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Anti-Acne Activity of Italian Medicinal Plants Used for Skin Infection PDF

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ORIGINALRESEARCH published:10November2016 doi:10.3389/fphar.2016.00425 Anti-Acne Activity of Italian Medicinal Plants Used for Skin Infection KateNelson1,JamesT.Lyles2,TracyLi2,AlessandroSaitta3,EugeniaAddie-Noye2, PaulaTyler4andCassandraL.Quave1,2,5* 1DepartmentofDermatology,EmoryUniversitySchoolofMedicine,Atlanta,GA,USA,2CenterfortheStudyofHuman Health,EmoryUniversityCollegeofArtsandSciences,Atlanta,GA,USA,3DepartmentofAgriculturalandForestSciences, UniversitàDegliStudidiPalermo,Palermo,Italy,4DepartmentofChemistry,EmoryUniversityCollegeofArtsandSciences, Atlanta,GA,USA,5AntibioticResistanceCenter,EmoryUniversity,Atlanta,GA,USA Propionibacterium acnes is implicated in the pathogenesis of acne vulgaris, which impacts >85% of teenagers. Novel therapies are in high demand and an ethnopharmacological approach to discovering new plant sources of anti-acne therapeutics could contribute to filling this void in effective therapies. The aims of our study were two-fold: (1) To determine if species identified in ethnopharmacological field studies as having traditional uses for skin and soft tissue infection (SSTI) exhibit significantlymoreactivityagainstP.acnesthanspecieswithnosuchreporteduse;and(2) Chemicallycharacterizeactiveextractsandassesstheirsuitabilityforfutureinvestigation. Extracts of Italian medicinal (for acne and other skin infection) and randomly collected Editedby: plantsandfungiwerescreenedforgrowth-inhibitoryandanti-biofilmactivityinP.acnes AdolfoAndrade-Cetto, usingbrothmicrodilutionmethods.Bioactiveextractswerechemicallycharacterizedby NationalAutonomousUniversityof HPLC and examined for cytotoxicity against human keratinocytes (HaCaTs). Following Mexico,Mexico evaluationof157extractsfrom10fungiand58plants,weidentifiedcrudeextractsfrom Reviewedby: TomCoenye, seven species exhibiting growth inhibitory activity (MICs 64–256 µg mL−1). All active GhentUniversity,Belgium extracts were examined for cytotoxicity against HaCaTs; extracts from one fungal and AdeyemiOladapoAremu, UniversityofKwaZulu-Natal, oneplantspeciesweretoxic(IC50256µgmL−1).HPLCanalysiswithchemicalstandards SouthAfrica revealed many of these extracts contained chlorogenic acid, p-coumaric acid, ellagic *Correspondence: acid,gallicacid,andtannicacid.Inconclusion,speciesusedintraditionalmedicinefor CassandraL.Quave theskinexhibitedsignificantlygreater(p<0.05)growthinhibitoryandbiofilmeradication [email protected] activity than random species, supporting the validity of an ethnobotanical approach to Specialtysection: identifying new therapeutics. The anti-acne activity of three extracts is reported for the Thisarticlewassubmittedto first time: Vitis vinifera leaves, Asphodelus microcarpus leaves, and Vicia sativa aerial Ethnopharmacology, asectionofthejournal parts. FrontiersinPharmacology Keywords: biofilms, antimicrobials, antibiotics, acne, medicinal plants, Propionibacterium acnes, Received:30August2016 ethnopharmacology Accepted:26October2016 Published:10November2016 Citation: INTRODUCTION NelsonK,LylesJT,LiT,SaittaA, Addie-NoyeE,TylerPandQuaveCL Acne vulgaris is a common skin disorder affecting more than 85% of teenagers in the United (2016)Anti-AcneActivityofItalian States (James et al., 2009). While it is not a lethal or debilitating disorder, it can be painful MedicinalPlantsUsedforSkin Infection.Front.Pharmacol.7:425. and disfiguring, causing significant physiological distress, and heavy economic burden. Acne is doi:10.3389/fphar.2016.00425 associatedwithincreasesinanxiety,depression,andsuicidalideation(Dunnetal.,2011).In2001, FrontiersinPharmacology|www.frontiersin.org 1 November2016|Volume7|Article425 Nelsonetal. Anti-AcneActivityofItalianPlantsandFungi areportestimatedthatover$1billionisspenteachyearintheUS plant species of which 31 had an ethnobotanical use and on acne related health care visits and acne therapies (Lehmann 32 were random collections. The random collection extracts et al., 2001). However, these therapies are not cures, but rather had no vasorelaxation activity, but 19% of ethnobotanical waysofmanagingthisfolliculardisorder. extracts did (Slish et al., 1999). Another study focused on Current treatments fall into either two categories: topical the search for antifungal activity compared 114 extracts with or oral. Common topical treatments include benzoyl peroxide, antifungal ethnobotanical use and 183 extracts with either no retinoids, and antibiotics (i.e., erythromycin or clindamycin), ethnobotanical indication or non-fungal ethnobotanical use. In and common oral treatments include retinoids and antibiotics a series of bioassays, extracts in the ethnobotanical indication (i.e.,tetracyclineandmacrolides;Layton,2016;Zaengleinetal., group consistently had higher hit rates with the antifungal 2016).Incasesofsevereacne,combinationaltreatmentsareused, indicated extracts; 40% had antifungal activity against at least usuallyemployingbenzoylperoxide,retinoids,and/orantibiotics onefungusvs.21%ofplantswithnoanti-fungalethnobotanical together(Layton,2016;Zaengleinetal.,2016).Antibioticshave use (Svetaz et al., 2010). Similarly, a study comparing three beenusedforover50yearstotreatacneandtodayonecourseof groups,skinandsofttissueinfection(SSTI)botanicals,non-skin topicalorsystemictreatmenttypicallylasts3–6months(Walsh botanicals, and random plants, for their Staphylococcus aureus et al., 2016). Antibiotics are thought to inhibit inflammation antibacterial and anti-biofilm actions found no difference indicativeofacnewhenusedtopicallyandsystemically,aswellas between the three groups for antibacterial activity, but SSTI targetP.acneswhenusedtopically(Walshetal.,2016).Likemany ethnobotanicals had more anti-biofilm potential in S. aureus other bacteria, P. acnes is also subject to emerging antibiotic models than the random collections (Quave et al., 2008a). resistance and novel therapies are in high demand worldwide Investigating antibacterial bioactivities beyond bacteriostatic or (Sardanaetal.,2015;DelRossoandZeichner,2016;Walshetal., bactericidal action, such as pathogenesis factors, could reveal 2016).Pathogenesistargets,suchasquorumsensingandbiofilms, other mechanisms through which plant secondary metabolites are organism specific and could limit resistance development impact pathogen survival and fitness, increasing the chance of (LaSarreandFederle,2013). discoveringnewtherapeutics.Forthepurposesofclarity,herewe Biofilms contribute to the recalcitrant nature of acne by useSSTItorefertoinfectionsoftheskinandsofttissuesranging presentingaphysicalbarriertowhichfewmoleculesarecapable from mild to severe, including those that are purulent (acne, ofpenetrating,allowingthebacteriawithintopersistandcause furuncles, abscesses, carbuncles) to non-purulent (necrotizing infection(Donlan,2001;Vlassovaetal.,2011).Biofilmshavebeen infection,cellulitis,erysipelas)innature. implicated in implant-related and chronic infections (Donlan, Our research group has already demonstrated interesting 2001; Aubin et al., 2014), accounting for an estimated 80% of anti-staphylococcal activity (in terms of growth, biofilm, and microbialinfections inthebody(Sun etal.,2013).P. acneshas quorumsensinginhibitoryaction)intheQuaveNaturalProducts beendetectedinbiofilmsassociatedwithbone,jointandspinal Library(QNPL),whichincludesacollectionofplantandfungal prosthetics, breast implants, external ventricular shunts, and, extractsderivedfromnaturalingredientsusedspecificallyinthe in rare instances, cardiac devices (Aubin et al., 2014). P. acnes treatment of SSTIs—caused by a number of skin pathogenic biofilmsareassociatedwithpathogenesisofacne,withextensive bacteria, including Propionibacterium acnes—and other health biofilm growth being associated with acne vulgaris (Jahns and concerns in the Mediterranean and other parts of the world Alexeyev,2014).Thehighincidenceofantibioticresistanceseen (Quave et al., 2012, 2015). Extracts from Italian species in in P. acnes worldwide is thought to be due to biofilms, as well the QNPL are uniquely tied to ethnopharmacological data asthehighuseofantibiotics(Sardanaetal.,2015;Walshetal., documentedinfieldstudiesconductedbyQuaveandcolleagues, 2016).OnlyafewstudieshaveevaluatedpotentialP.acnesanti- and the detailed reports of ethnopharmacological uses of these biofilm compounds (Brackman et al., 2014; Sivasankar et al., species have been previously published (Pieroni et al., 2002, 2016) and to the best of our knowledge only one study has 2004a,b;PieroniandQuave,2005;Quaveetal.,2008b). evaluatedmedicinalplantsforanti-biofilmactivity(Coenyeetal., TheQNPLhasonlybeentestedagainstalimitednumberof 2012). Medicinal plants, in particular, may present a unique pathogensresponsibleforSSTIs,andhasneverbeenscreenedfor source of new therapeutic options. Many studies have been activityagainstP.acnes.Inthisstudy,wecomparetheactivityof dedicated to documentation of traditional uses of medicinal ItalianplantsandfungiintheQNPLthatwereidentifiedasbeing plants for managing dermatological conditions, and these may usedintraditionalmedicineforthetreatmentofacneandother representastrongstartingpointfordrugdiscoveryresearchon skininfectionstoarandomcollectionofItalianspecieswithno thistopic(Pieronietal.,2004b;Quaveetal.,2008b;Caveroetal., reportedtopicalapplicationsforskininfectionorinflammation. 2013;MabonaandVanVuuren,2013;Afolayanetal.,2014;Lall The overall aim of this study is to compare activity of these andKishore,2014). two groups through examination of their anti-acne potential An ethnobotanical approach for drug discovery uses against planktonic and biofilm-associated P. acnes and evaluate traditional medicine, historical texts or traditional healers, active extracts for future investigation. We hypothesize that as a guide toward potentially medicinal plant species. A extracts from medicinal plants or fungi used for the traditional number of studies addressing different biological targets have treatmentofSSTIswilldemonstrategreateranti-bacterialactivity demonstrated that an ethnobotanical approach to identifying against P. acnes (in terms of killing planktonic cells and bioactivecompoundsinplantsismoreefficaciousthanarandom eradicatingbiofilms)thanthosewithnoreportedapplicationto search. More than 15 years ago, Slish et al. (1999) compared theskin. FrontiersinPharmacology|www.frontiersin.org 2 November2016|Volume7|Article425 Nelsonetal. Anti-AcneActivityofItalianPlantsandFungi MATERIALS AND METHODS thenpreparedatastockconcentrationof10mgmL−1 indH O 2 andfilteredat0.2µmpriortouseinbioassays.Fungalextracts Plant and Fungal Materials werepreparedin100%MeOHordH Obydoublesonicationat 2 PlantmaterialswerecollectedinSpring-Summer(May–August) room temperature for 20 min at a ratio of 1 g:10 mL, followed over a period of 2006–2013 from the Vulture Alto-Bradano by filtration, concentration and stock preparation as described region of Basilicata, Italy and imported to the United States for plant extracts. In addition to the crude extracts, we also (US) under US Department of Agriculture permits (PCIP-14- included bioactive fractions 220D-F2 (from Rubus ulmifolius) 00388; PDEP-09-0228; DP63438). All specimens were collected and 224C-F2 (from Castanea sativa) in the panel of tested following the World Health Organization (WHO) guidance extracts.Themethodsforcreationoftheserefinedfractionshave on the collection of wild medicinal plants (WHO, 2003). beenpreviouslypublished(Quaveetal.,2012,2015). All collections were made on private lands with permission of landowners. Voucher specimens were deposited at the Microbial Strains and Culture Conditions Herbarium Lucanum (HLUC) at the Universitá della Basilicata The P. acnes isolate was obtained from the American Type inPotenza,Italy,andtheEmoryUniversityHerbarium(GEO)in Culture Collection (ATCC(cid:13)R 6919TM). The strain was streaked Atlanta,GA,USA.Identificationofspeciesfollowedthestandard from freezer stock onto Tryptic soy agar plates (TSA) Italian flora (Pignatti, 2002), and family assignments followed supplemented with 5% sheep blood (BD, Franklin Lakes, NJ) the Angiosperm Phylogeny Group III guidance (Tropicos.Org, and incubated at 37◦C for 72 h prior to making liquid cultures 2015).Bulkmaterialswereseparatedbypart(e.g.,leaves,stems, in brain heart infusion (BHI) broth (BD, Franklin Lakes, NJ) flowers,roots),cutintosmallpieceswithclippers,andthendried supplemented with 1% dextrose (Fisher Scientific, Waltham, in a plant drier with a heat source (35◦C) and fan for 48–72 h, MA)(additional72hincubation)foruseinthebelowdescribed untilcompletelydried.Sampleswerepackedwithsilicapackets assays.Allculturesweregrowninanaerobicchambersusingthe andvacuumsealedbeforeshippingtothelabforextractionand EZAnaerobeChamber(BD,FranklinLakes,NJ)andGasPakEZ analysis. Upon arrival, plant materials were ground into a fine Anaerobecontainersachets(BD,FranklinLakes,NJ). powderusingaWileymill(2mmmeshsize;WileyScientific). FungiwerecollectedinDecember2013andApril–November Minimum Inhibitory Concentration (MIC) 2014 from locations in Sicily and imported to the US under for Growth USDA permit (P526P-14-02182). Fungal collections were made There are no established Clinical and Laboratory Standard in broad-leaved and coniferous forests, preserved in paper Institute(CLSI)guidelinesforMICtestinginP.acnes.Thus,we bags and then transported to the laboratory, dried, and followedpreviouslydescribedmethodswithsomemodifications identified. Identification of fungi was carried out using fresh (Tsaietal.,2010).Briefly,liquidculturewasstandardizedto5× or dried sporomes using European monographs (Ryvarden 107CFUmL−1byopticaldensity(0.05atOD )infreshBHI 590nm andGilbertson,1993–1994).Speciesnomenclaturefollowedthe supplemented with 1% dextrose, and this was confirmed with Index Fungorum (IF, 2015). Bulk materials were dried and platecounts.OurinitialscreenoftheQNPLwasundertakenin processed as described above. Retention vouchers of the fungal 96-wellplates(GreinerBio-OneInternational,Monroe,NC)ata materialarestoredintheQuavelab. finalwell-concentrationof256µgmL−1(<1.28%DMSOinwell) Extractsfromspeciesincludedinthisstudyweresortedinto inatotalwellvolumeof200µL.TheOD ofplateswasread 600nm groupsbasedonhistoryoftraditionaluseforornotforacneand with a Cytation 3 multimode plate reader (BioTek, Winooski, other SSTI treatments, as documented in previously published VT)priortoincubatingunderanaerobicconditionsfor72hat findings from ethnopharmacological field studies conducted in 37◦C. A second OD read was taken at 72 h post-inoculation, Italy (Pieroni et al., 2002, 2004a,b; Pieroni and Quave, 2005; andthefinalpercentinhibitionofgrowthwasdeterminedusing Quave et al., 2008b). Importantly, these prior studies included apreviouslyreportedformula(Quaveetal.,2008a)whichtakes reportsofvoucherspecimens,use-citations,anddetaileddataon intoaccountanyinterferenceduetocolorofthetestextracts.The localpreparationandapplicationofthenaturalremedies. mostactiveextracts(%inhibition≥50%)wereretestedbyserial dilution from 2 to 256 µg mL−1 to determine concentrations Natural Product Extractions required for MIC and MIC . The MIC and MIC values 50 90 50 90 Crude plant extracts were made as macerations in either 95% weredefinedastheminimumconcentrationnecessarytoachieve EtOHor100%MeOHwitharatioof1g(plantmaterial):10mL ≥50and≥90%inhibitionofgrowth,respectively. organic solvent for two successive periods of 72 h, with daily Minimum Biofilm Eradication agitation. Filtered extracts were combined and concentrated at reduced pressure with rotary evaporators (<40◦C water bath Concentration (MBEC) temperature), shell frozen, and then lyophilized. Extracts were Apreviouslydescribedmethodwasfollowedwithmodifications then suspended in DMSO at a stock concentration of 10mg (Coenyeetal.,2007).Briefly,liquidculturewasstandardizedas mL−1priortobioassaytesting,withDMSOrepresenting<1.28% described above for MIC testing. Biofilms were established in of the final well volume for all tests. Aqueous extracts were tissueculturetreatedU-bottom96-wellplates(TPP,Trasadingen, created by boiling ground plant material in dH O for 20 min Switzerland). Following 24 h incubation under anaerobic 2 (ratio of 1 g:10 mL), followed by filtration, rotary evaporation conditions,mediawasgentlyaspiratedbymanualpipettingand and lyophilization as described above. Aqueous extracts were extract treated media or control -resveratrol (MP Biomedicals, FrontiersinPharmacology|www.frontiersin.org 3 November2016|Volume7|Article425 Nelsonetal. Anti-AcneActivityofItalianPlantsandFungi Santa Ana, CA), was added. Initial screens were conducted Santa Clara, CA) with an Agilent ZORBAX Eclipse XDB- at a final well-concentration of 256 µg mL−1 in a total well C18 (250 mm × 4.6 mm, 5 µm) column (Santa Clara, CA) volumeof100µL.Establishedbiofilmswereexposedtoextract with compatible guard column at a column temperature of treatmentfor24hunderanaerobicconditions,andthenmedia 35◦C. Mobile phase reagents were HPLC grade and purchased was aspirated, wells gently rinsed with PBS, heat-fixed at 37◦C from Fisher Scientific (Waltham, MA), except for the Type 1 for 60 min in an oven and stained with crystal violet (Hardy water, which was obtained from an EMD Millipore MILLI- Diagnostics, Santa Maria, CA) for 15 min. Excess crystal violet Q water system (Billerica, MA). Mobile phase consisted of a was washed off the plates in water and the plates were dried linear gradient elution 0.1% formic acid in water (A) and 0.1% prior to eluting the stain with 10% Tween 80 (2.5% aqueous formic acid in acetonitrile (B) at a flow rate of 2 mL min−1. preparation) in EtOH. The eluate was diluted at a ratio of 1:10 Initial conditions were 95:5 (A:B) changing to 63:37 (A:B) at in PBS and the final OD measured with a plate reader. 40 min, to 100% B at 80 min and held until 90 min. Samples 595nm The most active extracts (% inhibition ≥50%) were retested by were prepared in MeOH and 10 µL or 20 µL injections were serial dilution from 2 to 256 µg mL−1 to determine MBEC made.Chromatogramsweremonitoredat254nmand280nm. 50 andMBEC .TheMBEC andMBEC valuesweredefinedas Authentic standards were used to aid in peak identification by 90 50 90 theminimumconcentrationnecessarytoachieve≥50and≥90% comparison of retention times and UV profiles. Caffeic acid, eradicationofattachedbiofilm,respectively. chlorogenicacid,p-coumaricacid,ellagicacid,ferulicacid,and resveratrol were purchased from MP Biomedicals (Solon, OH) at≥98%purity.GallicacidwaspurchasedfromAcrosOrganics Cytotoxicity Analysis (NJ) at 98% purity. ACS grade tannic acid from Sigma Aldrich Human immortalized keratinocytes (HaCaT) were used to (St. Louis, MO) was characterized prior to use by HPLC-PDA evaluate the potential skin toxicity of the most active extracts analysis. identifiedviaMICandMBECtesting.Cellsweremaintainedin Liquid chromatography-Fourier transform mass Dulbecco’smodifiedEagle’smediumwithglucoseat4.5gL−1and spectrometry (LC-FTMS) was performed on the MeOH L-glutamine(Corning,Corning,NY).Mediawassupplemented extract of Hapalopilus rutilans using a Shimadzu SIL-ACHT with10%heat-inactivatedfetalbovineserum(Seradigm,Randor, (Kyoto, Japan) and Dionex 3600SD HPLC pump (Sunnyvale, PA) and a solution of 100 IU Penicillin and 100 µg mL−1 CA) with the above described chromatographic conditions. Streptomycin(Corning,Corning,NY).Cellswereculturedin75 The data was acquired in MS1 mode scanning from m/z 150 cm2 flasksincubatedat37◦Cwith5%CO .Asolutionof0.25% 2 to 1500 on a Thermo Scientific LTQ-FT Ultra MS (Waltham, trypsin and 0.1% EDTA in HBSS (Corning, Corning, NY) was MA)innegativeESImodeandprocessedwithThermoScientific usedtodetachcellsfromthebottomoftheflaskbeforesplitting Xcalibur 2.2 SP1.48 software (San Jose, CA). The capillary andplating. temperatureandvoltagewere275.0◦Cand−19.00V,sheathgas After reaching at least 80% confluence in the flask, cells of60,sourcevoltage5.0kV,andsourcecurrent100.0µA. were seeded to a 96-well tissue culture plate (Fisher Scientific, Waltham, MA). Cells were resuspended, counted with a Statistical Analyses hemocytometer, and standardized to a concentration of 4 × Percent inhibition of growth and biofilm formation (screening 104 cells per mL (8 × 103 cells per final 200 µL well volume). concentrationof256µgmL−1)wascomparedforextractssorted Plateswereincubatedfor48hat37◦Cwith5%CO .Following 2 into two groups: plants used for SSTI and plants those not incubation, the medium was aspirated, replaced with fresh documentedforthisuse.GraphPadPrismsoftwarewasusedto medium, and sterile filtered extracts and the vehicle control conduct statistical tests. A Student’s t-test (unpaired, 2-tailed), (DMSO) were serially diluted from 2 to 256 µg mL−1. Plates wasconductedtocomparepercentinhibitoryactivityofthetwo wereincubatedfor24hat37◦Cwith5%CO2.Cytotoxicitywas groups,withp<0.05consideredsignificant.Asecondanalysis determinedwithaLDHAssayKit(G-Biosciences,St.Louis,MO) ofthedatawasalsoperformedfollowingtheremovalofmultiple following manufacturer’s protocol. Briefly, after 24 h, 20 µL of outliersbytheROUTmethod,whichwasmoresuitabletothis lysis buffer was added in triplicate and the plate was incubated analysis than the Grubbs’ method as it accounts for multiple for another 45 min. Plates were centrifuged at 1500 rpm for 4 outliers (Barnett and Lewis, 1994; Motulsky and Brown, 2006). min.Followingcentrifugation,50µLofsupernatantfromeach Thefalsediscoveryrate,or“Q,”wassetto1%forthisprocedure. well was transferred to a new 96-well plate, mixed with 50 µL ofsubstratemixandincubatedfor20minwhilebeingprotected RESULTS from light. After incubation, 50 µL of stop solution was added toallwells,andabsorbancewasrecordedat490nmwithaplate A total of 10 fungal species, distributed across 10 genera and 6 reader. families,and58plantspecies,distributedacross55generaand32 familieswereextractedandevaluatedforgrowthinhibitionand Characterization of Active Extracts biofilm eradication activity against P. acnes. Seventeen of these Preliminary characterization of the most active extracts, which species have been documented in the ethnobiological literature either exhibited a MIC or MBEC , was pursued by HPLC. asbeingusedintherapiesforSSTIs(Pieronietal.,2002,2004a,b; 50 50 TheanalysiswasperformedonanAgilent1260Infinitysystem PieroniandQuave,2005;Quaveetal.,2008b);thesearedenoted running OpenLab CDS ChemStation (Agilent Technologies, witha“+”intheSSTIcolumnofTable1. FrontiersinPharmacology|www.frontiersin.org 4 November2016|Volume7|Article425 Nelsonetal. Anti-AcneActivityofItalianPlantsandFungi TABLE1|Minimuminhibitoryconcentrations(MICs)ofplantextracts(µgmL−1)againstPropionibacteriumacnes(ATCC6919). Taxa[vouchercode] CommonName SSTIuse‡ PartExtracted† ExtractionSolvent MIC50 MIC90 FUNGI Amanitaceae Amanitacaesarea(Scop.)Pers.[AS-19] Caesar’smushroom − fb MeOH − − Ganodermataceae Ganodermalucidum(Curtis)P.Karst.[AS-10] Lingzhimushroom − fb MeOH − − H2O − − Gleophyllaceae Gloeophyllumsepiarium(Wulfen)P.Karst.[AS-4] − − fb MeOH − − Hymenochaetales Fuscoporiatorulosa(Pers.)T.Wagner&M.Fisch.[AS-1] − − fb H2O − − Trichaptumbiforme(Fr.)Ryvarden[AS-12] − − fb MeOH − − H2O − − Meripilaceae Meripilusgiganteus(Pers.)P.Karst.[AS-11] Giantpolypore − fb MeOH − − H2O − − Polyporaceae Coriolopsisgallica(Fr.)Ryvarden[AS-13] − − fb MeOH − − H2O − − Fomesfomentarius(L.)Fr.[AS-4] Tinderfungus − fb MeOH − − H2O − − Hapalopilusrutilans(Pers.)Murrill[AS-5] Tendernesting − fb MeOH 128 256 polypore H2O − − Trametesversicolor(L.)Lloyd[AS-8] Turkeytail − fb MeOH − − H2O − − PLANTAE Adoxaceae SambucusebulusL.[CQ-180] DwarfElder + infl EtOH − − MeOH − − le EtOH − − MeOH − − st EtOH − − SambucusnigraL.[CQ-151] Elderberry + fr EtOH − − MeOH − − le EtOH − − MeOH − − wp EtOH − − infl MeOH − − Amaryllidaceae AlliumcepaL.[CQ-206] Onion + le;bu EtOH − − MeOH − − Apiaceae DaucuscarotaL.[CQ-215] QueenAnne’slace − le;st EtOH − − MeOH − − infl;infr EtOH − − FerulacommunisL.[CQ-214] Giantfennel − fr EtOH − − st EtOH − − MeOH − − infl MeOH − − ro MeOH − − Foeniculumvulgaresubsp.piperitumCout.[CQ-192] Fennel − le;st EtOH − − (Continued) FrontiersinPharmacology|www.frontiersin.org 5 November2016|Volume7|Article425 Nelsonetal. Anti-AcneActivityofItalianPlantsandFungi TABLE1|Continued Taxa[vouchercode] CommonName SSTIuse‡ PartExtracted† ExtractionSolvent MIC50 MIC90 Foeniculumvulgaresubsp.vulgare[CQ-196] Fennel − le;st EtOH − − MeOH − − Apocynaceae VincamajorL.[CQ-139] Bigleafperiwinkle − le;st;ro MeOH − − Araceae ArumitalicumMill.[CQ-175] Italianlordsand − st EtOH − − ladies fr EtOH − − sta EtOH − − le EtOH − − MeOH − − Asparagaceae Leopoldiacomosa(L.)Parl.[CQ-105] Tasselhyacinth − le;infl MeOH − − bu MeOH − − Asteraceae AchilleamillefoliumL.[CQ-176] Commonyarrow + infl EtOH − − le;st EtOH − − le;st;fl EtOH − − MEOH − − Anacyclustomentosus(Gouan)DC.[CQ-167] Whitebuttons − le;st;fl EtOH − − CichoriumintybusL.[CQ-161] Chicory − le;st;fl EtOH − − ScolymushispanicusL.[CQ-199] Common − le;st;fl EtOH − − goldenthistle MeOH − − TussilagofarfaraL.[CQ-202] Coltsfoot − le;st;ro EtOH − − le;st;fl MeOH − − Brassicaceae Cardariadraba(L.)Desv.[CQ-108] Whitetop − fl;st;le;ro MeOH − − Caprifoliaceae DipsacusfullonumL.[CQ-201] Fuller’steasel − le;st EtOH − − MeOH − − fl EtOH − − KnautiaarvensisJ.M.Coult.[CQ-190] Fieldscabiosa − le;st;fl EtOH − − KnautialucanaLacaita&Szabó[CQ-166] − − le;st;fl EtOH − − MeOH − − LoniceraalpigenaL.[CQ-213] Alpinehoneysuckle − wp EtOH − − MeOH − − le EtOH − − Caryophyllaceae SaponariaofficinalisL.[CQ-210] Bouncingbet − le;st;fl EtOH − − MeOH − − Dennstaedtiaceae Pteridiumaquilinum(L.)Kuhn[CQ-211] Western − st MeOH − − brackenfern Fabaceae AcaciadealbataLink[CQ-115] Silverwattle − infl MeOH − − le MeOH − − st MeOH − − AnthyllisvulnerariaL.[CQ-147] Common − le;st;fl EtOH − − kidneyvetch MeOH − − AstragalusmonspessulanusL.[CQ-112] Montpelliermilk − fl;le;ro;st EtOH − − vetch MeOH − − (Continued) FrontiersinPharmacology|www.frontiersin.org 6 November2016|Volume7|Article425 Nelsonetal. Anti-AcneActivityofItalianPlantsandFungi TABLE1|Continued Taxa[vouchercode] CommonName SSTIuse‡ PartExtracted† ExtractionSolvent MIC50 MIC90 CoronillaemerusL.[CQ-137] Scorpionsenna − wst EtOH − − MeOH − − le;fl MeOH − − MelilotusalbusMedik.[CQ-193] Sweetclover − le;st;fl EtOH − − MeOH − − Trifoliumspp.[CQ-185] − − le;st;fl EtOH − − MeOH − − RobiniapseudoacaciaL.[CQ-155] Blacklocust − le MeOH − − Viciasativasubsp.sativa[CQ-119] Gardenvetch − le;st;fl MeOH 128 256 Fagaceae CastaneasativaMill.[CQ-191] SweetChestnut + le EtOH 256 − MeOH 256 − *Fraction224C-F2 256 256 H2O − − gle EtOH − − MeOH 256 − wp EtOH − − MeOH 128 − QuercuscerrisL.[CQ-228;CQ-301] Europeanturkeyoak − st;fr EtOH − − le MeOH − − Gentianaceae Centauriumpulchellum(Sw.)Druce[CQ-217] Branchedcentaury − le;ro;st;fl EtOH − − Hypericaceae HypericumperforatumL.[CQ-183] St.John’sWort + le;st;fl EtOH − − MeOH − − Juglandaceae JuglansregiaL.[CQ-181] Walnut + le EtOH − − MeOH − − wp EtOH 256 256 MeOH 128 256 imfr MeOH − − Juncaceae JuncusarticulatusL.[CQ-216] Jointleafrush − le;fr EtOH − − Lamiaceae BallotanigraL.[CQ-160] Blackhorehound + ro MeOH − − le MeOH − − st MeOH − − MarrubiumvulgareL.[CQ-170] Horehound + ro MeOH − − le;st;fl MeOH − − MenthaspicataL.[CQ-224] Spearmint − le;st;fl EtOH − − RosmarinusofficinalisL.[CQ-113] Rosemary + le;st;fl MeOH 128 256 Liliaceae LiliumcandidumL.[CQ-174] Madonnalily − infl EtOH − − Malvaceae MalvasylvestrisL.[CQ-156] Commonmallow + le MeOH − − st MeOH − − Moraceae FicuscaricaL.[CQ-173] Ediblefig + le EtOH − − wp EtOH − − MeOH − − imfr MeOH − − (Continued) FrontiersinPharmacology|www.frontiersin.org 7 November2016|Volume7|Article425 Nelsonetal. Anti-AcneActivityofItalianPlantsandFungi TABLE1|Continued Taxa[vouchercode] CommonName SSTIuse‡ PartExtracted† ExtractionSolvent MIC50 MIC90 Nyctaginaceae MirabilisjalapaL.[CQ-222] Fouro’clockflower − le;fl;fr EtOH − − MeOH − − Oleaceae OleaeuropaeaL.[CQ-197] Olive − wp EtOH − − MeOH − − le MeOH − − Plantaginaceae PlantagomajorL.[CQ-225] Boradleafplantain + le;ro;fl;st EtOH − − MeOH − − Poaceae Agropyronrepens(L.)P.Beauv.[CQ-208] Couchgrass − le;st;ro EtOH − − ArundodonaxL.[CQ-146] Giantreed + le;st MeOH − − in MeOH − − Ranunculaceae DelphiniumfissumWaldst.[CQ-187] − − le;st;fl;fr EtOH − − RanunculusacrisL.[CQ-135] Meadowbuttercup − le;st;fl MeOH − − Rosaceae PrunusspinosaL.[CQ-163] Blackthorn - wp;le EtOH − − fr MeOH − − Rosacaninavar.canina[CQ-152] Dogrose wp MeOH − − 80%MeOH − − ga MeOH − − le 80%MeOH − − fr MeOH − − le;fl 80%MeOH − − RubusulmifoliusSchott. Elmleafblackberry + ro EtOH − − *Fraction220D-F2 − − MeOH − − wst EtOH − − Rubiaceae GaliumverumL.[CQ-177] Yellowbedstraw + le;st;fl EtOH − − MeOH − − Scrophulariaceae VerbascumthapsusL.[CQ-172] Greatmullein − le MeOH − − Ulmaceae UlmusminorMill.[CQ-195] Fieldelm − wp EtOH − − MeOH − − le MeOH − − Vitaceae Vitisviniferavar.aglianico[CQ-209] Grapevine − le MeOH 64 64 Xanthorrhoeaceae AsphodelusmicrocarpusSalzm.&Viv.[CQ-109] - + infl MeOH − − le MeOH 128 128 ANTIBIOTICCONTROLS Clindamycin 0.25 2 Erythromycin 0.063 2 Resveratrol 100 100 PartExtracted†:bu,bulb;fl,flowers;gle,gallinfectedleaves;imfr,immaturefruit;in,internodes;infl,inflorescence;infr,infructescence;fb,fruitingbody;ga,galls;le,leaves;ro,roots; st,stems;sta,stalk;wp,woodyparts;wst,woodystem.SSTIuse‡:“+”indicatesthatthereisadocumentedethnobotanicaluseforskinandsofttissueinfections(SSTI)orskin inflammationsforthisspecies;“−“indicatesnodocumenteduseforSSTIs.*Theextractionprotocolfor224C-F2and220D-F2havebeenpreviouslypublished(Quaveetal.,2012, 2015).TheMICforgrowthisrepresentedatMIC50(orat50%inhibitionofthegrowthcontrol)orMIC90for90%inhibition.“−“indicatesthattheMIC50wasnotdetectedinthe concentrationrangetested(2-256µgmL−1).NoneoftheextractstestedexhibitedMBEC50withinthetestedconcentrationrange,andthusthiscolumnisomittedfromthetable. FrontiersinPharmacology|www.frontiersin.org 8 November2016|Volume7|Article425 Nelsonetal. Anti-AcneActivityofItalianPlantsandFungi Anti-Bacterial Activity other extracts tested exhibited limited to no toxicity at the GrowthInhibition concentrationsnecessaryforantibacterialactivity. MIC and MIC values were detected for one fungus 50 90 (Hapalopilus rutilans) and 6 plants (Vicia sativa subsp. sativa, Chemical Characterization of Active C.sativa,Juglansregia,Rosmarinusofficinalis,Vitisviniferavar. Extracts aglianico,andAsphodelusmicrocarpus)atthetestedrange(2–256 We used a panel of ubiquitous chemical standards in effort to µgmL−1).Theextractionmethodandplantorfungaltissue(s) provide basic chemical characterization of extracts of interest. extracted for each species, as well as all MICs for extracts and The most bioactive extracts were examined for the presence controlsarereportedinTable1. of caffeic acid (1), chlorogenic acid (2), p-coumaric acid (3), Themostactiveextractintermsofgrowthinhibitionincluded ellagic acid (4), ferulic acid (5), gallic acid (6), resveratrol (7), aleafextractofV.viniferavar.aglianico,withaMIC andMIC 50 90 and tannic acid (8) by comparison with authentic standards valueof64µgmL−1.ExtractswithMIC valuesof128µgmL−1 50 by HPLC-DAD. The presence or absence of these standards in included Hapalopilus rutilans (MeOH extractof fruiting body), extracts is reported in Table2. Several extracts derived from C. V. sativa subsp. sativa (MeOH extract of aerial parts), J. regia sativawereactiveasgrowthinhibitorsforP.acnes.Ellagicacid (MeOHextractofwoodyparts),R.officinalis(MeOHextractof (4)andgallicacid(6)werebothdetectedinalloftheC.sativa aerialparts)andA.microcarpus(MeOHextractofleaves).Several extracts (SupplementaryFigure1B). More detailed chemical extracts derived from the leaves and woody parts of C. sativa characterization of the most active extract fraction, 224C-F2, is alsoexhibitedMIC valuesrangingfrom128to256µgmL−1. 50 reported in a recent publication concerning its anti-virulence PositivecontrolsclindamycinanderythromycinexhibitedMIC 50 effectsagainstS.aureus(Quaveetal.,2015). of0.25µgmL−1and0.063µgmL−1,respectively,andMIC of 90 The H. rutilans extract underwent further characterization 2µgmL−1,whileresveratrolexhibitedanMIC50 andMIC90 of usingnegativeESILC-FTMS.The[M-H]−for9wasdetermined 100µgmL−1. tobe291.06755,providinganempiricalformulaofC H O (1 18 11 4 2.365). Comparison with published literature identified 9 as BiofilmEradication the antitumor and dihydroorotate dehydrogenase inhibitor None of the extracts tested exhibited at least 50% eradication polyporic acid, which can account for up to 40% of the fungal of mature biofilm within the tested concentration range. The fruitingbody’smass(Kraftetal.,1998). positive control for biofilm eradication (resveratrol) exhibited MBEC andMBEC of100µgmL−1. 50 90 DISCUSSION ComparisonofActivityBasedonTraditionalUse Initial screening of Italian plants and fungi in the QNPL was The central aim of this study was to determine whether or conductedat256µgmL−1,resultinginpercentinhibitionvalues not extracts that are derived from plants or fungi used in for both growth and biofilm. Extracts were sorted into two topical skin therapeutics for acne and other forms of SSTI in groups, based on history of traditional medicinal use for acne traditionalmedicinewouldhavegreateractivityagainstP.acnes andotherSSTIsinItaly.Extractsfromplantsusedintraditional than specimens from a random sample. Our hypothesis was therapies for skin infections exhibited a mean value of 38% supported; we found that extracts of plants used for traditional inhibitionofgrowth,whichwassignificantlygreater(p<0.001) anti-infectiveskintherapeuticshadasignificantlygreaterimpact than that of extracts from randomly selected plants and fungi on planktonic growth and on mature biofilms of P. acnes than (12%), Figure1A. Likewise, there was a significant difference extractsfromrandomsamples(includingmedicinalplantsused (p < 0.05) in biofilm eradicating activity between both groups forotherpurposesunrelatedtotheskin).Here,wediscusssome (10% in SSTI versus 5% in random, Figure1B). Outliers in of the specific sources of bioactivity reported in this study and the data set were also identified and removed by the ROUT makerecommendationsforfutureinvestigation. methodandthenreassessedusingaStudent’st-test.Fiveoutliers Ofthe157extractsscreenedinthisstudy,12exhibitedmore were identified and removed from the growth inhibitory data, than50%growthinhibitionatthetestconcentrationrange.These and the groups were found to be significantly different (p < twelvecamefromonefungusandsixplantspecies.Thebioactive 0.0001),Figure1C.Threeoutlierswereidentifiedandremoved fungal species is a polypore fungus, and is also known by the inthebiofilmdatasets,alsoreconfirmingasignificantdifference commonnamesoftendernestingpolypore,purpledyepolypore, betweengroups(p<0.001),Figure1D. orthecinnamonbracket.Whilesomeotherpolyporefungi(i.e., Trametes versicolor, also known as Turkey tail) can play an Mammalian Cytotoxicity important role as cosmetic or cosmeceutical ingredients (Hyde Extracts with MIC values detected were examined for et al., 2010), to the best of our knowledge, there are no reports 50 cytotoxicityagainstanimmortalizedlineofhumankeratinocytes ofsuchusesforH.rutilans.Althoughnothinghasbeenreported at a test range of 2–256 µg mL−1 in order to determine concerningtopicaltoxicityorcontactdermatitiswiththisspecies, whether the observed antibacterial activity was due to specific multiplereportsonpoisoningeventsfollowingconsumptionof antibacterial action or general toxicity. The only extracts to this fungus have been reported, and include symptoms such exhibit an IC came from J. regia and Hapalopilus rutilans, as purple discoloration of the urine, nausea, vomiting, blurred 50 both at the highest test dose of 256 µg mL−1 (Figure2). All visions, hallucinations, and even death (Kraft et al., 1998; Villa FrontiersinPharmacology|www.frontiersin.org 9 November2016|Volume7|Article425 Nelsonetal. Anti-AcneActivityofItalianPlantsandFungi FIGURE1|Extractswerescreenedforpercentinhibitoryactivityagainst(A)growthand(B)biofilmataconcentrationof256µgmL−1.Outlierdatapoints wereidentifiedusingtheROUTmethod,removedandthedata-setreanalyzedfor(C)growthand(D)biofilmactivity.*p<0.05;**p<0.01;***p<0.001;****p< 0.0001. etal.,2013).Suchneurotoxiceffectshavebeenattributedtothe growthinhibitoryactivityobservedastheMICfortheseagainst high content of polyporic acid in the fungus, which was also anotherstrainofP.acneswasreportedas800,1800,and1000µg identifiedastheprincipalcomponentoftheextractevaluatedin mL−1,respectively(Patiletal.,2012).While7wasnotdetectedin thepresentstudy(65.74%ofthecrudeextract,representing5.7% thisleafextract,itisknowntobefoundingrapevine,particularly ofdrymassofthefruitingbody).Whiletheextractofthisspecies thegrapeskin.Ithasbeenidentifiedashavinggrowthinhibitory inhibited P. acnes growth (MIC 128 µg mL−1) and inhibited and biofilm-eradicating activity against P. acnes (Coenye et al., 50 mature biofilm by 45% at a concentration of 256 µg mL−1, it 2012). This is the first report of grape leaf extracts exhibiting alsoexhibitedcytotoxicitytoskincells(HaCaT)(IC of256µg growth inhibitory effects. The interactions between grapevine 50 mL−1)atornearconcentrationsinhibitorytoP.acnes,suggesting and P. acnes are quite interesting, especially considering recent thattheactivityobservedisduetogeneraltoxicityoftheextract. phylogenetic and population genetic research that suggests a While none of the plant species examined were effective at horizontal interkingdom transfer of this human opportunistic eradicatingmatureP.acnesbiofilm,wedididentifyfivespecies pathogentograpevineasanobligateendophyteduringtheperiod withgrowthinhibitoryactivityatconcentrationsthatwerenon- inwhichthisspecieswasdomesticatedbyhumans(Campisano toxic to HaCaTs. The most active was a leaf extract from the etal.,2014).Furtherstudiesonanti-acneactivityofthisextract aglianicograpevarietal(V.viniferavar.aglianico)withaMIC anditsindividualconstituentsarewarranted. 50 andMIC of64µgmL−1.Nocytotoxicitywasdetectedagainst Another active extract came from V. sativa subsp. sativa 90 HaCaT cells at that concentration and only 40% cytotoxicity (Garden vetch), and it exhibited a MIC and MIC against 50 90 wasreachedatthehighestconcentrationtested(256µgmL−1). P.acnesatconcentrationsof128and256µgmL−1,respectively. Amongthestandardsincludedinourchemicalcharacterization TheIC forcytotoxicitytoskincells(HaCaT)wasnotdetectable 50 studies, 3, 4, 6, and 8 were all detected in this extract. It is atthistestrange.HPLCanalysisrevealedlowlevelsof6and8,as unlikely that 4, 6, or 8 were individually responsible for the well as a number of larger peaks that should be prioritized for FrontiersinPharmacology|www.frontiersin.org 10 November2016|Volume7|Article425

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extracts from medicinal plants or fungi used for the traditional treatment of SSTIs will until completely dried. Samples were packed with silica packets.
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