DM is a chronic progressive metabolic disorder characterized by hyperglycemia mainly because of the absolute or relative deficiency of insulin hormone (
1,
2). According to the International Diabetes Federation reports, diabetes is a serious global health issue that continues to gain momentum, currently affecting 425 million people and set to affect over 690 million people by 2045 (
3).
Dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM among developing countries. Awareness about diabetes complications and consequent improvement in dietary knowledge, attitude, and practices lead to better control of the disease (
4). The goals of therapy for diabetes are to alleviate the symptoms related to hyperglycemia and to prevent or reduce the complications of diabetes that can be acute as hypoglycemia, diabetic ketoacidosis and hyperosmolar coma, or chronic as microvascular and macrovascular alterations (
5).
Dipeptidyl peptidase-IV (DPP-IV) inhibitors have been widely used as outstanding blood glucose-dependent antidiabetic agents for patients with type II DM (
6-
8). These inhibitors prevent the degradation of incretins, glucagon-likepeptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP), by DPP-IV enzyme and therefore elevate their endogenous levels. GLP-1 stimulates insulin secretion from β-cells in a glucose-dependent manner, suppresses glucagon secretion from α-cells, and inhibits hepatic glucose production, eventually contributing to the antihyperglycemic effect. In addition, DPP-IV inhibitors preserve the β-cell mass (
9,
10).
Natural products are characterized by their chemical diversity and being a good source of a range of bioactive structures including antidiabetic compounds. Rational drug design has been widely accomplished, to discover and optimize innovative leads for different molecular targets of type II diabetes including DPP-IV, α-glucosidase, peroxisome proliferator-activated receptor gamma (PPARγ), glycogen synthase kinase-3β (GSK-3β), glucokinase (GK), and others (
9).
Natural products have been traditionally used for curing many diseases against various infectious agents such as bacteria, viruses, fungi, protozoans and worms; and are widely used for treatment of different diseases and physiological disorders (
11). Numerous plants are traditionally used for the treatment of DM, but very little is known about the mechanism of action of antidiabetic activity of these medicinal plants. Therefore, the aim of this study was to evaluate the DPP-IV inhibitory potential of
Calotropis procera,
Artemisia herba-alba,
Ephedra foeminea,
Hylocereus undatus,
Marrubium vulgare extracts, and additional four isolated compounds.
Calotropis procera Linn, known historically as apple of Sodom and named by Edwaed Robinson, grows wild from West Africa to South East Asia and belongs to the
Asclepiadaceae family (
Figure 1). Most members of the family have milky juice, flowers with five united petals, pod like fruits, and usually tufted seeds. It includes more than 180 genera and about 2200 species of tropical herbs or shrubby climbers. Two species belonging to this family,
Calotropis procera and
Calotropis gigantea, are of economic importance. Active components of
Calotropis procera (known in Arabic as Al oshar) displayed cytostatic, cytotoxic, wound healing, procoagulant, analgesic, anticonvulsant, antiarthritic, antidiabetic, hepatoprotective, antifertility, antipyretic, anticoccidial, anticancer, and anti-inflammatory properties. Sterols, triterpenes, flavonoids, and cardiac glycosides (cardenolides) have been isolated from
Calotropis procera (
11,
12)
. Artemisia herba-alba is thought to be the plant translated as “wormwood” in English-language versions of the Bible (
apsinthos in the Greek text) (
Figure 1). It is from the
Asteraceae family.
Artemisia herba-alba is a chamaeophyte that grows to 20–40 cm (8–16 in). Leaves are strongly aromatic and covered with fine glandular hairs that reflect sunlight giving a greyish aspect to the shrub. The leaves of sterile shoots are grey, petiolate, ovate to orbicular in outline; whereas, the leaves of flowering stems, more abundant in winter, are much smaller. The plants flower from September to December.
Artemisia herba-alba, grows commonly on the dry steppes of the Mediterranean regions, in Northern Africa, Western Asia and Southwestern Europe also known as desert wormwood (known in Arabic as shih), has been traditionally used in the treatment of a variety of ailments such as cold, diabetes, and bronchitis (
13,
14). Herbal tea from this species has been used as analgesic, antibacterial, antispasmodic, and hemostatic agents (
15). During an ethnopharmacological survey carried out among the Bedouins of the Negev desert, it was found that
Artemisia herba-alba relieved stomach disorders (
16). Various secondary metabolites have been isolated from
Artemisia herba-alba, including sesquiterpene lactones that are considered the most important and occur with great structural diversity. Additional studies have focused on flavonoids and essential oils (
13).
Pitahaya or dragon fruit or Belle-of-the-night are the common names of
Hylocereus undatus (
Pitaya blanca or white-fleshed pitahaya) belonging to the
Cactaceae family (
Figure 1). It originates from tropical and subtropical America and belongs to a group of fruit trees considered promising for farming, which are distributed in Costa Rica, Venezuela, Panama, Uruguay, Brazil, Colombia, and Mexico (
17). For its nutritional importance and culinary applications, pitaya can be utilized for hyperglycemia, as a diuretic, and a healing agent. The seeds have a laxative effect, the fruit has an effect on gastritis, and the stalk and flowers are also used for kidney problems. Extracts from dragon fruit have been associated as central nervous system stimulants and regulators of blood pressure, sleep, hunger and thirst. The fatty acid, phenolic, tocopherol, and sterol contents of the extracted plant were analysed (
18).
Ephedra is likely one of the oldest medicinal plants still currently in use (
Figure 1).
Ephedra is a ubiquitous genus of gymnosperm shrubs that grow in temperate and subtropical regions usually on shores or in sandy soils under direct sunlight throughout North and Central America, Europe, Africa and Asia (
19). In folk medicine, the extracts of
Ephedra foeminea (
Ephedraceae) named by Peter Forsskal are commonly used to treat cancer (
20). It was used in the treatment and/or prophylaxis of various conditions such as asthma, nasal congestion, and hypotension caused by spinal anaesthesia and urinary incontinence Phytochemical investigations showed that
Ephedra foeminea contains high contents of benzaldehyde, phenolics, and flavonoid compounds. Among all
Ephedra species
Ephedra foeminea lacks epherdrin alkaloid (
21).
Marrubium vulgare, belonging to the
Lamiaceae or
Labiatae family, habitats in Europe, the Mediterranean, and Asia (
Figure 1). Horehound which is the common name for
Marrubium vulgare has been mentioned in conjunction with medicinal use dating at least back to the 1st century BC, where it appeared as a remedy for respiratory ailments in the treatise
De Medicina by Roman encyclopaedist Aulus Cornelius Celsus. It is an aromatic herbaceous perennial plant used in traditional medicine in some countries such as Jordan in the treatment of diabetes and wounds. The plant is reported to possess vasorelaxant, antihypertensive, analgesic, anti-inflammatory, and antioxidant properties. On the other hand, some studies reported that the antioxidant effect of the plant extract is due to its flavonoid content. Earlier phytochemical investigations of
Marrubium vulgare led to the characterization of the diterpene marrubiin which is the major constituent of the plant, and exhibits potent antinociceptive properties and vasorelaxant activity, in addition to marruboside and marrubic acid (
22).
Several studies have been performed on the effect of various extracts of
Calotropis procera (
12)
Artemisia herba-alba (
23) and
Hylocereus undatus (
24) on Diabetes mellitus (DM) while no studies were reported on
Ephedra foeminea extracts.
The research began after some local citizens having diabetes mellitus, claimed to be cured after drinking tea from Marrubium vulgare for several months. The tea was prepared by cooking the plant for 2 h in boiling hot water. Since four of the herbs under study, Calotropis procera, Marrubium vulgare, Artemisia herba-alba, and Ephedra foeminea grow wildly in Jordan it was a challenge to have a scientific study on these plants.
Calotropin and calotoxin (
Figure 2), isolated and identified from
Calotropis procera (
25), belong to the cardenolide cardiac glycosides family, which has been recognized for its antidiabetic effect (
26). Pectolinarigenin, a flavonoid, and apigenin7-O-(3”,6”-di-O-E-p-coumaroyl)-β-glycoside, a flavonoid glycoside, (
Figure 2) have been isolated from
Marrubium vulgare (
Figure 1) (
22). Flavonoids and glycosides represent a beneficial group of naturally occurring compounds with hypoglycemic potential (
27).