Use (CEUA) of Federal University of Minas Gerais (protocol 069/10).

Assessment of food, body weight, energy intake and adiposity

Food intake and body weight were recorded weekly. The energy intake was calculated as the product of food intake and calorie density. The relative weights of liver and the adiposity index were estimated as recommended (Paulino et al. 2008PAULINO G, DARCEL N, TOME D & RAYBOULD H. 2008. Adaptation of lipid-induced satiation is not dependent on caloric density in rats. Physiol Behav 93: 930-936.).

Lipid profile, serum enzymes, urea and creatinine

Serum triglycerides and total cholesterol

All tests were performed by enzymatic colorimetric assay as recommended by the manufacturer’s protocols (Labtest kit, Brazil), adapted for a microplate assay (Fazio et al. 1997FAZIO S, BABAEV VR, MURRAY AB, HASTY AH, CARTER KJ, GLEAVES LA, ATKINSON JB & LINTON MF. 1997. Increased atherosclerosis in mice reconstituted with apolipoprotein E null macrophages. Proc Natl Acad Sci U S A 94: 4647-4652.). In brief, 10 l of serum was mixed with 100 ml of cholesterol reagent, and the absorbance at 492 nm was read (Molecular Devices microplate reader) after a 10-min incubation at 37 o C.

Cholesterol carried by lipoproteins

Serum lipoproteins fractioning was performed through gel filtration chromatography with a Fast Protein Liquid Chromatography (FPLC) system (Waters model 600), using a Superose column (Pharmacia) (Fazio et al. 1997FAZIO S, BABAEV VR, MURRAY AB, HASTY AH, CARTER KJ, GLEAVES LA, ATKINSON JB & LINTON MF. 1997. Increased atherosclerosis in mice reconstituted with apolipoprotein E null macrophages. Proc Natl Acad Sci U S A 94: 4647-4652.).

Three samples from serum from each group (pooled serum of animals 1 2, 3 -sample 1; 4, 5, 6 – sample 2; 7, 8, 9 and 10 - sample 3) were used for lipoprotein determination. The pooled serum (a 100 µl aliquot) was loaded onto a Superose 6 column and separated at a flow rate of 0.5 ml/min, with a buffer containing 0.15 M NaCl, 0.01 M Na2HPO4, 0.1 mM EDTA, pH 7.5. Forty fractions were collected (0.5 ml each), with the lipoproteins (high density lipoprotein) being contained within tubes 17–37. Cholesterol levels in the fractions were determined as described for serum samples, except that 100 µl of each fraction were mixed with the cholesterol reagent (1:1 vol ratio).

Hepatic lipids

Hepatic total lipids were extracted from liver using organic solvents (Folch et al. 1957FOLCH J, LEES M & SLOANE STANLEY GH. 1957. A simple method for the isolation and purification of total lipids from animal tissues. J Biol Chem 226: 497-509.). Briefly, 100 mg of liver was homogenized in a chloroform:methanol solution (2: 1). After adding methanol and centrifugation, the supernatant was transferred to a pre-weighed container and mixed with chloroform and 0.73% NaCl solution. After another centrifugation, the upper phase was discarded and washed three times with Folch’s solution. The tubes were placed at 37 ° C and total liver fat was gravimetrically quantified. The lipid extracts were resuspended in 500 μL of isopropanol and the determination of hepatic cholesterol and triglyceride concentrations was performed using commercial kits (Labtest kit, Brazil).

Determination of serum transaminases activities, urea and creatinine

Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine were determined using biochemical assay kits (Labtest, Brazil).

Oxidative stress in the liver

Fragments of tissue (approximately 100 mg) were homogenized in 1mL (w/v) of 50mM ice cold phosphate buffer pH 7.03. After centrifugation at 12.000 rpm, 10 min, 4 ° C, supernatants were kept at -70 ° C for assays. The content of total liver protein was determined according to Lowry et al. (1951)LOWRY OH, ROSEBROUGH NJ, FARR AL & RANDALL RJ. 1951. Protein measurement with the Folin phenol reagent. J Biol Chem 193: 265-275..

TBARS analysis was performed as previously described (Buege & Aust 1978BUEGE JA & AUST SD. 1978. Microsomal lipid peroxidation. Methods Enzymol 52: 302-310.). Briefly, 200 µL of supernatant were mixed with a solution containing thiobarbituric acid (TBA 0.375%) in acid solution (15% trichloroacetic acid and 0.25 M hydrochloric acid), incubated in boiling water (95 ° C) for 15 min and subsequently placed on ice for cooling. Samples were mixed with 600 µL of n-butanol and centrifuged at 6000 rpm (Neofuge 15R, Heal Force) for 10 min. Aliquots of the supernatant (150 µL) were transferred to microplate (96 wells) and the absorbance was read at 535 nm on a microplate reader (Biotek, ELx800 absorbance microplate reader, VT, USA). The results were expressed in μmol Malondialdehyde (MDA)/g protein.

Hepatic hydroperoxide concentration was determined by the ferrous oxidation of xylenol orange (Nourooz-Zadeh et al. 1994NOUROOZ-ZADEH J, TAJADDINI-SARMADI J & WOLFF SP. 1994. Measurement of plasma hydroperoxide concentrations by the ferrous oxidation-xylenol orange assay in conjunction with triphenylphosphine. Anal Biochem 220: 403-409.). Briefly, 20 µL of supernatant were transferred into the microplate, followed by the FOX-2 reagent. After 30 min at room temperature, the absorbance was measured spectrophotometrically at 560 nm. In order to reduce hydroperoxides with triphenylphosphine (TPP), 15 µL of supernatant and 5 µL of TPP solution in methanol (10 mM) were added directly in the microplate and kept for 30 min at room temperature, followed by the FOX-2 reagent. After 30 min at room temperature, the absorbance was measured spectrophotometrically at 560nm. The hydroperoxide concentrations were calculated by the difference between the measurements without TPP from those with TPP. The results were normalized by the protein content and expressed as µmol hydroperoxides/g protein.

Antioxidant enzymes activities

Superoxide dismutase (SOD) activity in the liver homogenates was determined based on the inhibition of pyrogallol autoxidation (Dieterich et al. 2000DIETERICH S, BIELIGK U, BEULICH K, HASENFUSS G & PRESTLE J. 2000. Gene expression of antioxidative enzymes in the human heart: increased expression of catalase in the end-stage failing heart. Circulation 101: 33-39.). Catalase activity was measured, considering the decrease in the absorbance at 240 nm (Nelson & Kiesow 1972NELSON DP & KIESOW LA. 1972. Enthalpy of decomposition of hydrogen peroxide by catalase at 25 degrees C (with molar extinction coefficients of H2O2 solutions in the UV). Anal Biochem 49: 474-478.). The results were expressed in enzyme units /g of liver proteins.

Statistical analysis

In this study, completely randomized design was performed with four treatment groups. Data were analyzed statistically by the Shapiro-Wilk test to verify for normal distribution, and Grubbs’ test was used to detect outliers. The effects of cholesterol in the diet (control or hypercholesterolemic) and the presence or not of kinkan orange supplementation (without or with kinkan) and the interaction between these investigated factors (cholesterol x kinkan) were assessed by two-way analysis of variance (ANOVA). When the two-way ANOVA detected significance for the interaction and the main effects, the differences were assessed with Bonferroni’s multiple comparisons post hoc test at P < 0.05. Data were expressed as means ± S.E.M. The analysis was carried with Prism software 7.0 (GraphPad Software, USA).

RESULTS

Effect of kinkan orange on food intake and weight parameters

Hypercholesterolemic diets (Hyper and Hyperkinkan) showed higher caloric density than control diets (Control and CTkinkan), leading to increased body weight (P < 0.0001) and relative liver weight (P < 0.0001), supported by increased adiposity (P = 0.0003). On the other hand, dietary cholesterol did not influence ad libitum food nor energy intake. Kinkan orange supplementation did not change food, energy intake and weight parameters (P > 0.05) (Table I).

Table I
Food and energy intake, body weight, adiposity and metabolic parameters of animals fed with different diets.

Effect of kinkan orange on liver and renal function

Serum AST and urea were both reduced by kinkan administration (CTkinkan and Hyperkinkan groups, P = 0.002 and P = 0.03, respectively). For serum ALT levels, there was an interaction effect between experimental factors (cholesterol X kinkan, P < 0.0001). Thus, ALT levels were lower in animals fed hypercholesterolemic diet supplemented with kinkan orange than in the other groups (Hyperkinkan group, P < 0.0001). Serum creatinine levels were significantly increased by the hypercholesterolemic diet (P < 0.0001) and reduced by supplementation with kinkan orange (CTkinkan and Hyperkinkan groups, P = 0.005) (Table I).

Changes in lipid profile

The serum and hepatic lipids were considerably increased by the hypercholesterolemic diet (Table I). For all these measured parameters, an interaction effect between cholesterol and kinkan supplementation was observed; thus, the concentration was higher in Hyper group related to the control groups (Control and CTkinkan). Interestingly, the hypercholesterolemic rats fed with kinkan orange (Hyperkinkan) showed a marked reduction in serum levels of cholesterol (P = 0.001) and triglycerides (P = 0.005), and in hepatic total lipids (P = 0.002), cholesterol (P = 0.015), and triglycerides (P < 0.0001), compared to Hyper group. The FPLC cholesterol elution profiles (Fig. 1a) demonstrated that serum cholesterol was mainly carried by HDL in all groups. Control groups (Control and CTkinkan diets) showed similar lipoprotein profiles, while hypercholesterolemic group showed lower average content of cholesterol in lipoproteins. The supplementation with kinkan orange in hypercholesterolemic condition (Hyperkinkan diet) resulted in an increase of circulating HDL-cholesterol, improving the lipoprotein profile (Fig. 1b). Lipoprotein cholesterol concentration was affected by cholesterol (P < 0.0001) and kinkan supplementation (P < 0.0001) and an interaction effect between these dietary factors was also observed (P = 0.0001).

Figure 1
Cholesterol distribution on circulating lipoproteins in rats given Control, CTkinkan, Hyper and Hyperkinkan diets, after 4 weeks of experiment. a) Cholesterol profile found in lipoprotein fractions analyzed. b) Mean values of the sum of the cholesterol concentration found in the different experimental groups. Gel filtration chromatography was performed using a Superose 6 column (Pharmacia) on a Waters 600 FPLC system. The pooled serum (a 100μl aliquot) was loaded onto a Superose 6 column and separated as described above. Cholesterol determinations were measured in the microplate assay. Data points represent mean values for cholesterol from three pooled serum from each group (n=5). *Bars in Figure 1b represent statistical significance, p < 0.05, using twoway ANOVA followed by post hoc Bonferroni test.

Changes in antioxidant capacity

Animals fed Control and CTkinkan diets had similar results of hepatic TBARS, hydroperoxides, SOD and catalase activities (Fig. 2a, 2b, 3a, and 3b). Hypercholesterolemic diet increased TBARS and hydroperoxides levels (P < 0.0001 and P = 0.0002, respectively) compared to animals fed control diets. Kinkan orange administration normalized hydroperoxides levels and increased catalase activity (P = 0.036 and P = 0.0053, respectively) in animals fed hypercholesterolemic diet (Hyperkinkan group).

Figure 2
Effect of kinkan orange intake on hepatic (a) TBARS and (b) hydroperoxides levels of rats given Control, CTkinkan, Hyper, and Hyperkinkan diets. The data represents means + SEM of 10 animals per group. *p < 0.05. *Bars represent statistical significance, p < 0.05, using two-way ANOVA followed by post hoc Bonferroni test.
Figure 3
Effect of kinkan orange intake on hepatic (a) superoxide dismutase (SOD) and (b) catalase activities of rats given Control, CTkinkan, Hyper, and Hyperkinkan diets. The data represents means + SEM of 10 animals per group. *p < 0.05. *Bars represent statistical significance, p < 0.05, using two-way ANOVA followed by post hoc Bonferroni test.

DISCUSSION

Hypercholesterolemia is well-known as one of the most important risk factors of atherosclerosis. Our data confirmed previous studies showing that diet containing 25% soybean oil and 1% cholesterol induces weight gain, dyslipidemia, hepatic lipid accumulation, and oxidative stress in female rats (Abreu et al. 2014ABREU IC, GUERRA JF, PEREIRA RR, SILVA M, LIMA WG, SILVA ME & PEDROSA ML. 2014. Hypercholesterolemic diet induces hepatic steatosis and alterations in mRNA expression of NADPH oxidase in rat livers. Arq Bras Endocrinol Metabol 58: 251-259., Silva et al. 2013SILVA LS, DE MIRANDA AM, DE BRITO MAGALHÃES CL, DOS SANTOS RC, PEDROSA ML & SILVA ME. 2013. Diet supplementation with beta-carotene improves the serum lipid profile in rats fed a cholesterol-enriched diet. J Physiol Biochem 69: 811-820.). Many studies have indicated the consumption of fruits for prevention and treatment of cardiovascular diseases, paying special attention to the composition of fruits and the mechanisms of action (Deyhim et al. 2007DEYHIM F, VILLARREAL A, GARCIA K, RIOS R, GARCIA C, GONZALES C, MANDADI K & PATIL BS. 2007. Orange pulp improves antioxidant status and suppresses lipid peroxidation in orchidectomized male rats. Nutrition 23: 617-621., Zhao et al. 2017ZHAO CN, MENG X, LI Y, LI S, LIU Q, TANG GY & LI HB. 2017. Fruits for Prevention and Treatment of Cardiovascular Diseases. Nutrients 9: 598., Zheng et al. 2017ZHENG J, ZHOU Y, LI S, ZHANG P, ZHOU T, XU DP & LI HB. 2017. Effects and Mechanisms of Fruit and Vegetable Juices on Cardiovascular Diseases. Int J Mol Sci 18: 555.). The flavonoid content of different Brazilian citrus varieties was reported to be found more abundantly in the fruit peels than in juices (Pereira et al. 2017PEREIRA RM, LÓPEZ BGC, DINIZ SN, ANTUNES AA, GARCIA DM, OLIVEIRA CR & MARCUCCI MC. 2017. Quantification of flavonoids in Brazilian orange peels and industrial orange juice processing wastes. Agric Sci 8: 631-644.). The nutrient composition of raw kinkan (Fortunella spp.) (exclude 7% seeds) per 100g edible portion was reported as: water 80.85 g, energy 71 kcal (296 kJ), protein 1.88 g, total lipid 0.86 g, ash 0.52 g, carbohydrate 15.90 g and dietary fiber 6.5 g (Lim 2012LIM TK. 2012. Citrus japonica ‘Marumi’. In: Edible Medicinal And Non-Medicinal Plants. Springer, Dordrecht, p 647-650.).

Because kinkan orange can be eaten whole and showed high content of dietary fiber, vitamin C, total phenolics and considerable antioxidant capacity compared to other Brazilian citrus fruits (Oliveira & Diniz 2015OLIVEIRA DR & DINIZ AB. 2015. Chemical composition of kinkan orange and citrus fruits. Demetra: Alimentação, Nutrição & Saúde 10: 835-844.), we conducted the present study to investigate its effects on the metabolic changes in rats fed with control or hypercholesterolemic diet. We found that supplementation with 5% kinkan orange did not affect the caloric density of diets and reflected in the similar results of food and energy intake, body weight, liver relative weight and adiposity index in control groups (Table I).

Dietary-induced hypercholesterolemia is a strategy used to study lipid metabolism. In our study, rats receiving Hyper diet presented metabolic alterations characterized by increased circulating total cholesterol and triglycerides, reduced HDL-cholesterol levels and ectopic fat deposition in the liver, in agreement to some studies reported before using male or female (Fischer / Wistar) rats (Abreu et al. 2014ABREU IC, GUERRA JF, PEREIRA RR, SILVA M, LIMA WG, SILVA ME & PEDROSA ML. 2014. Hypercholesterolemic diet induces hepatic steatosis and alterations in mRNA expression of NADPH oxidase in rat livers. Arq Bras Endocrinol Metabol 58: 251-259., Baldissera et al. 2017BALDISSERA MD, SOUZA CF, GRANDO TH, DOLESKI PH, BOLIGON AA, STEFANI LM & MONTEIRO SG. 2017. Hypolipidemic effect of beta-caryophyllene to treat hyperlipidemic rats. Naunyn Schmiedebergs Arch Pharmacol 390: 215-223., Hassan et al. 2011HASSAN S, EL-TWAB SA, HETTA M & MAHMOUD B. 2011. Improvement of lipid profile and antioxidant of hypercholesterolemic albino rats by polysaccharides extracted from the green alga Ulva lactuca Linnaeus. Saudi J Biol Sci 18: 333-340.). Administration of kinkan orange along with hypercholesterolemic diet (Hyperkinkan group) modulated serum and hepatic lipid profile and showed its prophylactic potential. These results could be attributed mainly to dietary fiber and phenolic components (Choi 2005CHOI HS. 2005. Characteristic odor components of kumquat (Fortunella japonica Swingle) peel oil. J Agric Food Chem 53: 1642-1647., Sadek et al. 2009SADEK ES, MAKRIS DP & KEFALAS P. 2009. Polyphenolic composition and antioxidant characteristics of kumquat (Fortunella margarita) peel fractions. Plant Foods Hum Nutr 64: 297-302.), that displace cholesterol and decrease the hydrolysis of cholesterol esters, reducing the absorption of dietary and biliary cholesterol in the small intestine (Jesch & Carr 2017JESCH ED & CARR TP. 2017. Food Ingredients That Inhibit Cholesterol Absorption. Prev Nutr Food Sci 22: 67-80.). The binding to dietary fiber and phenolic components would make bile acids unavailable in the small intestine as surfactants, thus disturbing lipid emulsification, formation of mixed micelles, and the complete digestion of lipids and their absorption, lowering the levels of circulating triglycerides and the bioavailability of lipophilic nutrients (Capuano 2017CAPUANO E. 2017. The behavior of dietary fiber in the gastrointestinal tract determines its physiological effect. Crit Rev Food Sci Nutr 57: 3543-3564.).

Mulvihill et al. (2009)MULVIHILL EE, ALLISTER EM, SUTHERLAND BG, TELFORD DE, SAWYEZ CG, EDWARDS JY, MARKLE JM, HEGELE RA & HUFF MW. 2009. Naringenin prevents dyslipidemia, apolipoprotein B overproduction, and hyperinsulinemia in LDL receptor-null mice with diet-induced insulin resistance. Diabetes 58: 2198-2210. observed that western diet decreased hepatic carnitine palmitoyl-transferase 1α (CTP-1α) activity and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) mRNA and reduced fatty acid oxidation in LDL Receptor–Null Mice. The citrus-derived flavonoid, naringin, increased PGC-1α gene expression, which increased mitochondrial DNA, enhanced fatty acid oxidation and corrected liver triglyceride accumulation. Cho et al. (2011)CHO KW, KIM YO, ANDRADE JE, BURGESS JR & KIM YC. 2011. Dietary naringenin increases hepatic peroxisome proliferators-activated receptor alpha protein expression and decreases plasma triglyceride and adiposity in rats. Eur J Nutr 50: 81-88. have shown that a 0.003% naringin flavonoid supplementation (equivalent to a glass of grapefruit juice) in male Long-Evans hooded rats fed a control diet increased the expression of CTP-1α and uncoupling protein 2 (UCP2), that was associated with the increase in their regulator peroxisome proliferator-activated receptor alpha (PPARα), leading to lower levels of serum and liver triglycerides.

HDL is an important protective factor against coronary heart disease, and it exerts various potentially antiatherogenic properties, including the mediation of reverse transport of cholesterol (RCT) from cells of the arterial wall to the liver and steroidogenic organs (von Eckardstein et al. 2001VON ECKARDSTEIN A, NOFER JR & ASSMANN G. 2001. High density lipoproteins and arteriosclerosis. Role of cholesterol efflux and reverse cholesterol transport. Arterioscler Thromb Vasc Biol 21: 13-27.). These properties have made HDL metabolism an interesting target for pharmacological intervention in atherosclerosis (Nofer et al. 2002NOFER JR, KEHREL B, FOBKER M, LEVKAU B, ASSMANN G & VON ECKARDSTEIN A. 2002. HDL and arteriosclerosis: beyond reverse cholesterol transport. Atherosclerosis 161: 1-16.). Cholesterol could be transferred from HDL to LDL by cholesterol ester transfer protein (CETP), which is a plasma glycoprotein that facilitates the exchange of cholesteryl esters and triglycerides between HDL and apolipoprotein B-containing lipoproteins (VLDL and LDL). CETP then plays an important role in reverse cholesterol transport (Malhotra et al. 2020MALHOTRA P, GILL RK, SAKSENA S & ALREFAI WA. 2020. Disturbances in Cholesterol Homeostasis and Non-alcoholic Fatty Liver Diseases. Front. Med 7: 467.). However, mice and rats are CETP-deficient species and transport plasma cholesterol mainly in HDL, unlike humans, where LDL is the main plasma cholesterol transporter (Mindham & Mayes 1991MINDHAM MA & MAYES PA. 1991. Reverse cholesterol transport in the rat. Studies using the isolated perfused spleen in conjunction with the perfused liver. Biochem J 279(Pt 2): 503-508., Liang et al. 2020LIANG YQ, ISONO M, OKAMURA T, TAKEUCHI F & KATO N. 2020. Alterations of lipid metabolism, blood pressure and fatty liver in spontaneously hypertensive rats transgenic for human cholesteryl ester transfer protein. Hypertens Res 43: 655-666.).

Our results confirmed those found by Lemieux et al. (2005)LEMIEUX C, GELINAS Y, LALONDE J, LABRIE F, RICHARD D & DESHAIES Y. 2005. The selective estrogen receptor modulator acolbifene reduces cholesterolemia independently of its anorectic action in control and cholesterol-fed rats. J Nutr 135: 2225-2229. in female Sprague-Dawley rats fed a cholesterol-free diet, which is that HDL is the major cholesterol carrier, and our study also showed that animals receiving kinkan orange with hypercholesterolemic diet (Hyperkinkan group) had their HDL-C levels increased.

In addition to transporting cholesterol and lipids in the RCT pathway, HDL transports a diverse group of proteins, small RNAs, bioactive lipids, and many other small molecules, that may confer many of alternative HDL functions, including anti-thrombotic, anti-apoptotic, anti-inflammatory, anti-oxidative, anti-infectious, and pro-vasodilatory capacities (Linton et al. 2019LINTON MF, YANCEY PG, DAVIES SS, JEROME WG, LINTON EF, SONG WL, DORAN AC & VICKERS KC. 2019. The role of lipids and lipoproteins in atherosclerosis. In: feingold kr et al. (Eds), Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-2019 Jan 3.). In this way, HDL-C levels alone do not represent HDL particle numbers or HDL function (e.g. cholesterol efflux capacity). Although not having studied the particularities of the circulating HDL in the present study, we believe that animals supplemented with kinkan orange could have HDL particles enriched with bioactive compounds, potentiating the beneficial functions of HDL in hypercholesterolemic conditions. The present study did not focus on the structure and components of HDL, which could be useful to understand the real effects of kinkan orange on the increase in HDL-C for the prevention and treatment of cardiovascular diseases (Ahn & Kim 2016AHN N & KIM K. 2016. High-density lipoprotein cholesterol (HDL-C) in cardiovascular disease: effect of exercise training. Integr Med Res 5: 212-215.).

After feeding Sprague-Dawley male rats with a high-cholesterol diet (1%) for two weeks, Lasser et al. (1973)LASSER NL, ROHEIM PS, EDELSTEIN D & EDER HA. 1973. Serum lipoproteins of normal and cholesterol-fed rats. J Lipid Res 14: 1-8. found that a new lipoprotein fraction containing low density and high density lipoproteins appeared between the density range of 1.006 and 1.030. The lipoprotein found in the HDL range (between 1.070 and 1.21) was also decreased, but the total HDL protein did not change, suggesting that HDL shifted in part to a lower density class. The authors found that in hypercholesterolemic condition, the increase in lower density lipoproteins was accompanied by a decrease in HDL. Besides that, low density lipoprotein (LDL) consists of several subclasses of particles with different sizes and densities, including large buoyant, intermediate and small dense (sd) LDLs. sdLDL has a greater atherogenic potential than that of other LDL subfractions (Ivanova et al. 2017IVANOVA EA, MYASOEDOVA VA, MELNICHENKO AA, ANDREY V, GRECHKO AV & OREKHOV AN. 2017. Small Dense Low-Density Lipoprotein as Biomarker for Atherosclerotic Diseases. Oxid Med Cell Longev 2017: 1273042.). In this way, we believe that these changes in lipoprotein density profile could explain the new way of transporting the excess of cholesterol in hypercholesterolemic group.

Oxidative stress plays an important role in disease pathophysiology of hypercholesterolemia due to increased hepatic production of ROS (Abreu et al. 2014ABREU IC, GUERRA JF, PEREIRA RR, SILVA M, LIMA WG, SILVA ME & PEDROSA ML. 2014. Hypercholesterolemic diet induces hepatic steatosis and alterations in mRNA expression of NADPH oxidase in rat livers. Arq Bras Endocrinol Metabol 58: 251-259., Baldissera et al. 2017BALDISSERA MD, SOUZA CF, GRANDO TH, DOLESKI PH, BOLIGON AA, STEFANI LM & MONTEIRO SG. 2017. Hypolipidemic effect of beta-caryophyllene to treat hyperlipidemic rats. Naunyn Schmiedebergs Arch Pharmacol 390: 215-223., Ben Gara et al. 2017BEN GARA A, BEN ABDALLAH KOLSI R, CHAABEN R, HAMMAMI N, KAMMOUN M, PAOLO PATTI F, EL FEKI A, FKI L, BELGHITH H & BELGHITH K. 2017. Inhibition of key digestive enzymes related to hyperlipidemia and protection of liver-kidney functions by Cystoseira crinita sulphated polysaccharide in high-fat diet-fed rats. Biomed Pharmacother 85: 517-526., Hassan et al. 2011HASSAN S, EL-TWAB SA, HETTA M & MAHMOUD B. 2011. Improvement of lipid profile and antioxidant of hypercholesterolemic albino rats by polysaccharides extracted from the green alga Ulva lactuca Linnaeus. Saudi J Biol Sci 18: 333-340.). In this present study, hypercholesterolemia was able to increase lipid peroxidation and probably ROS production, demonstrated by the increase of hepatic TBARS and hydroperoxides levels, respectively, without changing SOD and catalase activities, different from the results found by other authors (Baldissera et al. 2017BALDISSERA MD, SOUZA CF, GRANDO TH, DOLESKI PH, BOLIGON AA, STEFANI LM & MONTEIRO SG. 2017. Hypolipidemic effect of beta-caryophyllene to treat hyperlipidemic rats. Naunyn Schmiedebergs Arch Pharmacol 390: 215-223., Ben Gara et al. 2017BEN GARA A, BEN ABDALLAH KOLSI R, CHAABEN R, HAMMAMI N, KAMMOUN M, PAOLO PATTI F, EL FEKI A, FKI L, BELGHITH H & BELGHITH K. 2017. Inhibition of key digestive enzymes related to hyperlipidemia and protection of liver-kidney functions by Cystoseira crinita sulphated polysaccharide in high-fat diet-fed rats. Biomed Pharmacother 85: 517-526., Hassan et al. 2011HASSAN S, EL-TWAB SA, HETTA M & MAHMOUD B. 2011. Improvement of lipid profile and antioxidant of hypercholesterolemic albino rats by polysaccharides extracted from the green alga Ulva lactuca Linnaeus. Saudi J Biol Sci 18: 333-340.), which related a decrease in SOD, catalase and glutathione peroxidase activities. The study of Baldissera et al. (2017)BALDISSERA MD, SOUZA CF, GRANDO TH, DOLESKI PH, BOLIGON AA, STEFANI LM & MONTEIRO SG. 2017. Hypolipidemic effect of beta-caryophyllene to treat hyperlipidemic rats. Naunyn Schmiedebergs Arch Pharmacol 390: 215-223. on female Wistar rats concluded that the increase on lipid peroxidation possesses pro-inflammatory and cytotoxic properties, that contribute to the initiation and progression of atherosclerosis. Interestingly, we found that the administration of kinkan orange stimulates the hepatic anti-oxidant capacity evidenced by the increase of catalase activity and the normalization of hydroperoxides contents in hypercholesterolemic rats, which possibly could be attributed to some natural antioxidant components, such as phenolic compounds and vitamin C. As shown by other authors, phytochemicals are various biological active compounds which have antioxidant and anti-inflammatory activities based on biochemical interactions with target enzymes or proteins (Sierra-Campos et al. 2020SIERRA-CAMPOS E, VALDEZ-SOLANA M, AVITIA-DOMÍNGUEZ C, CAMPOS-ALMAZÁN M, FLORES-MOLINA I, GARCÍA-ARENAS G & TÉLLEZ-VALENCIA A. 2020. Effects of Moringa oleifera leaf extract on diabetes-induced alterations in paraoxonase 1 and catalase in rats analyzed through progress kinetic and blind docking. Antioxidants (Basel) 9: 840., Rana et al. 2019RANA S, DIXIT S & MITTAL A. 2019. In silico target identification and validation for antioxidant and anti-inflammatory activity of selective phytochemicals. Braz Arch Biol Technol 62: e19190048.). They bind antioxidant enzymes (catalase, dismutase superoxide and glutathione peroxidase) with different binding affinities and they are responsible for the effects on the antioxidant activity (Rana et al. 2019RANA S, DIXIT S & MITTAL A. 2019. In silico target identification and validation for antioxidant and anti-inflammatory activity of selective phytochemicals. Braz Arch Biol Technol 62: e19190048.). Catalase is known for its ability to bind hydrogen peroxide with high affinity, degrade it into water and oxygen, being the main regulator of its cellular concentration (Sierra-Campos et al. 2020SIERRA-CAMPOS E, VALDEZ-SOLANA M, AVITIA-DOMÍNGUEZ C, CAMPOS-ALMAZÁN M, FLORES-MOLINA I, GARCÍA-ARENAS G & TÉLLEZ-VALENCIA A. 2020. Effects of Moringa oleifera leaf extract on diabetes-induced alterations in paraoxonase 1 and catalase in rats analyzed through progress kinetic and blind docking. Antioxidants (Basel) 9: 840.). In this way, we suppose that some phytochemicals found in kinkan orange may have a higher catalase binding affinity, acting as agonists and increasing the activity of this enzyme, mainly in hypercholesterolemic condition.

The present study is the first that has showed the effect of kinkan orange on liver and kidney functions in hypercholesterolemic rats. We found that hyperlipidemia was accompanied by the increase in the amount of liver toxicity in blood, due to the elevation of serum ALT, as reported before (Abreu et al. 2014ABREU IC, GUERRA JF, PEREIRA RR, SILVA M, LIMA WG, SILVA ME & PEDROSA ML. 2014. Hypercholesterolemic diet induces hepatic steatosis and alterations in mRNA expression of NADPH oxidase in rat livers. Arq Bras Endocrinol Metabol 58: 251-259., Ben Gara et al. 2017BEN GARA A, BEN ABDALLAH KOLSI R, CHAABEN R, HAMMAMI N, KAMMOUN M, PAOLO PATTI F, EL FEKI A, FKI L, BELGHITH H & BELGHITH K. 2017. Inhibition of key digestive enzymes related to hyperlipidemia and protection of liver-kidney functions by Cystoseira crinita sulphated polysaccharide in high-fat diet-fed rats. Biomed Pharmacother 85: 517-526., Hassan et al. 2011HASSAN S, EL-TWAB SA, HETTA M & MAHMOUD B. 2011. Improvement of lipid profile and antioxidant of hypercholesterolemic albino rats by polysaccharides extracted from the green alga Ulva lactuca Linnaeus. Saudi J Biol Sci 18: 333-340.). Renal function, assessed by the levels of serum creatinine, was also impaired in male Wistar rats (Faran et al. 2019FARAN SA, ASGHAR S, KHALID SH, KHAN IU, ASIF M, KHALID I, GOHAR UF & HUSSAIN T. 2019. Hepatoprotective and Renoprotective Properties of Lovastatin-Loaded Ginger and Garlic Oil Nanoemulsomes: Insights into Serum Biological Parameters. Medicina (Kaunas) 55: 579.). Kinkan orange consumption did not cause liver or kidney toxicity, reflected by the reduced serum AST, ALT, urea and creatinine levels in hypercholesterolemic condition, suggesting a potential protective effect in liver function. These findings highlighted possibly the efficacy of kinkan orange phenolic compounds as hepatic-protectant in hypercholesterolemic toxicity mainly through suppressing the oxidative status as well as improving metabolic profile.

CONCLUSIONS

Dietary supplementation with 5% of kinkan orange improved lipid profile and had a beneficial effect against oxidative damage in rats submitted to hypercholesterolemic diet. Our findings raise the possibility that kinkan orange can be used as adjuvant in lipid abnormalities and it is a potential food for cardiovascular protection.

ACKNOWLEDGMENTS

This work was supported by grants from the Minas Gerais Research Foundation (Fundação de Amparo à Pesquisa de Minas Gerais, FAPEMIG) to DLS.

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Publication Dates

  • Publication in this collection
    05 Sept 2022
  • Date of issue
    2022

History

  • Received
    10 July 2020
  • Accepted
    6 Nov 2020
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