Chemotherapy is a broadly accepted form of gastric cancer therapy and there is growing interest in its application in earlier stages of the cancer particularly when combined with other therapy approaches. Platinum drug based chemotherapy is one of the cancer therapy strategies which has been widely used in the patients with gastric cancer (
3).
Actually, platinum drugs are still of crucial importance based on clinical investigations and the outcomes of meta-analyses, despite their undesirable side effects such as exposing systematic toxicity and the inherent resistance. Therefore, of overcoming the pointed challenges of efficient gastric cancer chemotherapy, a wide range of relevant investigation have been focused on the combinational therapy strategies.
The recent research demonstrated that utilizing natural compounds along with chemotherapy drugs in the patients with advanced solid tumors could decrease the side effects caused by chemotherapy, and this could be a critical strategy to cancer control and treatment (
3).
Moraceae family as one of the medicinal plants has been known traditionally because of their resourceful applications in different aspects such as agriculture, cosmetic and food in addition to pharmaceutical industries. Their biomedical significance is related to their wide range of pharmacological properties due to treatment of diverse inflammatory, cancer, metabolic, infectious, and gastrointestinal diseases (
5-
6).
Bioactivity guided fractionation of Moraceae herbal family has made the discovery of diverse bioactive phytochemical and secondary metabolites involving in this family. Findings from previous investigations have verified that the aqueous, methanolic, and ethanolic extracts of the belonging species and their bioactive compounds demonstrate significant antioxidative, antidiabetic, antistress, nephroprotective, antimicrobial, antimutagenic, anticancer, anxiolytic, hepatoprotective, anthelmintic, antimicrobial, immunemodulatory, and cholesterol lowering properties (
5-
6).
M. alba is the white mulberry from Moraceae and also famous as Tout in Iran and India. This known herb with broad distribution has been traditionally utilized for treatment of different diseases such as asthma, cough, bronchitis, edema, insomnia, wound healing, diabetes, influenza, eye infections, and nosebleeds (
13).
M. alba is a rich source of ascorbic acid, carotene, vitamin B1, folic acid, folinic acid, isoquercetin, quercetin, tannins, flavonoids and saponins (
13). Additionally, white mulberry leaf contains triterpenes (lupeol), sterols (β-sitosterol), bioflavonoid (rutin, moracetin, quercetin-3-triglucoside and isoquercitrin), coumarins, volatile oil, alkaloids, 1-deoxynojirimycin, amino acids, and organic acids.
Previous phytochemical screening of
M. alba fruit and leaf extract has revealed significant antiproliferative efficacy against various cancer cells lines involving Calu-6, MCF-7, HCT-116 and SNU-601 (
6).
Two flavonoids, quercetin-3-
O-
β-D-glucopyranoside, and quercetin-3-7-di-
O-
β-D-glucopyranoside were isolated from the aqueous methanol leaf extract of
M. alba inhibiting the growth of human leukemia HL-60 cells (
14)
. Also, a flavanone glycoside isolated from the root bark of
M. alba displays antiproliferative activity against HO-8910 cell line (
14)
. Additionally, albanol A from the root bark of
M. alba showed cytotoxic and apoptotic activities in human leukemia HL-60 cells with inducing early apoptosis based on significant diminution in procaspases-3, -8, and -9, and activation of caspase-2 (
14)
. Also
, isolated morusin from the root bark of mulberry stimulates apoptosis and suppresses NF-
κB in HT-29 cells (
14).
Another investigation demonstrated the anticancer property of the methanol root bark extract of mulberry with simulating cell growth arrest and apoptosis in SW480 cells based upon degradation of ROS-dependent cyclin D1 proteasomal and expression of ROS/GSK3
β-dependent ATF3 (
14). Furthermore, the isolated 11 flavonoids from the methanol leaf extract of mulberry demonstrated cytotoxic property against HeLa, MCF-7, and Hep-3B cells (
14).
Moreover, methanol leaf extracts of
M. alba displayed considerable inhibitory property on the proliferation of HepG2 cells with suppressing nuclear factor kappa B gene expression and major refuses in
α-fetoprotein,
γ-glutamyl transpeptidase, and alkaline phosphatase in HepG2 (
14-
15)
. In another study, the synergistic effect of flavonoid extract of white
M. alba leaf in combination with doxorubicin was proved with significant reducing in Bcl2 level and an enhancing in Bax level in A-172 GBM cell line (
16).
Indeed, the previous investigations finalized by research group that has been involved in current study, demonstrated the inhibitory effects of mulberry leaf crude extract against six cancerous cell lines as AGS, MCF7, SW742, SKLC6, A375, and PLC/PRF/5 with significant less effective toxicity dose than HFFF normal cells. In addition, the synergistic property of the
M. alba leaf crude extract with cisplatin and doxorubicin against drug resistance tumor cells-ACHN and A2780/cp cell lines, were evaluated by the pointed research group (
17-
18). On the other hand, the reported findings showed the significant anticancer effects of isoquercetin and rutin as the major flavonoid isolated from
M. alba (
19)
. As another significant point, it would be notable that during the previous study,
in-vivo investigated the acute toxicity of
M. alba leaf ethanol extract when intraperitoneally administered. The relevant findings cleared that the mulberry leaf ethanol extract was not genotoxic with highly inhibitory property against acute inflammation that confirmed safety of the medicinal use of
M. alba leaves (
20).
Three of the identified flavones are quercetin, an aglycone structure broadly found in nature, rutin as a hydrophilic molecule in addition to isoquercetin, a naturally stirring glycoside of quercetin. The last
in-vitro and
in-vivo investigations evaluated the antioxidants, antiinflammatory, antiallergic, and antiproliferative effects of isoquercetin against fibrosarcoma, prostatic, pancreatic, breast, cerebral, lymphoproliferative, colon, and liver cancers (
21). In addition, the relevant findings demonstrated the synergistic property of isoquercetin with anticancer drug sunitinib against renal cell carcinoma. In fact, isoquercetin was extremely safe, with a significant activity in terms of improvement of sunitinib adverse concept in phase I trial (
22).
A wide range of pharmacological properties such as antioxidant, cytoprotective, vasoprotective, anticarcinogenic, neuroprotective, and cardioprotective activities in addition to anticancer effects against leukemia, colon cancer, neuroblastoma, colorectal pulmonary metastasis, melanotic melanoma, and hepatic carcinoma have been reported for rutin as a flavonol glycoside (
23). Moreover, previous data cleared that rutin arrested cell cycle at G2/M and G0/G1 phases towards simulating cell apoptosis. Indeed, rutin by nonselective embarrassment of P-gp and BCRP pumps reversed multidrug resistance and renovated chemosensitivity to cyclophosphamide of human chemoresistant in triple-negative breast cancer cells, competently (
24).
On the subject of mentioned facts in addition to other investigations demonstrateing the nephroprotective property of leaf extract and flavonoid isolated from
M. alba on cisplatin-induced nephrotoxicity in the rats (
25), the neuroprotection ability of mulberry leaf extract against glyphosate-induced toxicity (
26), and the effect of rutin as a neuroprotective agent as well as protection property of rutin on optic nerve against cisplatin-induced toxicity (
27-
28), the current research was planned.
Findings from MTT assay demonstrated that ethyl acetate fraction of M. alba leaf extract with IC50 62.51 µg/mL was the most bioactive fraction in inducing toxicity on gastric cancer cell line. Moreover, it was cleared that the water fraction was the less activity that led to removing the water extract from further tests in the current research.
Indeed, analyzing the combination effects of isoquercetin, rutin, crude, ethyl acetate, and chloroformic fractions of M. alba leaf extract with cisplatin was cleared that the mentioned plant extracts/compounds induced the toxicity effect of cisplatin in its IC50 and less than IC50 doses in synergistic manner (CI<1). The relevant results based on calculated CIs showed that the ethyl acetate fraction (80 and 160 µg/mL doses) can simulate anticancer effect of cisplatin in both tested doses in comparison with isoquercetin and rutin as well as other examined extracts in the current study.
Analysis of the cell cycle based on quantitation of DNA contentwas confirmed the properties of isoquercetin, rutin, crude, ethyl acetate, and chloroformic fractions (IC50 doses) in reducing cell count percentage in G0/G1, S, and G2/M phases as well as inducing it in sub G0 phase (dead cells) in comparison with non-treated cells (RPMI 1640) and solvent treated cells.
Moreover, the pointed data demonstrated that isoquercetin, rutin, and the entire M. alba leaf extracts in combination with cisplatin (IC50 and less than IC50 doses) could decrees cell count percentage in G0/G1, S, and G2/M phases in addition to increase it in sub G0 phase in comparison with the single doses of cisplatin.
In addition, data from evaluating the M. alba leaf extracts, isoquercetin and rutin in single (two times the IC50 dose) and combination (IC50 dose) doses with cisplatin (2 and 10 µg/mL) towards inducing pre-apoptosis, apoptosis and necrosis percentages on gastric cancer cells showed that the combination treatment of AGS cells with cisplatin plus the entire tested extracts and natural compounds could raise the pointed percentages in comparison with the single dose treatment of cisplatin.
Besides, free radical scavenging activities of M. alba leaf extracts were examined based on DPPH method and cleared that ethyl acetate fraction of M. alba leaf extract with IC50 32.578 µg/mL was the most active fraction. The phytochemical fingerprint of the ethyl acetate fraction was evaluated by HPLC method based on the obtained facts as its highest potency among the examined extracts.
Findings during the current research showed the possible anticancer properties of M. alba leaf extracts especially the ethyl acetate fraction, as well as isoquercetin and rutin against gastric cancer cells. As the important view, these findings cleared that combination usage of cisplatin with isoquercetin, rutin, and ethyl acetate fraction of M. alba leaf extract can introduce innovative gastric cancer therapy strategy with profitable efficacy parallel to the minimum systematic side effects caused by the current chemotherapy regimen using cisplatin in single manner.
Findings in related to Annexin V-FITC vs. propidium iodide quantitation of AGS cells treated with the solvent, cisplatin (2 and 10 µg/mL) doses in addition to non treated cells (RPMI 1640).
Findings in related to Annexin V-FITC vs. propidium iodide quantitation of AGS cells treated with M. alba extracts in addition to cisplatin (single and combination manner). FL1 and FL2 channels are related to Annexin V and FITC
Findings in related to Annexin V-FITC vs. propidium iodide quantitation of AGS cells treated with natural compounds (isoquercetin and rutin) to cisplatin (single and combination manner). FL1 and FL2 channels are related to Annexin V and FITC
Free radical scavenging abilities of M. alba extracts based on DPPH method, each column in graph is referred to the relevant concentration
HPLC based phytochemical fingerprinting of ethyl acetate fraction of M. alba extract
| Samples | IC50 (µg/mL)1 | Statistical comparison with the solvent (p < 0.05) |
|---|
| M. alba (crude) | 103.49 ± 0.75 | *** p < 0.001 |
| M. alba (ethyl acetate) | 62.51 ± 0.67 | *** p < 0.001 |
| M. alba (chloroformic) | 151.33 ± 0.96 | *** p < 0.001 |
| M. alba (Water) | 892 ± 0.99 | * p < 0.05 |
| Isoquercetin | 31.8 ± 0.68 | *** p < 0.001 |
| Rutin | 14.87 ± 0.74 | *** p<0.001 |
| Cisplatin | 10.58 ± 0.57 | - |
| Samples | Herbal dose (µg/mL) | Cisplatin dose (µg/mL) | CI | Fa |
|---|
| M. alba (crude) plus cisplatin | 200.0 | 10.0 | 0.313 | 0.84 |
| 100.0 | 10.0 | 0.669 | 0.39 |
| 200.0 | 2.0 | 0.307 | 0.84 |
| 100.0 | 2.0 | 0.700 | 0.24 |
| M. alba (ethyl acetate) plus cisplatin | 160.0 | 10.0 | 0.315 | 0.82 |
| 80.0 | 10.0 | 0.486 | 0.47 |
| 160.0 | 2.0 | 0.316 | 0.81 |
| 80.0 | 2.0 | 0.384 | 0.43 |
| M. alba (chloroformic) plus cisplatin | 320.0 | 10.0 | 0.474 | 0.55 |
| 160.0 | 10.0 | 0.552 | 0.39 |
| 320.0 | 2.0 | 0.460 | 0.48 |
| 160.0 | 2.0 | 0.581 | 0.23 |
| Isoquercetin plus cisplatin | 80.0 | 10.0 | 0.516 | 0.52 |
| 40.0 | 10.0 | 0.380 | 0.48 |
| 80.0 | 2.0 | 0.427 | 0.51 |
| 40.0 | 2.0 | 0.324 | 0.41 |
| Rutin plus cisplatin | 80.0 | 10.0 | 0.988 | 0.64 |
| 40.0 | 10.0 | 0.904 | 0.42 |
| 80.0 | 2.0 | 0.997 | 0.61 |
| 40.0 | 2.0 | 0.842 | 0.34 |
| Samples | Sub G0 (% cell) | G0/G1(% cell) | S (% cell) | G2/M (% cell) |
|---|
| Negative control (RPMI) | 1.2 | 70.8 | 16.2 | 10.1 |
| Solvent | 2.8 | 68.3 | 14.4 | 11.5 |
| Cisplatin (2 µg/mL) | 16.9 | 52.2 | 9.8 | 18.1 |
| Cisplatin (10 µg/mL) | 30.4 | 45.9 | 6.3 | 14.9 |
| M. alba (crude) | 49.2 | 39.6 | 7.2 | 2.5 |
| M. alba (ethyl acetate) | 59.2 | 29.6 | 4.7 | 4.2 |
| M. alba (chloroformic) | 47.9 | 37.5 | 5.1 | 2.7 |
| Isoquercetin | 67.8 | 24.9 | 3.9 | 2.1 |
| Rutin | 40.1 | 41.2 | 9.8 | 6.3 |
| M. alba (crude) + Cisplatin (2 µg/mL) | 67.8 | 23.2 | 3.2 | 3.7 |
| M. alba (ethyl acetate) + Cisplatin (2 µg/mL) | 71.9 | 20.1 | 3.8 | 1.9 |
| M. alba (chloroformic) + Cisplatin (2 µg/mL) | 50.9 | 30.4 | 6.1 | 6.9 |
| Isoquercetin + Cisplatin (2 µg/mL) | 63.1 | 28.5 | 4.2 | 3.1 |
| Rutin + Cisplatin (2 µg/mL) | 40.1 | 40.8 | 9.1 | 7.1 |
| M. alba (crude) + Cisplatin (10 µg/mL) | 70.4 | 20.6 | 2.9 | 3.1 |
| M. alba (ethyl acetate) + Cisplatin (10 µg/mL) | 86.9 | 6.8 | 2.9 | 1.1 |
| M. alba (chloroformic) + Cisplatin (10 µg/mL) | 60.9 | 30.2 | 5.3 | 2.3 |
| Isoquercetin + Cisplatin (10 µg/mL) | 70.4 | 18.9 | 5.7 | 3.9 |
| Rutin + Cisplatin (10 µg/mL) | 52.1 | 32.7 | 6.0 | 5.2 |
| Samples | IC50 (µg/mL)1 | Statistical comparison with the solvent (p < 0.05) |
|---|
| M. alba (crude) | 46.044 ± 0.48 | *** p < 0.001 |
| M. alba (ethyl acetate) | 32.578 ± 0.51 | *** p < 0.001 |
| M. alba (chloroformic) | 81.41 ± 0.53 | *** p < 0.001 |
| Vitamin C | 7.125 ± 0.53 | *** p < 0.001 |