Oxidative Medicine and Cellular Longevity
Volume 2018 (2018), Article ID 3914384, 10 pages
https://doi.org/10.1155/2018/3914384

Research Article

Monolluma quadrangula Protects against Oxidative Stress and Modulates LDL Receptor and Fatty Acid Synthase Gene Expression in Hypercholesterolemic Rats

May N. Bin-Jumah

Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

Correspondence should be addressed to May N. Bin-Jumah; may_binjumah@outlook.com

Received 9 July 2018; Accepted 16 August 2018; Published 30 September 2018

Academic Editor: Ayman M. Mahmoud

Copyright © 2018 May N. Bin-Jumah. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Hypercholesterolemia is a metabolic disorder associated with oxidative stress. The present study investigated the protective effect of Monolluma quadrangula extract on hypercholesterolemia-induced oxidative stress in the liver and heart of high-cholesterol-diet- (HCD-) fed rats. The experimental animals received HCD for 10 weeks and were concurrently treated with 300 or 600 mg/kg M. quadrangula extract. HCD-fed rats showed a significant increase in serum triglycerides, total cholesterol, LDL-cholesterol, vLDL-cholesterol, and cardiovascular risk indices along with decreased HDL-cholesterol and antiatherogenic index. The M. quadrangula extract significantly improved dyslipidemia and atherogenesis in HCD-fed rats. HCD induced a significant increase in serum transaminases, creatine kinase-MB, and proinflammatory cytokines. In addition, HDC induced a significant increase in hepatic and cardiac lipid peroxidation and decreased antioxidant enzymes. Treatment with the M. quadrangula extract significantly alleviated liver and heart function markers, decreased proinflammatory cytokines and lipid peroxidation, and enhanced the antioxidant defenses. Also, the M. quadrangula extract significantly reduced the expression of fatty acid synthase (FAS) and increased the expression of LDL receptor in the liver of HCD-fed rats. In conclusion, the M. quadrangula extract has a potent antihyperlipidemic and cholesterol-lowering effect on HCD-fed rats. The beneficial effects of the M. quadrangula extract were mediated through the increased antioxidant defenses, decreased inflammation and lipid peroxidation, and modulated hepatic FAS and LDL receptor gene expression.

1. Introduction

Hyperlipidemia is a lipid metabolism disorder associated with the development of atherosclerosis and cardiovascular disease [1, 2]. Excessive consumption of foods containing high amounts of saturated fats and cholesterol is the major risk factor of hyperlipidemia [3]. Studies have reported that hyperlipidemia, particularly hypercholesterolemia, leads to atherosclerosis which is a chronic inflammatory status initiated by subendothelial retention and oxidation of low-density lipoprotein (LDL) cholesterol [4].

Dyslipidemia/hypercholesterolemia leads to increased accumulation of lipids in the liver, hence reducing its ability to lower blood lipids [2]. Studies have reported the significant role of hypercholesterolemia in inducing oxidative stress [2, 5, 6]. Increased production of free radicals and decreased enzymatic and nonenzymatic antioxidants are the main features of oxidative stress [7]. Cholesterol accumulation in endothelial cells, hepatocytes, leukocytes, erythrocytes, and platelets provokes the production of reactive oxygen species (ROS) and reduces antioxidant defenses [7, 8]. This can lead to redox imbalance, oxidative stress, and metabolic alterations [9, 10]. Therefore, agents that combine lipid-lowering and antioxidant potentials can prevent the negative impact of cholesterol on the liver, heart, and other body tissues.

Ethnopharmacological data has been the base for the discovery of natural drugs from medicinal plants [11]. Monolluma quadrangula (Forssk.) Plowes belongs to family Apocynaceae and is also known as Caralluma quadrangula [11]. Plants of the Caralluma spp. have shown different beneficial effects on the treatment of skin rashes, diabetes, snake bites, inflammation, and cancer [12–16]. M. quadrangula is a succulent plant that has been used traditionally as an appetite suppressant and as diabetes and peptic ulcer treatment. Recently, the M. quadrangula hydroethanolic extract has been reported to protect against ethanol-induced gastric ulcers and to attenuate oxidative stress in rats [17]. The mechanism of the antihypercholesterolemic effect of M. quadrangula has not been previously investigated. Therefore, we carried out this investigation to study the antihypercholesterolemic effect of M. quadrangula and its protective effect against hypercholesterolemia-induced oxidative stress in the liver and heart of rats. In addition, we studied the effect of M. quadrangula on the gene expression levels of hepatic LDL receptor (LDLR) and fatty acid synthase (FAS) in hypercholesterolemic rats.

2. Materials and Methods

2.1. Collection and Preparation of the M. quadrangula Extract

M. quadrangula was collected from Abha-Al-Taif road (Kingdom of Saudi Arabia) during the period from September to November 2017. The plant samples were identified and authenticated by an expert taxonomist. The collected samples were air-dried in shade, and the hydroethanolic extract was prepared as previously described [17]. Briefly, the dried M. quadrangula samples were ground into a fine powder and soaked in ethanol/water (1 : 1 vol/vol) for 24 hr. The mixture was filtered, and the solvent was evaporated in a rotary evaporator at temperature not exceeding 45°C. The dried extract was kept frozen at −20°C until it will be used in the animal experiments.

2.2. Experimental Animals and Treatments

Male albino Wistar rats, weighing 160–180 g, were obtained from the animal house of King Saud University (Saudi Arabia). The rats were housed in standard well-aerated cages (4 rats/cage) in controlled 12 hr dark/light cycles. The animals were provided a standard diet of known composition with free access to water. All animal procedures were approved by the ethical committee at Princess Nourah bint Abdulrahman University (Riyadh, Saudi Arabia).

After a 10-day acclimatization period, the rats were allocated into four groups, each comprising 8 rats. Group I included control rats supplied with a normal diet for 10 weeks and a daily oral dose of distilled water. Groups II–IV included rats fed with a hypercholesterolemic diet for 10 weeks. The hypercholesterolemic diet consisted of a normal diet supplemented with 2% cholesterol. Group II received distilled water daily via oral gavage for 10 weeks. Groups III and IV received 300 and 600 mg/kg body weight M. quadrangula, respectively, dissolved in distilled water via oral gavage daily for 10 weeks. The doses of M. quadrangula were selected based on the study of Ibrahim et al. [17] who showed that rats receiving up to 5 g/kg body weight M. quadrangula extract showed no signs of hepatotoxicity or nephrotoxicity and no morbidity or mortality.

2.3. Sample Collection and Preparation

At the end of the experiment, both the control and treated groups were fasted overnight and sacrificed under anesthesia. Blood samples were quickly collected in 5 ml sterilized glass tubes, were left to coagulate, and then centrifuged to separate serum. Immediately, the rats were dissected, and the liver and heart were excised, washed in cold phosphate-buffered saline (PBS), and weighed. Samples from the liver and heart were homogenized in cold 0.1 M phosphate buffer (pH 7.4) using a polytron homogenizer. The homogenate was centrifuged at 8000 rpm in a cooling centrifuge, and the clear supernatant was collected and stored at −80°C for biochemical analyses.

2.4. Assay of Liver and Heart Function Enzymes

Alanine transaminase (ALT) and aspartate transaminase (AST) were determined in serum of rats using commercial kits (Spinreact, Spain) based on the method of Reitman-Frankel [25]. Serum creatine kinase-MB (CK-MB) was determined using the commercial ELISA kit (EIAab, China) [18].

2.5. Determination of Serum Lipids and Cardiovascular Risk Indices

The levels of triglycerides [19], total cholesterol [20], and HDL-cholesterol [21] were determined in the serum of rats using a commercially available reagent kit supplied by Accurex (Mumbai, India). vLDL- and LDL-cholesterol levels were calculated using the following formulas: vLDL-cholesterol = triglycerides/5 and LDL-cholesterol = total cholesterol − (HDL-cholesterol + vLDL-cholesterol).

Cardiovascular risk indices [22] and antiatherogenic index (AAI) [23] were calculated as follows: cardiovascular risk index 1 = total cholesterol/HDL-cholesterol, cardiovascular risk index 2 = LDL-cholesterol/HDL-cholesterol, and AAI = (HDL-cholesterol × 100)/(total cholesterol − HDL-cholesterol).

2.6. Assay of Serum Cytokines and C-reactive Protein (CRP)

Serum levels of tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and CRP were determined using commercially available ELISA kits (Merck Millipore, USA) according to the provided instructions.

2.7. Assay of Lipid Peroxidation and Antioxidants

The levels of lipid peroxidation, reduced glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) were determined in the homogenates of the liver and heart following the instructions of the assay kits purchased from OxiSelect (USA).

2.8. Gene Expression Assay of LDL Receptor (LDLR) and Fatty Acid Synthase (FAS)

Quantitative polymerase chain reaction (qPCR) was used to analyze the mRNA expression levels of LDLR and FAS in the liver of control and treated rats. Total RNA was extracted using the RNA Mini kit (Bioline, USA) according to the manufacturer’s protocol. RNA was quantified using Nanodrop 8000 (Thermo Scientific, USA), and samples with a 260/280 absorbance ratio of 1.8–2.0 were reverse-transcribed into cDNA using a reverse transcription kit (Invitrogen, USA). cDNA amplification was carried out using SYBR green (Invitrogen, USA) and the following primer pairs (Metabion International AG, Germany): LDLR (F: 5-CAGCTCTGTGTGAACCTGGA-3 and R: 5-TTCTTCAGGTTGGGGATCAG-3), FAF (F: 5-CTGGACTCGCTCATGGGTG-3 and R: 5-CATTTCCTGAAGCTTCCGCAG-3), and GAPDH (F: 5-AACTTTGGCATCGTGGAAGG-3 and R: 5-TACATTGGGGGTAGGAACAC-3). The results were analyzed using the 2−ΔΔCt method of analysis as described by Livak and Schmittgen [24].

2.9. Statistical Analysis

All statistical comparisons were made by means of the one-way ANOVA test followed by Tukey’s test on GraphPad Prism (GraphPad Software, CA, USA). Results were presented as mean ± standard error (SEM), and a value less than 0.05 was considered significant.

3. Results

3.1. Effect of the M. quadrangula Extract on Serum Lipids, Cardiovascular Indices, and Antiatherogenic Index

In the present study, the effect of the M. quadrangula extract on the lipid profile in HCD-supplemented rats was evaluated as shown in Figure 1. When compared with the control group, HCD-induced rats showed a significant increase in serum levels of triglycerides (), total cholesterol (), LDL-cholesterol (), and vLDL-cholesterol (). On the other hand, HCD-induced rats showed a significant () decrease in serum levels of HDL-cholesterol (Figure 1). HCD-induced rats treated with 300 and 600 mg/kg M. quadrangula extract showed a significant () alleviation in serum levels of triglycerides, total cholesterol, LDL-cholesterol, and vLDL-cholesterol, while this treatment had a nonsignificant effect on serum HDL-cholesterol levels.

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Figure 1: Effect of the M. quadrangula extract on serum (a) triglycerides, (b) total cholesterol, (c) LDL-cholesterol, (d) vLDL-cholesterol, and (e) HDL-cholesterol of high-cholesterol-diet-fed rats. Data are mean ± SEM. The number of animals in each group is eight. and compared to control. compared to high-cholesterol diet.

HCD induced cardiac injury as shown by the significant increase in serum CK-MB level () when compared with the control rats (Figure 2(a)). Similarly, HCD-induced rats showed a significant increase in total cholesterol/HDL-cholesterol (Figure 2(b)) and LDL-cholesterol/HDL-cholesterol ratios (Figure 2(c)). On the other hand, HCD-induced rats showed significantly decreased AAI (Figure 2(d)). HCD-induced rats treated with 300 and 600 mg/kg M. quadrangula extract showed a significant () alleviation in serum levels of CK-MB and total cholesterol/HDL-cholesterol (Figure 2(b)) and LDL-cholesterol/HDL-cholesterol ratios (Figure 2(c)), and the AAI (Figure 2(d)).

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Figure 2: Effect of the M. quadrangula extract on (a) serum creatine kinase-MB, (b, c) cardiovascular risk indices, and (d) antiatherogenic index of high-cholesterol-diet-fed rats. Data are mean ± SEM. The number of animals in each group is eight. compared to control. compared to high-cholesterol diet.

3.2. Effect of the M. quadrangula Extract on Liver Function Indices

Rats receiving HCD for 10 weeks showed significantly increased ALT () and AST () levels in serum (Figure 3). Rats supplemented with the HCD and concurrently treated with 300 and 600 mg/kg M. quadrangula extract showed significantly alleviated serum ALT () and AST () levels as represented in Figure 3.

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Figure 3: Effect of the M. quadrangula extract on serum (a) ALT and (b) AST in high-cholesterol-diet-fed rats. Data are mean ± SEM. The number of animals in each group is eight. and compared to control. and compared to high-cholesterol diet.

3.3. Effect of the M. quadrangula Extract on Serum Cytokines and CRP Levels

Rats receiving HCD for 10 weeks showed a significant increase in serum TNF-α (), IL-6 (), and CRP () when compared to control rats (Figure 4). Rats supplemented with the HCD and treated with 300 and 600 mg/kg M. quadrangula extract showed significantly alleviated serum levels of TNF-α, IL-6, and CRP.

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Figure 4: Effect of the M. quadrangula extract on serum (a) tumor necrosis factor alpha (b) interleukin-6 and (c) C-reactive protein of high-cholesterol-diet-fed rats. Data are mean ± SEM. The number of animals in each group is eight. compared to control. and compared to high-cholesterol diet.

3.4. Effect of the M. quadrangula Extract on Lipid Peroxidation and Antioxidants in the Liver and Heart of HCD-Induced Rats

Lipid peroxidation level was significantly () increased in the liver (Figure 5(a)) and heart (Figure 6(a)) of rats supplemented with HCD for 10 weeks. On the other hand, levels of GSH in the liver (Figure 5(b)) and heart (Figure 6(b)) of HCD-induced rats were significantly () decreased. The antioxidants SOD and CAT showed to be significantly decreased in the liver (Figures 5(c) and 5(d)) and heart (Figures 6(c) and 6(d)) of HCD-induced rats. Rats supplemented with the HCD and treated with 300 and 600 mg/kg M. quadrangula extract showed a significant decrease in liver and heart lipid peroxidation levels and a significant alleviation in the antioxidants GSH, SOD, and CAT.

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Figure 5: Effect of the M. quadrangula extract on (a) lipid peroxidation, (b) reduced glutathione, (c) superoxide dismutase, and (d) catalase in the liver of high-cholesterol-diet-fed rats. Data are mean ± SEM. The number of animals in each group is eight. and compared to control. , , and compared to high-cholesterol diet.

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(b)

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Figure 6: Effect of the M. quadrangula extract on (a) lipid peroxidation, (b) reduced glutathione, (c) superoxide dismutase, and (d) catalase in the heart of high-cholesterol-diet-fed rats. Data are mean ± SEM. The number of animals in each group is eight. and compared to control. , , and compared to high-cholesterol diet.

3.5. Effect of the M. quadrangula Extract on Gene Expression Levels of LDLR and FAS in the Liver of HCD-Induced Rats

FAS mRNA expression analysis in the present study revealed a significant () increase in the liver of HCD-induced rats when compared with the control rats (Figure 7(a)). On the other hand, HCD-induced rats showed a nonsignificant () change in LDLR mRNA expression as represented in Figure 7(b). Treatment of the HCD-induced rats with 300 and 600 mg/kg M. quadrangula extract significantly decreased the expression of FAS () and increased the expression of LDLR () in the liver as depicted in Figures 7(a) and 7(b), respectively.

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Figure 7: Effect of the M. quadrangula extract on gene expression levels of (a) fatty acid synthase and (b) LDL receptor in the liver of high-cholesterol-diet-fed rats. Data are mean ± SEM. The number of animals in each group is eight. compared to control. compared to high-cholesterol diet.

4. Discussion

Hyperlipidemia is a lipid metabolism disorder associated with the etiopathogenesis of different diseases, including atherosclerosis, metabolic syndrome, hypertension, renal injury, and cardiovascular disease [18, 25–28]. Hypercholesterolemia has been reported to be implicated in protein glycation, oxidative modification of LDL, and lipid peroxidation [29]. In the present study, we studied the protective effect of the M. quadrangula extract against hypercholesterolemia-induced oxidative stress in the liver and heart of rats. In addition, we evaluated the effect of the M. quadrangula extract on the lipid profile and the gene expression of LDLR and FAS in the liver of hypercholesterolemic rats.

Rats receiving HCD for 10 weeks exhibited dyslipidemia and hypercholesterolemia as shown by the significant increase in serum total cholesterol, triglyceride, LDL-cholesterol, and vLDL-cholesterol levels. These results were in agreement with different studies showing developed hypercholesterolemia in HCD-fed rats [2, 5, 6]. In addition, HCD-induced rats exhibited a significant decrease in serum levels of HDL-cholesterol. Accordingly, previous reports have shown that elevated total cholesterol, LDL-cholesterol, and vLDL-cholesterol and decreased HDL-cholesterol are the common features of dyslipidemia/hypercholesterolemia irrespective of the etiology [2, 18, 30]. Dyslipidemia can also lead to increased hepatic accumulation of lipids which may reduce the ability of the liver to lower the levels of these lipid components [2]. Increased hepatic lipid accumulation in cases of hypercholesterolemia leads to hepatic cell injury [2]. In the present investigation, HCD-induced rats showed a significant increase in serum levels of ALT and AST, hence leading to liver injury. Interestingly, HCD-induced rats treated with the M. quadrangula extract showed a significant improvement in serum lipids and transaminases. These results point to the potent antihypercholesterolemic and hepatoprotective effects of the M. quadrangula extract.

Dyslipidemia/hypercholesterolemia can lead to atherosclerosis and cardiovascular disease which represent a major cause of death. Therefore, lowering blood lipids might help counteract the bad impact of hyperlipidemia on the heart. In the present study, HCD-induced rats showed different cardiovascular effects evidenced by the increased values of cardiovascular risk indices and decreased AAI. These results were supported by the increased serum levels of the heart function marker CK-MB. In contrast, HCD-induced rats treated with the M. quadrangula extract showed significantly improved serum CK-MB levels, cardiovascular indices, and AAI. These findings are a direct result the improved lipid profile. Hence, the antihyperlipidemic effect of the M. quadrangula extract represents the mechanism behind its cardioprotective efficacy.

Oxidative stress has been reported to increase under hypercholesterolemic conditions [2, 5, 6]. In addition, oxidative stress has been suggested to be the mechanism through which hypercholesterolemia induces tissue damage [3, 31]. In the present study, HCD-induced hypercholesterolemic rats showed increased levels of lipid peroxidation and decreased antioxidant defenses in the heart and liver of rats as previously reported [2, 5, 6]. Increased lipid peroxidation and declined antioxidant defenses induced by hyperlipidemia can provoke oxidative stress and lead to injury and cell death. Accordingly, previous studies have demonstrated that obesity/hyperlipidemia is an independent risk factor for increased lipid peroxidation, declined cytoprotective defenses, and cell death [32, 33]. HCD-fed rats treated with the M. quadrangula extract showed a significant decrease in lipid peroxidation levels and an increase in GSH, SOD, and CAT in the heart and liver. These findings could be attributed to the improved lipid profile as well as to the antioxidant potential of the M. quadrangula extract. In agreement with our findings, Ibrahim et al. [17] have recently reported the antioxidant effect of the M. quadrangula extract on a rat model of peptic ulcer. Pretreatment with the M. quadrangula extract decreased lipid peroxidation and increased the antioxidant enzymes SOD and CAT in the stomach of a rat model of ethanol-induced gastric ulcer [17].

In addition to induction of oxidative stress, hypercholesterolemia in the present study was associated with increased serum proinflammatory cytokines and CRP. Increased proinflammatory cytokines could be a direct result of hypercholesterolemia-induced production of reactive oxygen species (ROS). ROS are well known to activate nuclear factor-kappa B (NF-κB) which elicits the expression of proinflammatory cytokines, including TNF-α and IL-6. These cytokines can induce further production of ROS and hence more cell and tissue damage. Moreover, oxidative modification of LDL particles can induce the expression of adhesive molecules and lead to the secretion of cytokines [4]. The M. quadrangula extract significantly decreased serum proinflammatory cytokines in HCD-induced rats. This anti-inflammatory potential of the M. quadrangula extract could be a result of its lipid-lowering and antioxidant potential.

The observed lipid-lowering effect of the M. quadrangula extract in this study could be exerted, at least in part, through its ability to decrease the gene expression of FAS and increase LDLR expression in the liver of rats. FAS is one of the fatty acid-synthesizing enzymes, and multiple studies have reported its increased expression in the liver of rodents fed with a high-fat or high-cholesterol diet [2, 34]. In the liver, LDLR is primarily responsible for the absorption of circulating cholesterol through LDLR-mediated endocytosis. The absorbed cholesterol via LDLR is then metabolized within the hepatocytes [31, 35]. HCD-induced rats in the present study showed a significant increase in the gene expression of FAS while LDLR has not been affected as recently reported by Lee et al. [2]. In our investigation, we showed for the first time that the M. quadrangula extract exerts its lipid-lowering effect through decreasing the expression of hepatic FAS while increasing the expression of LDLR. These beneficial effects of the M. quadrangula extract on HCD-fed rats could be linked to its active constituents. Studies have reported the rich content of steroidal and pregnane glycosides, sterols, and flavonoids of Caralluma spp. [36, 37]. Flavonoids have been reported to exert multiple effects such as antioxidant, anti-inflammatory, anticarcinogenic, antihyperlipidemic, hepatoprotective, and antidiabetic effects [38–40].

In conclusion, the M. quadrangula extract has a potent antihyperlipidemic and cholesterol-lowering effect on HCD-fed rats. The M. quadrangula extract significantly decreased serum lipids, proinflammatory cytokines, and heart and liver lipid peroxidation. In addition, the M. quadrangula extract increased the antioxidant defenses in the liver and heart of HCD-fed rats. The lipid-lowering effect of the M. quadrangula extract was mediated partially through the decreased expression of hepatic FAS and increased expression of LDLR. However, further studies to determine the exact lipid-lowering mechanism of the M. quadrangula extract are recommended.

Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.

Conflicts of Interest

The author declares that she has no conflicts of interest.

Acknowledgments

The author thanks the Princess Nourah bint Abdulrahman University (Riyadh, Saudi Arabia) for funding this study.

References

X. Zhang, C. Wu, H. Wu et al., “Anti-hyperlipidemic effects and potential mechanisms of action of the caffeoylquinic acid-rich Pandanus tectorius fruit extract in hamsters fed a high fat-diet,” PLoS One, vol. 8, no. 4, article e61922, 2013.

K. S. Lee, S. Y. Chun, Y. S. Kwon, S. Kim, and K. S. Nam, “Deep sea water improves hypercholesterolemia and hepatic lipid accumulation through the regulation of hepatic lipid metabolic gene expression,” Molecular Medicine Reports, vol. 15, no. 5, pp. 2814–2822, 2017.

Y. Ma, W. Wang, J. Zhang et al., “Hyperlipidemia and atherosclerotic lesion development in Ldlr-deficient mice on a long-term high-fat diet,” PLoS One, vol. 7, no. 4, article e35835, 2012.

V. Z. Rocha and P. Libby, “Obesity, inflammation, and atherosclerosis,” Nature Reviews Cardiology, vol. 6, no. 6, pp. 399–409, 2009.

O. S. Olorunnisola, G. Bradley, and A. J. Afolayan, “Protective effect of T. violacea rhizome extract against hypercholesterolemia-induced oxidative stress in Wistar rats,” Molecules, vol. 17, no. 5, pp. 6033–6045, 2012.

S. S. Al-Rejaie, A. M. Aleisa, M. M. Sayed-Ahmed et al., “Protective effect of rutin on the antioxidant genes expression in hypercholestrolemic male Westar rat,” BMC Complementary and Alternative Medicine, vol. 13, no. 1, p. 136, 2013.

L. Anila and N. R. Vijayalakshmi, “Antioxidant action of flavonoids from Mangifera indica and Emblica officinalis in hypercholesterolemic rats,” Food Chemistry, vol. 83, no. 4, pp. 569–574, 2003.

U. Forstermann, “Oxidative stress in vascular disease: causes, defense mechanisms and potential therapies,” Nature Clinical Practice Cardiovascular Medicine, vol. 5, no. 6, pp. 338–349, 2008.

D. P. Jones, “Redefining oxidative stress,” Antioxidants & Redox Signaling, vol. 8, no. 9-10, pp. 1865–1879, 2006.

H. E. Seifried, D. E. Anderson, E. I. Fisher, and J. A. Milner, “A review of the interaction among dietary antioxidants and reactive oxygen species,” The Journal of Nutritional Biochemistry, vol. 18, no. 9, pp. 567–579, 2007.

A. De Felice, A. Bader, A. Leone et al., “New polyhydroxylated triterpenes and anti-inflammatory activity of Salvia hierosolymitana,” Planta Medica, vol. 72, no. 7, pp. 643–649, 2006.

M. Deleo, N. Detommasi, R. Sanogo et al., “New pregnane glycosides from Caralluma dalzielii,” Steroids, vol. 70, no. 9, pp. 573–585, 2005.

M. Oyama, I. Iliya, T. Tanaka, and M. Iinuma, “Five new steroidal glycosides from Caralluma dalzielii,” Helvetica Chimica Acta, vol. 90, no. 1, pp. 63–71, 2007.

M. Habibuddin, H. A. Daghriri, T. Humaira, M. S. A. Qahtani, and A. A. H. Hefzi, “Antidiabetic effect of alcoholic extract of Caralluma sinaica L. on streptozotocin-induced diabetic rabbits,” Journal of Ethnopharmacology, vol. 117, no. 2, pp. 215–220, 2008.

V. Aruna, C. Kiranmai, S. Karuppusamy, and T. Pullaiah, “Micropropagation of three varieties of Caralluma adscendens via nodal explants,” Journal of Plant Biochemistry and Biotechnology, vol. 18, no. 1, pp. 121–123, 2009.

E. Abdel-Sattar, F. M. Harraz, S. M. A. al-Ansari et al., “Antiplasmodial and antitrypanosomal activity of plants from the Kingdom of Saudi Arabia,” Journal of Natural Medicines, vol. 63, no. 2, pp. 232–239, 2009.

A. A. Ibrahim, M. Ameen Abdulla, M. Hajrezaie et al., “The gastroprotective effects of hydroalcoholic extract of Monolluma quadrangula against ethanol-induced gastric mucosal injuries in Sprague Dawley rats,” Drug Design, Development and Therapy, vol. 2016, no. 10, pp. 93–105, 2015.

N. M. Al-Rasheed, N. M. Al-Rasheed, I. H. Hasan et al., “Simvastatin ameliorates diabetic cardiomyopathy by attenuating oxidative stress and inflammation in rats,” Oxidative Medicine and Cellular Longevity, vol. 2017, Article ID 1092015, 13 pages, 2017.

P. Fossati and L. Prencipe, “Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide,” Clinical Chemistry, vol. 28, no. 10, pp. 2077–2080, 1982.

C. C. Allain, L. S. Poon, C. S. Chan, W. Richmond, and P. C. Fu, “Enzymatic determination of total serum cholesterol,” Clinical Chemistry, vol. 20, no. 4, pp. 470–475, 1974.

M. Burstein, H. R. Scholnick, and R. Morfin, “Rapid method for the isolation of lipoproteins from human serum by precipitation with polyanions,” Journal of Lipid Research, vol. 11, no. 6, pp. 583–595, 1970.

R. Ross, “The pathogenesis of atherosclerosis,” in Heart Disease: A Textbook of Cardiovascular Medicine, E. Braunwald, Ed., pp. 1106–1124, WB Saunders, Philadelphia, PA, USA, 1992.

S. Guido and T. Joseph, “Effect of chemically different calcium antagonists on lipid profile in rats fed on a high fat diet,” Indian Journal of Experimental Biology, vol. 30, no. 4, pp. 292–294, 1992.

K. J. Livak and T. D. Schmittgen, “Analysis of relative gene expression data using real-time quantitative PCR and the 2−ΔΔCT method,” Methods, vol. 25, no. 4, pp. 402–408, 2001.

N. M. Al-Rasheed, N. M. Al-Rasheed, Y. A. Bassiouni et al., “Simvastatin ameliorates diabetic nephropathy by attenuating oxidative stress and apoptosis in a rat model of streptozotocin-induced type 1 diabetes,” Biomedicine & Pharmacotherapy, vol. 105, pp. 290–298, 2018.

A. M. Mahmoud, M. B. Ashour, A. Abdel-Moneim, and O. M. Ahmed, “Hesperidin and naringin attenuate hyperglycemia-mediated oxidative stress and proinflammatory cytokine production in high fat fed/streptozotocin-induced type 2 diabetic rats,” Journal of Diabetes and its Complications, vol. 26, no. 6, pp. 483–490, 2012.

A. M. Mahmoud, F. L. Wilkinson, A. M. Jones et al., “A novel role for small molecule glycomimetics in the protection against lipid-induced endothelial dysfunction: involvement of Akt/eNOS and Nrf2/ARE signaling,” Biochimica et Biophysica Acta (BBA) - General Subjects, vol. 1861, no. 1, pp. 3311–3322, 2017.

D. M. Attia, Z. N. Ni, P. Boer et al., “Proteinuria is preceded by decreased nitric oxide synthesis and prevented by a NO donor in cholesterol-fed rats,” Kidney International, vol. 61, no. 5, pp. 1776–1787, 2002.

R. L. Yang, Y. H. Shi, G. Hao, W. Li, and G. W. le, “Increasing oxidative stress with progressive hyperlipidemia in human: relation between malondialdehyde and atherogenic index,” Journal of Clinical Biochemistry and Nutrition, vol. 43, no. 3, pp. 154–158, 2008.

A. Mahmoud, N. al-Rasheed, I. Hasan, M. al-Amin, H. al-Ajmi, and N. al-Rasheed, “Sitagliptin attenuates cardiomyopathy by modulating the JAK/STAT signaling pathway in experimental diabetic rats,” Drug Design, Development and Therapy, vol. 10, pp. 2095–2107, 2016.

P. T. Ma, G. Gil, T. C. Sudhof, D. W. Bilheimer, J. L. Goldstein, and M. S. Brown, “Mevinolin, an inhibitor of cholesterol synthesis, induces mRNA for low density lipoprotein receptor in livers of hamsters and rabbits,” Proceedings of the National Academy of Sciences of the United States of America, vol. 83, no. 21, pp. 8370–8374, 1986.

H. K. Vincent, S. K. Powers, A. J. Dirks, and P. J. Scarpace, “Mechanism for obesity-induced increase in myocardial lipid peroxidation,” International Journal of Obesity, vol. 25, no. 3, pp. 378–388, 2001.

B. Huisamen, D. Dietrich, N. Bezuidenhout et al., “Early cardiovascular changes occurring in diet-induced, obese insulin-resistant rats,” Molecular and Cellular Biochemistry, vol. 368, no. 1-2, pp. 37–45, 2012.

M. Inoue, T. Ohtake, W. Motomura et al., “Increased expression of PPARγ in high fat diet-induced liver steatosis in mice,” Biochemical and Biophysical Research Communications, vol. 336, no. 1, pp. 215–222, 2005.

Y. Yasunobu, K. Hayashi, T. Shingu et al., “Reduction of plasma cholesterol levels and induction of hepatic LDL receptor by cerivastatin sodium (CAS 143201-11-0, BAY w 6228), a new inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, in dogs,” Cardiovascular Drugs and Therapy, vol. 11, no. 4, pp. 567–574, 1997.

A. Bader, A. Braca, N. de Tommasi, and I. Morelli, “Further constituents from Caralluma negevensis,” Phytochemistry, vol. 62, no. 8, pp. 1277–1281, 2003.

H. M. Abdallah, A.-M. M. Osman, H. Almehdar, and E. Abdel-Sattar, “Acylated pregnane glycosides from Caralluma quadrangula,” Phytochemistry, vol. 88, pp. 54–60, 2013.

A. M. Mahmoud, “Hematological alterations in diabetic rats - role of adipocytokines and effect of citrus flavonoids,” EXCLI Journal, vol. 12, pp. 647–657, 2013.

A. M. Mahmoud, S. M. Abd el-Twab, and E. S. Abdel-Reheim, “Consumption of polyphenol-rich Morus alba leaves extract attenuates early diabetic retinopathy: the underlying mechanism,” European Journal of Nutrition, vol. 56, no. 4, pp. 1671–1684, 2017.

A. M. Mahmoud, H. M. Mohammed, S. M. Khadrawy, and S. R. Galaly, “Hesperidin protects against chemically induced hepatocarcinogenesis via modulation of Nrf2/ARE/HO-1, PPARγ and TGF-β1/Smad3 signaling, and amelioration of oxidative stress and inflammation,” Chemico-Biological Interactions, vol. 277, pp. 146–158, 2017.