Despite major progress for hyperglycemia control through diet therapy, pharmacological agents, insulin and islet transplantation, management of long-term diabetic complications such as blindness still remains a major clinical challenge (
23). Arginase, a key enzyme of urea cycle, mainly involved both in vascular and neuronal damage and the arginase/polyamine pathway plays an important role in the diabetic neurovascular damage in the retina (
17).
Since some conventional medications marketed for diabetic complications have troublesome side-effects, interest in natural complementary and alternative therapies is increasing. In traditional medicine, plants have been considered as a rich source of therapeutic compounds for many indications. A number of these herbal medicines may be promising as therapies for diabetes and hyperglycemia, an important one is
Z. officinale the blood glucose lowering effect of which has been observed and supported by recent in vivo and in vitro studies (
19-
24). Since no study regarding the effects of
Z. officinale hydroalcoholic extract on the arginase expression and activity in diabetes has ever been performed, the current study aimed at examining the effects of
Z. officinale hydroalcoholic extract, specifically in an animal model.
Our results indicated that body weight significantly decreased in the untreated diabetic rats compared to the healthy controls. In a study conducted by Kusari et al. loss of body weight in the STZ-induced diabetic rats had been attributed either to the enhancement of urine output, which leads to dehydration and loss of valuable fluids, or to muscle breakdown resulting from hyperglycemia (
27). Our results are also in agreement with the results of Eleazu et al. who reported the cause of weight loss in the STZ-induced-diabetic rats resulted from the loss and degradation of structural proteins (
28). We found that the
Z. officinale extract protects the STZ-induced diabetic rats against weight loss and this effect may be due to its potential hypoglycemic properties. Moreover, this result is in agreement with the findings reported by Faried et al. and Thomson et al. (
23,
29).
In the current study, following 10 weeks of diabetes induction, serum insulin significantly decreased in the untreated diabetic controls compared to healthy controls. In line with these findings, Zafar et al. observed that the diabetogenic effect of STZ is a direct result of the irreversible damages of β cells, which leads to degranulation and decrease of insulin secretion (
30). In addition, our results showed that serum insulin in diabetic rats treated with 400 mg/kg of the
Z. officinale extract significantly increased relative to the untreated diabetic group, results consistent with those reported by Iranloye et al., and Akhani et al. (
31,
32); according to their results, they speculated that the
Z. officinale extract may be attributed to increased insulin secretion from β cells or release of granule-bounded insulin (
31). Heimes et al. suggested that the effects of
Z. officinale in the retrieval of insulin may be due to its reaction with the 5-Hydroxy-tripetamin (5-HT3) receptor (
33). Several studies have confirmed that serotonin receptors may be involved in the hypoglycemic effects of the
Z. officinale extract. Serotonin receptors suppress the release of insulin and the
Z. officinale extract can antagonize this inhibitory effect (
34).
We found that, accompanied by a considerable decrease in serum insulin, a significant increase in the fasting blood glucose concentration was observed in the untreated diabetic rats compared to healthy control, a result consistent with those reported elsewhere (
21,
30,
31). Increased blood glucose concentration can be due to dysfunction of insulin secretion following STZ-induced diabetes (
35). On the other hand, we found that reduction of fasting blood glucose in diabetic rats treated with the
Z. officinale extract was dose-dependent, a result in accordance with those reported by several studies (
21,
22,
29). The antihyperglycemic property of
Z. officinal is possibly due to its phenols, polyphenol substances and flavonoids (
19). Previous studies suggested that the effect of the
Z. officinale extract on the reduction of blood glucose may be mediated by decreasing the absorption of glucose through inhibiting the activity of intestinal α-amylase and α-glucosidase (
36), and its antagonistic activity against serotonin receptors and blocking of them (
37).
Reduced blood flow into the retina is one of the most adverse consequences of the vascular dysfunction in diabetic retinopathy (
1-
3). Several signaling pathways are involved in the vascular dysfunction in diabetes, including, protein kinase C (PKC), endothelin, angiotensin II, and NO. Also, according to the recent studies, increased activity of arginase, induced by diabetes, plays a primary role in an impaired endothelium-dependent vasodilation response (
4). Combinations of these mechanisms contribute to the development of diabetic complications (
23). Previous studies conducted about the mediators, which impair retinal blood flow induced by diabetes, have demonstrated an important role for PKC and angiotensin II in changing retinal vasodilation responses. Activation of both PKC and angiotensin II pathways not only increases ROSs, but also leads to increased activity of arginase in vascular tissue. In addition, it has been showed that PKC inhibits the endothelium-dependent vasodilation of the retinal arteries. The protein kinase C can also activate the RhoA/Rho kinase signaling pathway in endothelial cells; RhoA/Rho kinase is one of the upstream regulators of arginase. Therefore, it seems that arginase is the last connector of various mediators of vascular injuries in the retina of diabetic individuals and this emphasizes the potential importance of arginase as a therapeutic target for treatment of diabetic retinopathy (
4). It has been proved that oxidative stress and inflammatory reactions increase in the diabetic conditions (
16). Moreover, various inflammatory factors and oxidative radicals increase arginase activity (
15). Our results revealed that arginase activity and expression significantly increased in the retina of the untreated diabetic controls compared to the healthy control group, findings similar those reported by Elms et al. (
4). On the other hand, our results indicated that treatment with 400 mg/kg of the
Z. officinale hydroalcoholic extract resulted in a significant increase in arginase activity and expression, results which can be explained by the antiinflammatory, antioxidant and antihyperglycemic properties of the
Z. officinal extract; that inhibit arginase activators (i.e. inflammatory factors, oxidative radicals and glucose). According to previous studies,
Z. officinale has a compound named 6-shogaol, which possesses the most antioxidant and anti-inflammatory effects (
19). On the other hand, many in vivo and in vitro studies have documented the beneficial effects of
Z. officinale extract on the improvement of diabetic retinopathy (
22-
24).
To the best of our knowledge, our study is the first to address the effect of the Z. officinale hydroalcoholic extract on the arginase I activity and expression in the retina of STZ-induced diabetic rats. This interventional study was conducted in a sample of the STZ-induced diabetic rats; thus, clinical outcomes may be expected in further studies. However, the small sample size is a limitation in the current study and the results should be interpreted with caution. Further studies should consider replicating these results with larger sample sizes.
Conclusion: According to recent studies, the role of the arginase I has been reported in the diabetic-induced retinal vascular dysfunction (
1,
10). Our results indicated that the
Z. officinale hydroalcoholic extract may be a promising therapeutic potential for treating vascular disorders associated with diabetes possibly through its reducing effect on the arginase I activity and expression.