Evaluation of the Therapeutic Effects of the Hydroethanolic Extract of Portulaca oleracea on Surgical-Induced Peritoneal Adhesion

Abstract

Objective: Peritoneal adhesion (PA) is an abnormal connective tissue that usually occurs between tissues adjacent to damaged organs during processes such as surgery. In this study, the anti-inflammatory and antioxidant effects of Portulaca oleracea (PO) were investigated against postoperative-induced peritoneal adhesion.

Methods: Thirty healthy male Wistar rats (220 ± 20 g, 6-8 weeks) were randomly divided into four groups: (1) normal, (2) control (induced peritoneal adhesion), and (3) and (4) PO extracts (induced peritoneal adhesion and received 100 or 300 mg/kg/day of PO extract for seven days). Finally, macroscopic and microscopic examinations were performed using different scoring systems and immunoassays in the peritoneal lavage fluid.

Results: We found that the levels of adhesion scores and interleukin- (IL-) 1β, IL-6, IL-10, tumour necrosis factor- (TNF-) α, transforming growth factor- (TGF-) β ₁, vascular endothelial growth factor (VEGF), and malondialdehyde (MDA) were increased in the control group. However, PO extract (100 and 300 mg/kg) notably reduced inflammatory (IL-1β, IL-6, and TNF-α), fibrosis (TGF-β ₁), angiogenesis (VEGF), and oxidative (MDA) factors, while increased anti-inflammatory cytokine IL-10, antioxidant factor glutathione (GSH), compared to the control group.

Conclusion: Oral administration of PO improved postoperational-induced PA by alleviating the oxidative factors, fibrosis, inflammatory cytokines, angiogenesis biomarkers, and stimulating antioxidative factors. Hence, PO can be considered a potential herbal medicine to manage postoperative PA. However, further clinical studies are required to approve the effectiveness of PO.

Figure 1

(a) The total ion chromatogram of Portulaca oleracea extract; (b) chromatogram of dopa and corresponding mass adduct, [M + 1], at m/z 198.120; (c) chromatogram of oleraceins D and corresponding mass adduct, [M + 1], at m/z 696.84; (d) chromatogram of portulacanone D and corresponding mass adduct, [M + 1], at m/z 299.76; (e) chromatogram of friedelane and corresponding mass adduct, [M + 1], at m/z 413.34; (f) chromatogram of riboflavin and corresponding mass adduct, [M + 1], at m/z 376.62; (g) chromatogram of aurantiamide acetate and corresponding mass adduct, [M + 1], at m/z 445.8.

Figure 2

Macroscopic evaluation of PA bands in normal, control, and PO at doses of 100 and 300 mg/kg groups.

Figure 3

The effects of different doses of PO on adhesion scores evaluated by Naier et al. (a) and Adhesion Scoring Scheme (b) scoring systems; data were presented as median ± interquartile range, IQR (n = 8 for all groups except normal as 6). ^∗P < 0.05 and ^∗∗P < 0.01.

Figure 4

The effects of different doses of PO on adhesion formation and collagen deposition by histopathological evaluation using Masson's trichrome staining; blue colour intensities (marked with yellow stars) represent fibrosis and collagen deposition. Pathological imaging; (a) normal group, (b) control group, (c) PO at the dose of 100 mg/kg, and (d) PO at the dose of 300 mg/kg. The highest rate of tissue fibrosis (blue colour) and collagen deposition was observed in the control group (b) compared to the normal group (a), which had the lowest fibrosis rate. Conversely, the blue colour intensities as a marker of fibrosis and collagen deposition in both doses of the extract groups (100 and 300 mg/kg) were significantly decreased compared to the control group (c, d).

Figure 5

The effects of different doses of PO on the peritoneal lavage levels of (a) IL-1β, (b) IL-6, (c) TNF-α, and (d) IL-10; data were presented as mean ± SD (n = 8 for all groups except normal as 6). ^∗P < 0.05, ^∗∗P < 0.01, and ^∗∗∗P < 0.001.

Figure 6

The effects of different doses of PO on the peritoneal lavage levels of (a) TGF-β and (b) VEGF; data were presented as mean ± SD (n = 8 for all groups except normal as 6). ^∗P < 0.05, ^∗∗P < 0.01, and ^∗∗∗P < 0.001.

Figure 7

The effects of different doses of PO on the peritoneal lavage levels of (a) MDA and (b) GSH; data were presented as mean ± SD (n = 8 for all groups except normal as 6). ^∗∗P < 0.01 and ^∗∗∗P < 0.001.