Review Article

Phytoceuticals in Acute Pancreatitis: Targeting the Balance between Apoptosis and Necrosis

Table 2

Phytoceuticals effects in acute pancreatitis (animal studies) and their proposed mechanism of action.

Animals/cell type usedDose, route of administration, 
duration of the study
AP modelFindingsRef.

Artemisinin (sesquiterpene lactone) found in Artemisia annua, fam. Asteraceae and its derivatives

Male Wistar rats50 mg/kg artemisinini.p. 20 μg/kg cerulein, 4 inj. at 1 h interval↑ apoptosis, caspase-3, 
↓ necrosis, amylase, pancreatic edema, inflammatory cell infiltration, NF-κB, MPO, MIP-1α protein, IL-1β mRNA
[89]

Male SD rats0.70, 1.75 and 3.50 mg/kg artesunater.i.BPD 3.5% sodium taurocholate↑ survival rate 
↓ pancreatic necrosis, hemorrhage, amylase, lipase, pancreatic release of IL-1β and IL-6
[90]

Baicalin (flavone glucuronide) found in Scutellaria spp., fam. Lamiaceae

SD rats5%, i.v.b. 10 mg/100 g f.c.i.v.i. 10 mg/h/100 gr.i.BPD 3.5% sodium taurocholate↓ renal pathological changes, mortality, renal Bcl-2 protein, serum NO, plasma endotoxin, serum BUN, IL-6, ET-1, TNF-α, PLA2.
↑ renal apoptotic indexes, Bax protein
[91]

Male SD rats5%, i.v.b. 10 mg/100 g f.c.i.v.i. 10 mg/h/100 gr.i.BPD 3.5% sodium taurocholate↓ TNF-α, P-selectin, ↑ caspase-3 (↑ apoptosis)[92]

SD rats5%, i.v.b. 10 mg/100 g f.c.i.v.i. 10 mg/h/100 gr.i.BPD 3.5% sodium taurocholate↓ mortality, endotoxin, TNF-α
↑ Bax protein, apoptosis index
[93]

SD rats5%, i.v.b. 10 mg/100 g f.c.i.v.i. 10 mg/h/100 gr.i.BPD 3.5% sodium taurocholate↓ mortality, pathological severity scores, plasma endotoxin, serum PLA2, ET-1, NO, P-selectin[94]

Crambene (nitrile) found in brussels sprouts and other plants from fam. Cruciferae

Female CD-1 micei.v.b. 70 mg/kgi.p. 50 μg/kg cerulein, 12 inj. at 1 h interval (4, 12, 24, 48 hours after pre-trt.)↓ amylase, pancreatic edema, necrosis (12 h after pre-trt.) 
↑ apoptosis, caspase-3, -8, -9
[51]

Male Swiss micei.v.b. 70 mg/kgi.p. 50 μg/kg cerulein, 3/6/10 inj. at 1 h interval (12 hours after pre-trt.)↑ apoptosis 
↓ MCP-1, IL-1β,TNF-α
↑ IL-10, TGF-β1
[95]

Curcumin (polyphenol/diarylheptanoid) found in Curcuma longa, fam. Zingiberaceae

Albino ratsi.p. 50 mg/kg/d × 6 d (pre-AP induction, post-AP induction or no-AP induction, resp.)250 mg/100 g L-arginine i.p., twice at an interval of 1 h↓ amylase, lipase, NAP78, protein carbonyls, TNF-α, MPO, pancreatic fgl-2 
↑ caspase-3 (apoptosis)
[96]

Male SD ratsi.p. 100 mg/kgr.i.BPD 5% sodium taurocholate↓ ascites, amylase, TNF-α, TLR4, NF-κB, IL-10[97]

WA ratsi.g. 100 mg/kg (curcumin in alcohol) 20 d before AP induction and all through the studyr.i.BPD 3% sodium taurocholate↓ total histopathologic scores, trypsin activity, NF-κB, AP-1, chemokine, TNF-α, IL-6, iNOS, NO 
↑ caspase-3 activity
[98]

Kun Ming male micei.p. 50 mg/kg/d × 6 di.p. 50 μg/kg cerulein↓ pancreas injury, amylase, ALT, AST, TNF-α, NF-κB-p65 
↑ PPARγ
[99]

Male SD ratsi.v. 35 mg/kg/h × 6 hi.v. cerulein (5 μg/kg/h) × 6 h and i.g.ethanol diet × 6 wk → i.v. CCK-8 (3 nmol/kg/h) × 6 h↓ pancreas injury (histologic changes, amylase, trypsin, neutrophil infiltration) ↓ NF-κB (↓ IκB degradation), AP-1, IL-6, TNF-α, chemokine KC, iNOS[100]

Male SD ratsi.p. 20 mg/kg2 h ischemia → 6 h reperfusion↓ amylase, HO, NO, TNF-α, WBC count; 
(lung) ↓ iNOS, TNF-α, hyperreactivity
[101]

Embelin (benzoquinone derivative) found in Ardisia japonica, fam. Primulaceae, Embelia ribes Burm, fam. Primulaceae

Male SD rats and male Swiss Webster CD-1 mices.c. 20 mg/kg × 5 di.p. 50 μg/kg cerulein↓ pancreatic necrosis and ↑ apoptosis in mouse model, ↑ caspase-9, -3, -8 in mouse model[7]

Emodin (anthraquinone) found in Rheum spp., fam. Polygonaceae, Rhamnus spp., fam. Rhamnaceae, Fallopia japonica, fam. Polygonaceae

Male SD ratsi.v. 2.5 mg/kg q6 hr.i.BPD 5% sodium taurocholate↑ pancreatic blood flow[102]

Male SD ratsi.v. 2.5 mg/kg q6 hr.i.BPD 5% sodium taurocholate↓ TXB2 
↑ 6-keto-PGF1α, PGE2 ↓ mortality, pancreatic pathologic scoring
[102]

Male SD ratsi.v. 2.5 mg/kg q6 hr.i.BPD 5% sodium taurocholate↓ TXB2 
↑ 6-keto-PGF1α, PGE2 
↓ mortality, amylase, lipase, ascites, pancreatic edema, inflammation, necrosis, bleeding, microthrombosis
[103]

Male SD ratsi.v. 2.5 mg/kgr.i.BPD 5% sodium taurocholate↓ TNF-α, IL-6, edema, extravasation, histological score 
↑ claudin-5, occludin
[104]

Male SD ratsi.v. 2.5 mg/kgr.i.BPD 5% sodium taurocholate↓ TNF-α, IL-6, MPO, pulmonary extravasation & edema; ↑ claudin-4, claudin-5, occludin[105]

Male SD ratsorally 20/40/80 mg/kg × 28 daysr.i.BPD trinitrobenzene sulfonic acid↓ TGF-β1, pancreatic fibrosis, glandular atrophy, collagen, fibronectin, laminin[106]

SD ratsi.v. 2.5 mg/kgr.i.BPD 3.5% sodium taurocholate↑ intestinal transit 
↓ TNF-α, IL-1β, NF-κB-p65
[107]

SD ratsi.v. 2.5 mg/kgr.i.BPD 3.5% sodium taurocholate↓ amylase, histological damage, edema, vacuolization, inflammation, necrosis, NF-κB activation, TNF-α, IL-6, IL-1β, MDA 
↑ SOD
[108]

SD ratsi.v. 2.5 mg/kgr.i.BPD 1.5% sodium deoxycholate↑ mCD14 & ICAM-3 expression in pMΦs[109, 110]

SD ratsi.v. 2.5 mg/kgr.i.BPD 1.5% sodium ursodeoxycholate↓ amylase, lung edema, pathological changes, serum TNF-α, SAP-induced acute lung injury 
↑ AQP1 and AQP5 
improved blood gases indexes
[111]

SD ratsi.v. 2.5 mg/kgr.i.BPD 3% sodium cholate↓ apoptosis of intestinal mucosa cells, translocation of bacteria and endotoxin 
↑ serum leptin, intestinal barrier function
[112]

RPA AR42J cells10 and 20 μMcerulein (10−7 M) + lipoplysaccharide (10 mg/l)↓ amylase 
↑ apoptotic indices & ↓ necrosis (↓ necrosis/apoptosis ratio); ↓ calcium overload in the cytoplasm 
↓ ER stress transducers
[113]

Emodin (EM) + baicalin (BA)/baicalein (BAe)

Male SD ratsi.v. 2.5 mg/kg for EM, 20 mg/kg for BAr.i.BPD 5% sodium taurocholate↓ amylase, TNF-α, IL-6, TLR4 expression in pancreas and lung, pancreatic and pulmonary damage[44]

Male SD ratsi.v. 2.5 mg/kg/6 h for EM, 20 mg/kg/6 h for BAr.i.BPD 5% sodium taurocholate↓ mortality, ascites, pancreatic pathological scores, amylase, TNF-α, IL-6[114]

Emodin (EM) + EEN

Male Wistar ratsEM (3.0 mg/100 g) by enteral tube q10 h × 6 timesr.i.BPD 5% sodium taurocholate↓ amylase, ALT, AST, MDA, hepatic & pancreatic MPO, TNF-α, AngII, CRP, endotoxin, lactate, mortality, pathological changes, ascites[115]

Hesperidin (flavone) found in citrus fruits

WA rats0.3 g/kg s.c.cerulein 50 μg/kg hourly 7 times↓ amylase, inflammatory infiltrate, edema, ROS burden, NO[116]

RPA AR42J cells53.7 μg/L hesperidincerulein↑ cell viability, apoptosis index; ↓ necrosis, LDH released from the cells, ROS generation[117]

Honokiol (lignan) found in Magnolia officinalis (Magnoliaceae)

RPA AR42J cells9.07  μg/L honokiolcerulein↑ cell viability, apoptosis index; ↓ necrosis, LDH released from the cells[118]

Ligustrazine (tetramethylpyrazine) found in Ligusticum wallichii, fam. Umbeliferae

Adult SD ratsi.p. 150 mg/kg/day, 3 days 
10 min after the first cerulein injection
i.p. 100 µg/kg/h cerulein, every 1 h, 6 times↓ amylase, pancreatic MPO, TNF-α, IL-1β, IL-6, p38, Erk 
↑ p53, cleaved caspase-3, apoptosis of acinar cells
[119]

SD ratsNPr.i.BPD 5% sodium taurocholate.↑ survival rate, 6-keto-PGF1 alpha 
↓ LPO, TXB2
[120]

Magnolol (lignan) found in Magnolia officinalis (Magnoliaceae)

RPA AR42J cells1.49 μg/L magnololcerulein↑ cell viability, apoptosis index; ↓ necrosis, LDH released from the cells, ROS generation[117]

BALB/c micei.v. magnolol immediately after the AP model was reproduced, then at 9, 12, 24 hours after modellingi.p. cerulein hourly 7 times↓ amylase, pancreatic histopathologic score 
↑ ratio of myeloid/lymphoid dendritic cells, ratio of IL-10/IFN-γ
[121]

Naringin (flavone) found in citrus fruits and tomatoes

RPA AR42J cells53.7 μg/L naringincerulein↑ cell viability, apoptosis index 
↓ necrosis, LDH released from the cells, ROS generation
[117, 118]

Nordihydroguaiaretic acid (lignan) found in creosote bush, Larrea tridentata (Zygophyllaceae)

Swiss albino rats30 mg/kg/h, orally, thrice at 1 h intervalsceruleinin plasma: 
↓ amylase; ↓ IGF-1 
in pancreas: 
↓ TBARS; ↑ SOD; ↑ GSH 
↓ edema, damage score 
↑ heat shock proteins 
↓ MPO, NF-κB, TNF-α, phosphorylated p38 
↑ apoptotic cells number 
modulates the posttranslational modifications of histone H3
[122]

Resveratrol (trans-3,5,4-trihydroxystilbene) found in grapes, peanuts, soy, giant knotweed (Polygonum cuspidatum) beans

SD male rats30 mg/kg b.m. intraperitoneallyr.i.BPD 4% sodium taurocholate↓ NF-κB, TNF-α, IL-8[123]

Male Wistar rats10 mg/kg i.p. 30 min pre-trt.s.c. 3 × 75 μg/kg CCK-8↓ amylase, lipase, total pancreatic histological damage, edema, acinar vacuolization 
↑ catalase
[124]

Male SD rats10 mg/kg, injected through penal vein 5 min post-trt.r.i.BPD 4% sodium taurocholate↓ severity, NF-κB, iNOS in pMΦs[125]

Male SD ratsi.v. 20 mg/kg, 5 min post-trt.r.i.BPD 4% sodium taurocholate↑ SOD 
↓ MDA, serum TNF-α, ICAM-1 and VCAM-1 expression in the intestine
[126]

Male SD ratsi.p. 10 mg/kgr.i.BPD 4% sodium taurocholate↑ Bcl-2 
↓ Bax, caspases-3 expressions in brain, serum Zonula occludens 1 and Myelin basic protein
[127]

Male SD ratsi.v. 20 mg/kg, 10 min after SAP inductionr.i.BPD 4% sodium taurocholate↓ amylase, MDA, neutrophil infiltration in pancreas 
↑ SOD
[128]

Dihydroresveratrol (trans-3,5,4-trihydroxystilbene) found in grapes, peanuts, soy, giant knotweed (Polygonum cuspidatum) beans

SD ratsp.o. 10, 20, or 50 mg/kg/hi.p.
50 μg/kg/h cerulein, 6 times and lipopolysaccharide 7.5 mg/kg, 1 time
↓ amylase, lung injury, pulmonary levels of TNF-α, IL-1β, IL-6, NF-κB[129]

SD ratsNPi.p. repetitive administration, cerulein 50 µg/kg/h followed LPS 7.5 mg/kg 1 time↓ amylase, lung injury, NF-κB, MPO[130]

Rhein (anthraquinone) found in Rheum spp. and in Senna spp.

RPA AR42J cells479, 119.8, and 29.9 μg/L rheincerulein↑ apoptotic-to-necrotic cell ratio, p53, cytochrome C, caspase-3, Bax/Bcl-2 ratio (dose dependent)[53]

male SD rats10 mg/kg rhein (conjugated with HPDM)r.i.BPD 3% or 5% sodium taurocholate↓ amylase, MPO, histological damage in pancreas (inflammatory infiltrate, acinar cell vacuolization & necrosis), ↓ IL-6, TNF-α (in serum, pancreas, lung)[131]

RPA AR42J cells479 μg/L rheincerulein↑ cell viability, apoptosis index; ↓ necrosis, LDH released from the cells, ROS generation[117]

Rutin (rhamnoglucoside of quercetin) found in citrics, grapes, black tea, apple skin peels, amalaki (Emblica officinalis)

Swiss micep.o. 37.5, 75, or 150 mg/kg, after 24, 36, 48, and 60 h of AP inductioni.p. 8% L-arginine hydrochloride 4 g/kg twice↓ pain, amylase, lipase, CRP, IL-6, pancreatic MPO, edema index, necrosis, MDA, 3-nitrotyrosine 
↑ apoptosis, catalase, SOD
[132]

Male albino Wistar ratsp.o. 100 mg/kg/day from the third weekp.o. ethanol (36% of total calories) 5 weeks, 
i.p. cerulein 20 µg/kg, thrice weekly, last 3 weeks
↓ amylase, IL-1β, IL-18, caspase-1, ASC-NLRP3 
↓ MPO, TBARS, lipid hydroperoxides, oxidative stress index 
↑ GPx, SOD, CAT
[133]

Male albino Wistar ratsp.o. 100 mg rutin/kg from 31st day till the experimental periodp.o. EtOH (8–12 g/kg/day) and HFD (22% fat) for 90 days↑ mRNA expressionof CARD 
↓ PYD, caspase-1, and TNF-α expressions, serum IL-18 and IL-6
[134]

AngII: angiotensin II, AP: acute pancreatitis, AP-1: activator protein-1, AQP: aquaporin, CARD: caspase activation recruitment domain, d.f.: disease-free, DMSO: dimethyl sulfoxide, EAEEN: emodin-assisted early enteral nutrition, EEN: early enteral nutrition, ER: endoplasmic reticulum, f.c.i.v.i.: followed by continuous i.v. infusion of, fgl2: Fibrinogen-Like Protein 2, HPDM = N,N,N′-trimethyl-N′-(4-hydroxy-3-methylbenzyl)-1,3-propane diamine, gr.: groups, i.g.: intragastric, i.p.: intraperitoneal, i.v.: intravenous, i.v.b.: i.v. bolus, iNOS: inducible NO synthase, LPO: lipid peroxide, mCD14: membrane-bound cluster of differentiation 14 protein, MCP-1: monocyte chemoattractant protein-1, MDA: malondialdehyde, MIP-1α: Macrophage inflammatory protein-1α, MPO: myeloperoxidase, NAP78: neutrophil-activating peptide 78, NO: nitric oxide, NP: not provided, PDTC: pyrrolidine dithiocarbamate, pMΦs: peritoneal macrophages, PYD: pyrin domain of apoptosis-associated speck-like protein, r.i.BPD:retrograde injection into the bilio-pancreatic duct of, resp.: respectively, RPA: rat pancreatic acinar, s.c.: subcutaneous injection, SAP: severe AP, SD: Sprague-Dawley, SS: Sandostatin, TLR-4: Toll-like receptor 4, trt.: treatment, WA: Wistar-Albino.