Abstract
Background
Asthma is an incurable hyper-responsive disease of the pulmonary system that is caused by various allergens, including indoor and outdoor stimulators. According to the Global Asthma Network, 339 million people suffered from asthma in 2018, with particularly severe forms in children. Numerous treatments for asthma are available; however, they are frequently associated with adverse effects such as growth retardation, neurological disorders (e.g., catatonia, poor concentration, and insomnia), and physiological disorders (e.g., immunosuppression, hypertension, hyperglycemia, and osteoporosis).
Methods
Korean Red Ginseng has long been used to treat numerous diseases in many countries, and we investigated the anti-asthmatic effects and mechanisms of action of Korean Red Ginseng. Eighty-four BALB/c mice were assigned to 6 treatment groups: control, ovalbumin-induced asthma group, dexamethasone treatment group, and 3 groups treated with Korean Red Ginseng water extract (KRGWE) at 5, 25, or 50 mg/kg/day for 5 days. Anti-asthmatic effects of KRGWE were assessed based on biological changes, such as white blood cell counts and differential counts in the bronchoalveolar lavage fluid, serum IgE levels, and histopathological changes in the lungs, and by examining anti-asthmatic mechanisms, such as the cytokines associated with Th1, Th2, and Treg cells and inflammation pathways.
Results
KRGWE affected ovalbumin-induced changes, such as increased white blood cell counts, increased IgE levels, and morphological changes (mucous hypersecretion, epithelial cell hyperplasia, inflammatory cell infiltration) by downregulating cytokines such as IL-12, IL-4, and IL-6 via GATA-3 inactivation and suppression of inflammation via NF-κB/COX-2 and PGE2 pathways.
Conclusion
KRGWE is a promising drug for asthma treatment.
Keywords: Asthma, Cytokines, GATA-3, Inflammation, Korea Red Ginseng (Panax ginseng)
1. Introduction
The Global Asthma Network reported that in 2018, 339 million people suffered from asthma, which is an important health disorder in children [1]. The main symptoms of asthma are very diverse; however, they are always associated with the pulmonary system and typically range from simple dyspnea, such as wheezing, irregular breathing, or coughing, to apnea [2], which, in severe cases, may be fatal. Airflow obstruction is associated with morphological changes such as hypersecretion of mucous in bronchial duct, hyperplasia of epithelial cell in bronchial duct, infiltration of inflammation-related cells near bronchioalveolar ducts and vessels, and airway remodeling [3,4].
Asthma is a chronic pulmonary hyperesponsiveness [5] and can be caused by various allergens that consist of two classes: (1) indoor stimulators such as pet dander and house mite dust and (2) outdoor ones such as pollutants, chemicals, and cold temperatures, among others [6,7]. Allergens induce cytokine modulation, including that of Th1-related factors (IFN-γ and IL-12) [8,9] and Th2-related cytokines (IL-4, IL-5, and IL-13) [[10], [11], [12]] through Th17-related ones (IL-6 and TNF-α) [13,14]; asthma is then considered the result of an imbalance of Th1 and Th2 cells [15,16]. The physiological balance of Th1 and Th2 lymphocytes may be shifted due to asthma, which causes Th2-related factors such as IL-4, IL-5, and IL-13 to increase [17]. GATA-3 is a transcription factor for Th2 cells, and IL-4 modulates GATA-3 activation via positive feedback mechanisms [18].
In the initiation step, various cytokines can be released, which then induce inflammation in the respiratory system [19,20]. There are two main pathways of phlogogenesis, the leukotriene pathway and the prostaglandin pathway. In the prostaglandin pathway, NF-κB and COX-2 are important intermediate factors, and prostaglandin can be increased via the NF-κB/COX-2 pathway [21]. In patients suffered by asthma, this is one of the crucial strategies to control inflammation in order to reduce the occurrence of asthma and its severity.
According to global statistics, asthma occurs predominantly in the younger population [1], and although corticosteroids such as dexamethasone are typically used for treatment, they may exert several adverse effects such as growth retardation [22]. Asthma medication treatments are generally associated with numerous side effects such as catatonia, lack of concentration, insomnia, immunosuppression, hypertension, hyperglycemia, and osteoporosis, among others [23]. For this reason, the development of more effective and safer anti-asthmatic drugs has attracted considerable research attention.
Korean Red Ginseng (Panax ginseng Meyer) is one of important traditional medicines [24], and recent studies reported effects of ginseng compounds on physiological functions, including immunity [25], circulation [26], and inflammation [27], and diseases, such as allergies [28], cancer [29], metabolic diseases [30], and neurodegenerative diseases [31]. In the present study, therapeutic effects and mechanisms of action of Korean Red Ginseng were assessed using an ovalbumin (OVA)-induced asthma model.
2. Materials and methods
2.1. Korean Red Ginseng water extract (KRGWE)
As previously reported, KRGWE (Korea Ginseng Corporation, Daejeon, South Korea) was prepared using the roots of P. ginseng, which contained compounds such as Rb1 (5.89 mg/g), -Rb2 (2.30 mg/g), -Rc (2.78 mg/g), -Rd (0.92 mg/g), -Re (1.16 mg/g), -Rf (1.00 mg/g), -Rg1 (0.96 mg/g), -Rg2s (1.42 mg/g), -Rg3r (1.16 mg/g), -Rg3s (2.41 mg/g), and -Rh1 (0.96 mg/g) [32].
2.2. Animal experiments
The animal experiments were conducted in two replicates, using 84 female BALB/c mice (Samtako Korea, Osan, South Korea). Animals were assigned to 6 treatment groups of 7 individuals, each: (1) control (tap water), (2) asthma group by ovalbumin-induction, (3) positive control receiving an asthma drug treatment (dexamethasone [DEX] 1 mg/kg/day, for 5 days) with ovalbumin treatment, and three ovalbumin-treated groups receiving KRGWE for 5 days at either 5 (4), 25 (5), or 50 mg/kg/day (6). After 7 days of acclimation, all mice apart from the control individuals were intraperitoneally injected with 20 μg ovalbumin (Sigma-Aldrich, St. Louis, MO, USA) and 1 mg aluminum hydroxide hydrate (Sigma-Aldrich) in 500 μL saline on day 1 and day 8. From day 21 to day 25, all animals were exposed to 5% ovalbumin for 0.5 h using NE-U17 (3 mL/min, OMRON Co. Ltd., Kyoto, Japan) on a daily basis in the mornings and afternoons.
2.3. Ethics statement
All animal experiments were conducted under approval from IACUC of Chonnam National University (CNU IACUC-YB-2017-04).
2.4. Bronchoalveolar lavage fluid (BALF) and serum analysis
BALF and serum analyses were conducted as described previously [17]. Mice were anesthetized by 50 mg/kg Zoletil (Virbac, Carros, France) intraperitoneal injection, and a flexible plastic mouse feeding needle was cannulated into the trachea to apply 0.4 mL phosphate buffered saline to the lung. Fluid was collected 3 times and was then centrifuged for 5 min at 900 g (Sorvall Legend Micro 17R, Thermo Fisher Scientific, Waltham, MA, USA). To produce differential cell counts, cells were resuspended using 80 μL phosphate buffered saline. White blood cell (WBC) and differential cell counts were produced using a Hemavet Multi-Species Hematology System (Drew Scientific Inc., Waterbury, CT, USA). In order to analyze the change of inflammatory cells in the BALF collected fluid was centrifuged again and stained using the Kwick-Diff kit (Thermo Fisher Scientific). Serum concentrations of IgE were analyzed using an IgE enzyme-linked immunosorbent assay kit (ELISA; #555248; BD Bioscience, San Jose, CA, USA) according to the manufacturer's instructions.
2.5. Histopathological analyses
In order to evaluate the morphological changes in the lung histological evaluations were done as described previously [17]. Collected lung was fixed in 10% (v/v) formaldehyde, dehydrated using a gradient ethanol (80%, 85%, 90%, 95%, and 99.9%), xylene, and embedded in paraffin. Paraffin blocks were then cut longitudinally in 4-μm sections (LEICA RM2125 RTS, Leica Microsystems Inc. Buffalo Grove, IL, USA), and lung tissue was stained either by hematoxylin and eosin staining to assess morphological changes or by periodic acid Schiff (PAS) staining to examine glycoproteins. In order to stain with PAS paraffined sections were deparaffinized and hydrated. Sections were oxidized in 0.5% periodic acid solution, rinsed with distilled water, were immersed in Schiff reagent, and counterstained with hematoxylin. The pathological level was scored from 0 (none) to 3 (severe) based on the representative pulmonary changes such as mucous hypersecretion (0, none; 1, little mucous releasing; 2, half packed mucous in whole duct; 3, packed mucous), epithelial cell hyperplasia (0, none; 1, corrugated wall; 2, folded epithelium; 3, severe folded epithelium), and inflammatory cell infiltration (0, none; 1, few leukocytes; 2, moderate number of leukocytes; 3, large number of leukocytes).
2.6. Immunofluorescence analyses
In order to evaluate activation of specific proteins, such as T helper cell transcription factors (T-bet for Th1 cells and GATA-3 for Th2 cells) and NF-κB/COX-2 for inflammation pathways, immunofluorescence analyses were conducted on individuals of four groups: control, OVA treatment, OVA-induced DEX treatment, and OVA-induced 50 mg/kg KRGWE treatment. Before the antibody binding step, the same materials detailed in the immunohistochemical analyses were used, in addition to T-bet (Biorbyt, orb7075, Cambridge, UK), GATA-3 (OriGene, TA305795, Rockville, MD, USA), NF-κB (ThermoFisher Scientific), or COX-2 (Invitrogen, PA1-9032, Carlsbad, CA, USA), which were used as primary antibodies for incubation at room temperature for 1 h. All of them were incubated with FITC-conjugated anti-rabbit IgG for 2 h (#315-095-003; Jackson Immunoresearch, West Grove, PA, USA) or Alexa Fluor 555-conjugated anti-goat IgG (ThermoFisher Scientific), and cells were counterstained using 4′,6-diamidino-2-phenylindole (DAPI; ThermoFisher Scientific).
Images were produced using a K1-Fluo confocal microscope (Nanoscope System, Daejeon, South Korea), and the fluorescence intensity was measured.
2.7. ELISA
ELISAs were conducted as described previously [18]. To analyze the levels of IL-12p40, IL-4, and IL-6 in lung tissue, OptEIA mouse ELISAs were purchased from BD Biosciences. All assays were conducted according to the manufacturer's instructions. Lung samples were incubated in lysis buffer containing a protease inhibitor cocktail and RIPA buffer (Thermo Fisher Scientific). Lung tissue aliquots from individuals of all groups were weighed and homogenized in lysis buffer, followed by centrifugation at 6,500 g for 15 min. Supernatants were collected and absorbance at 450 nm was measured using a microplate reader (EZ Read 400, Biochrom, Cambourne, UK).
2.8. Immunohistochemical (IHC) analyses
IHC analyses were conducted as previously described [33]. To remove endogenous peroxidases, tissue sections were placed in 3% hydrogen peroxide methanol for 10 min, and the antigen was retrieved in sodium citrate buffer (0.1M). To avoid unspecific binding, all slides were incubated with normal horse serum, were then incubated with rabbit anti-mouse PGE2 primary antibodies (1:100, bs-2639R, Bioss, MA, USA) for 1 h and were incubated again for 10 min with biotinylated secondary antibodies (PK-7800; Vector Laboratories, Burlingame, CA, USA) and horseradish peroxidase-conjugated streptavidin. Measurements were conducted using 3,3-diaminobenzidine tetrahydrochloride substrate chromogen solution and counterstaining with Mayer's hematoxylin.
2.9. Statistical analyses
Results are shown as means ± standard deviation. Treatment effects were tested using one-way analyses of variance, followed by Dunnett's multiple comparison tests. Statistical significance is reported at P < 0.05.
3. Results
3.1. Dose-dependent effects of KRGWE on populations of WBCs and inflammatory cells in BALF and on serum IgE
OVA treatments increased the numbers of WBCs (Fig. 1A), neutrophils (Fig. 1B), and inflammatory cells (Fig. 1C) in BALF and the concentrations of serum IgE (Fig. 1D). As shown in Fig. 1A and B, KRGWE significantly reduced the numbers of WBCs and neutrophils in BALF, which were increased in the OVA treatment group. In order to compare changes in inflammatory cells, Kwick-Diff staining was conducted, and the population of inflammatory cells in the 50 mg/kg KRGWE treatment group was similar to that in the 1 mg/kg DEX treatment group (Fig. 1C). IgE is one of the most important biomarkers for testing hyperresponsiveness disorders such as asthma [34], and KRGWE treatment showed dose-dependent decrease of serum IgE concentrations, which were increased in the OVA treatment group (Fig. 1D).
Fig. 1.
Dose-dependent effect of Korean Red Ginseng water extract (KRGWE) on white blood cells (WBCs), neutrophils, inflammatory cells in bronchoalveolar lavage fluid, and serum IgE (A) Effect of KRGWE on WBC counts; (B) dose-dependent effect of KRGWE on the levels of neutrophils, which were increased by ovalbumin treatments; (C) KRGWE significantly downregulated inflammatory cells to levels similar to those in the DEX treatment group; (D) KRGWE dose-dependently decreased the levels of serum IgE; a: control group; b: ovalbumin-treated group; c: 1 mg/kg/day DEX treated group after ovalbumin treatment; d: 5 mg/kg/day KRGWE-treated group after ovalbumin treatment; e: 25 mg/kg/day KRGWE-treated group after ovalbumin treatment; f: 50 mg/kg/day KRGWE-treated group after ovalbumin treatment. N = 6. Magnification 400-fold. Scale bar indicates 100 μm. Statistical significance is indicated as follows: ∗p < 0.05 vs. control group; ∗∗p < 0.01 vs. control group; $p < 0.05 vs. ovalbumin-treated group; $$p < 0.01 vs. ovalbumin-treated group; #p < 0.05 vs. DEX treated group; ##p < 0.01 vs. DEX treated group
3.2. Effects of KRGWE on morphological changes
Morphological changes such as mucous hypersecretion, epithelial cell hyperplasia, or inflammatory cell infiltration occur in the respiratory system of asthma patients [35], and they are the most important biomarkers of asthma. Compared to lung tissues of controls (Fig. 2A.a and 2B.a), OVA-treated mice showed morphological changes such as mucous hypersecretion (2.6 ± 0.43; p < 0.01; Table 1), epithelial cell hyperplasia (2.6 ± 0.49; p < 0.01; Table 1), and inflammatory cell infiltration (2.6 ± 0.42; p < 0.01; Table 1) in proximity to bronchioalveolar ducts and vessels (Fig. 2A.b and 2B.b). KRGWE treatments reduced respiratory morphological changes caused by OVA treatment in a dose-dependent manner, including mucous hypersecretion (2.4 ± 0.25 → 0.7 ± 0.42), epithelial cell hyperplasia (2.4 ± 0.38 → 0.5 ± 0.36), and inflammatory cell infiltration (2.5 ± 0.46 → 0.8 ± 0.25; Fig. 2A.d–2A.f and Fig. 2B.d–2B.f; Table 1). No differences were observed in the morphological change scores on epithelial cell hyperplasia and inflammatory cell infiltration between the control (0.3 ± 0.32 and 0.4 ± 0.29, respectively) and the 50 mg/kg KRGWE treatment group (0.5 ± 0.36 and 0.8 ± 0.25, respectively) (Table 1).
Fig. 2.
Effect of Korean Red Ginseng water extract (KRGWE) on pulmonary morphological changes. (A) KRGWE blocked ovalbumin-induced morphological changes in the lungs such as mucous hypersecretion, epithelial cell hyperplasia, inflammatory cells infiltration, etc. (hematoxylin and eosin staining); (B) KRGWE markedly suppressed ovalbumin-induced mucous hypersecretion in the bronchioalveolar duct (periodic acid Schiff staining); a: control group; b: ovalbumin-treated group; c: 1 mg/kg/day DEX treated group after ovalbumin treatment; d: 5 mg/kg/day KRGWE-treated group after ovalbumin treatment; e: 25 mg/kg/day KRGWE-treated group after ovalbumin treatment; f: 50 mg/kg/day-KRGWE treated group after ovalbumin treatment. N = 8. Magnification 200-fold. Scale bar indicates 100 μm. Statistical significance is indicated as follows: ∗p < 0.05 vs. control group; ∗∗p < 0.01 vs. control group; $p < 0.05 vs. ovalbumin-treated group; $$p < 0.01 vs. ovalbumin-treated group; #p < 0.05 vs. DEX treated group; ##p < 0.01 vs. DEX treated group
Table 1.
Dose-dependent effects of Korean Red Ginseng water extract (KRGWE) on ovalbumin-induced morphological changes in lung tissue. KRGWE suppressed pulmonary morphological changes caused by ovalbumin treatments
| Mucous hypersecretion (0-3) | Epithelial cell hyperplasia (0-3) | Inflammatory cell infiltration (0-3) | |
|---|---|---|---|
| CON | 0.1 ± 0.14 | 0.3 ± 0.32 | 0.4 ± 0.29 |
| OVA | 2.6 ± 0.43∗∗ | 2.6 ± 0.49∗∗ | 2.6 ± 0.42∗∗ |
| OVA+DEX | 0.6 ± 0.26∗,$$ | 0.8 ± 0.50$$ | 0.8 ± 0.50$ |
| OVA+5 mg/kg KRGWE | 2.4 ± 0.25∗∗,## | 2.4 ± 0.38∗∗ | 2.5 ± 0.46∗∗,## |
| OVA+25 mg/kg KRGWE | 1.9 ± 0.26∗∗,$,## | 1.7 ± 0.44∗∗,$,# | 1.3 ± 0.42∗,$ |
| OVA+50 mg/kg KRGWE | 0.7 ± 0.42∗,$$ | 0.5 ± 0.36$$ | 0.8 ± 0.25$$ |
The means ± standard deviation (N = 8) are shown; statistical significance is indicated as follows:∗p < 0.05 vs. control group; ∗∗p < 0.01 vs. control group; $p < 0.05 vs. ovalbumin-treated group; $$p < 0.01 vs. ovalbumin-treated group; #p < 0.05 vs. DEX treated group; ##p < 0.01 vs. DEX treated group
3.3. Effects of KRGWE on IL-12, IL-4, and IL-6 expression
Asthma is a hyperresponsive disease of the pulmonary tract and is caused by an imbalance of Th1-related factors and Th2-related factors [16,36]. In the OVA-induced asthma group, T-bet and GATA-3 occurred in the nucleus, whereas in the other groups, they were found in the cytoplasm, including the 50 mg/kg KRGWE treatment group (Fig. 3A). KRGWE treatment blocked T-bet and GATA-3 activation as transcription factors through translocation from the cytoplasm to the nucleus. KRGWE dose-dependently suppressed IL-12 expression (Fig. 3B) and reduced the levels of IL-4 and IL-6 in all KRGWE treatments (Fig. 3C and D).
Fig. 3.
Effect of Korean Red Ginseng water extract (KRGWE) on cytokines IL-12, IL-4, and IL-6. (A) KRGWE suppressed Th1 cell transcription factor T-bet and Th2 cell transcription factor GATA-3. KRGWE dose-dependently controlled the level of asthma-related cytokines such as (B) IL-12, (C) IL-4, and (D) IL-6, which were increased by ovalbumin treatment. N = 8. Magnification 1000-fold. Scale bar indicates 50 μm. Statistical significance is indicated as follows: ∗p < 0.05 vs. control group; ∗∗p < 0.01 vs. control group; $p < 0.05 vs. ovalbumin-treated group; #p < 0.05 vs. DEX treated group
3.4. Effects of KRGWE on NF-κB/COX-2 and PGE2 pathways
Asthma is strongly associated with allergic inflammation [20], and reducing the occurrence of inflammation may also reduce asthma severity. OVA treatment increased NF-κB translocation from the cytoplasm to the nucleus, where it is activated as a transcription factor for COX-2, compared to the control, and it enhanced COX-2 synthesis in the cytoplasm (Fig. 4A). However, the 50 mg/kg KRGWE treatment reduced NF-κB translocation and prevented COX-2 expression. As shown in Fig. 4B, the 50 mg/kg KRGWE treatment prevented COX-2 synthesis (1.13 ± 0.130), compared to OVA treatment (1.94 ± 0.450; p < 0.05), and no difference in COX-2 expression between the 50 mg/kg KRGWE treatment and the control was observed. Compared to the OVA treatment group, the 50 mg/kg KRGWE treatment suppressed PGE2 expression (Fig. 4C).
Fig. 4.
Effect of Korean Red Ginseng water extract (KRGWE) on translocation of NF-κBp65 from the cytoplasm to the nucleus. (A) KRGWE significantly inhibited the level of COX-2 expression in the cytoplasm through NF-κB translocation from the cytoplasm to the nucleus where it would act as a transcription factor of COX-2. Magnification 1000-fold. Scale bar indicates 50 μm. (B) According to the respective fluorescence, KRGWE downregulated NF-κB translocation and COX-2 expression. (C) KRGWE significantly suppressed PGE2 expression, which was elicited by ovalbumin treatments. Magnification 200-fold. Scale bar indicates 100 μm; a: control group; b: ovalbumin-treated group; c: 1 mg/kg/day DEX treated group after ovalbumin treatment; d: 50 mg/kg/day KRGWE-treated group after ovalbumin treatment. Statistical significance is indicated as follows: ∗p < 0.05 vs. control group; ∗∗p < 0.01 vs. control group; $p < 0.05 vs. ovalbumin-treated group; $$p < 0.01 vs. ovalbumin-treated group
4. Discussion
Asthma is an incurable chronic pulmonary disease [37], and most medications only alleviate the symptoms. Drugs for asthma treatment have a lot of adverse effects such as growth retardation [22], neurological disorders (e.g., catatonia, lack of concentration, and insomnia), and physiological disorders (e.g., immunosuppression, hypertension, hyperglycemia, and osteoporosis) [23]. Therefore, numerous studies have been conducted to identify safer and more effective anti-asthma drugs [4,8,13,17,18,28]. Korean Red Ginseng is known to affect various aspects of physiology, such as immunity [25], circulation [26], and inflammation [27], and diseases, such as allergy [28], cancer [29], metabolic diseases [30], and neurodegenerative diseases [31]. In asthma patient severe airway blockage was observed and this symptom was caused by airway remodeling which is related with epithelial cell and goblet cell hyperplasia, mucous hypersecretion by goblet cells, etc [3,4].
Numerous hypotheses regarding the pathogenesis of asthma have been suggested; however, the exact mechanism remain unclear. An imbalance in Th1 and Th2 cells is considered one of the most important causes [16,36]. T helper cells can be categorized as Th1, Th2, and T17 cells [38], and in asthma patients, Th2-related factors are increased but Th1-related factors are not [16,35]. IFN-γ and IL-12 are associated with Th1-related cytokines, and IL-4, IL-5, and IL-13 belong to Th2-related cytokines. The function of T17 cell-related factors such as TNF-α and IL-6 is to modulate expression of Th1-/Th2-related factors [39] and to gather chemo-attractive neutrophils and eosinophils [40]. IFN-γ is the important cytokine affecting asthma as it exerts a positive feedback control function on T-bet [41] and downregulation of IgE [42]. IL-12 can contribute to regulating asthma by inhibiting Th2-related factor proliferation and by promoting IFN-γ production [43,44]. IL-4 is a regulator of the positive feedback effects of GATA-3 and increases the levels of IgE and eosinophil proliferation [[45], [46], [47]]. IL-5 is strongly associated with the modulation of the eosinophil life cycle [44], and IL-13 induces morphological changes such as airway remodeling in the pulmonary system of asthma-suffered patients [12]. IL-6 stimulates IgE expression and T helper cell modulation [48], and TNF-α modulates airway hyperresponsiveness through interactions of mast cells and smooth muscle [49].
Phylogonesis is associated with leukotriene and prostaglandin pathways, and asthma occurrence and severity is correlated with inflammatory processes in the pulmonary system. NF-κB and COX-2 belong to one of the major pathways of prostaglandin synthesis [21], and blocking NF-κB and COX-2 pathways is one of the important strategies to control inflammation. NF-κB is the transcription factor for COX-2 protein synthesis, and in order to act as a transcription factor, it must be translocated from the cytoplasm to the nucleus. Synthesized COX-2 protein stimulates the release of prostaglandin, which may lead to severe inflammation.
We evaluated the anti-asthmatic effects of Korean Red Ginseng and investigated the underlying mechanisms. We measured the regulatory effects of Korean Red Ginseng on OVA-induced morphological changes in the pulmonary system. KRGWE prevented morphological changes induced by OVA treatments, and the respiratory system of the 50 mg/kg KRGWE treatment group was similar to that in control group (Table 1, Fig. 2). And we evaluated the modulatory effect of KRGWE on Th1-/Th2–Th17-related cytokines, and noted that it suppressed IL-12 expression and controlled the expression of IL-4 and IL-6 in a dose-dependent manner (Fig. 3B–D) through inhibiting T-bet and GATA-3 (Fig. 3A). KRGWE inhibited GATA-3 translocation from the cytoplasm to the nucleus where it would act as a Th2 cell transcription factor and then control Th2-related cytokine IL-4, and it restored the balance of Th1- and Th2-related factors via Treg-related cytokine IL-6. Especially IL-6 modulated the balance of Th1/Th2 and down-regulated the level of IgE. KRGWE effectively blocked NF-κB translocation, which was induced by the OVA treatment and then controlled COX-2 expression (Fig. 4A and B). Regarding the results of NF-κB/COX-2 pathway control by KRGWE, PGE2 synthesis was entirely suppressed (Fig. 4C).
5. Conclusions
KRGWE prevented OVA-induced morphological changes in the pulmonary system, such as mucous hypersecretion, epithelial cell hyperplasia, and inflammatory cell infiltration, by restoring the balance of Th1-/Th2-related cytokines including transcription factors such as T-bet and GATA-3, and IL-12, IL-4, and IL-6, and it blocked inflammatory pathways such as NF-κB/COX-2 and PGE2.
Data availability
All data will be made available upon reasonable request.
Conflicts of interest
The authors declare that there is no conflict of interest.
Acknowledgement
This work was supported by the 2016 grant from the Korean Society of Ginseng.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.jgr.2020.10.001.
Contributor Information
Dae-Hun Park, Email: dhj1221@hanmail.net.
Chun-Sik Bae, Email: csbae210@chonnam.ac.kr.
Appendix A. Supplementary data
The following is the Supplementary data to this article:
References
- 1.The Global Asthma Network . Global Asthma Network; Auckland: 2018. The global asthma report 2018. [Google Scholar]
- 2.Global Initiative for Asthma . 2015. Global strategy for asthma management and prevention. [Google Scholar]
- 3.James A.L., Bai T.R., Mauad T., Abramson M.J., McKay K.O., Maxwell P.S., Elliot J.G., Green F.H. Airway smooth muscle thickness in asthma is related to severity but not duration of asthma. Eur Respir J. 2009;34(5):1040–1045. doi: 10.1183/09031936.00181608. [DOI] [PubMed] [Google Scholar]
- 4.Lee S.Y., Kang B., Bok S.H., Cho S.S., Park D.H. Macmoondongtang modulates Th1-/Th-2-related cytokines and alleviates asthma in a murine model. PLoS One. 2019;14(12) doi: 10.1371/journal.pone.0224517. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.National Asthma Education and Prevention Program NAEaP Expert panel report: guidelines for the diagnosis and management of asthma update on selected topics–2002. J Allergy Clin Immunol. 2002;110:S141–S219. [PubMed] [Google Scholar]
- 6.Burge H.A., Rogers C.A. Outdoor allergens. Environ. Health Persp. 2000;108(4):653–659. doi: 10.1289/ehp.00108s4653. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Platts-Mills T.A.E., Vervloet D., Thomas W.R., Aalberse R.C., Chapman M.D. Indoor allergen and asthma: report of the third international workshop. J Allergey Clin Immunol. 1997;100(6, part 1):S2–S24. doi: 10.1016/s0091-6749(97)70292-6. [DOI] [PubMed] [Google Scholar]
- 8.Seo J.H., Bang M.A., Cho S.S., Park D.H. Erythronium japonicum significantly suppresses OVA-induced asthma via upregulation the IFN-γ expression and downregulation the expression of TNF-α and IL-4. Int J Mol Med. 2016;37(5):1221–1228. doi: 10.3892/ijmm.2016.2541. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Zedan M.M., El-Chennawi F.A., Fouda A.E. Interleukin-12 and peripheral blood invariant natural killer T cells as an axis in childhood asthma pathogenesis. Iran J Allergy Asthma Immunol. 2010;9(1):43–48. [PubMed] [Google Scholar]
- 10.Kalinski P., Smits H.H., Schuitemaker J.H.N., Vieira P.L., van Eijk M., de Jong E.C., Wierenga E.A., Kapsenberg M.L. IL-4 is a mediator of IL-12p70 induction by human Th2 cells: reversal of polarized Th2 phenotype by dendritic cells. J Immunol. 2000;165:1877–1881. doi: 10.4049/jimmunol.165.4.1877. [DOI] [PubMed] [Google Scholar]
- 11.Kouro T., Takatsu K. IL-5- and eosinophil-mediated inflammation: from discovery to therapy. Int Immunol. 2009;21(12):1303–1306. doi: 10.1093/intimm/dxp102. [DOI] [PubMed] [Google Scholar]
- 12.Zhu Z., Homer R.J., Wang Z., Chen Q., Geba G.P., Wang J., Zhang Y., Elias J.A. Pulmonary expression of interleukin-13 causes inflammation, mucus hypersecretion, subepithelial fibrosis, physiologic abnormalities, and eotaxin production. J Clin Invest. 1999;103:779–788. doi: 10.1172/JCI5909. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Xu H.D., Cho S.S., Lee S.Y., Oh D.S., Lim S.K., Park D.H. Immune-stimulating Effects of Mycoleptodonoides aitchisonii water extract via TNF-α and IFN-γ. Int J Med Mushrooms. 2017;19(9):809–815. doi: 10.1615/IntJMedMushrooms.2017024248. [DOI] [PubMed] [Google Scholar]
- 14.Lee S.Y., Bae C.S., Seo J.H., Cho S.S., Oh D.S., Park D.H. Mycoleptodonoides aitchisoii suppresses asthma via IL-6 and IL-13 in ovalbumin-induced asthma mouse model. Mol Med Rep. 2018;17(1):11–20. doi: 10.3892/mmr.2017.7901. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Ngoc L.P., Gold D.R., Tzianabos A.O. Cytokines, allergy, and asthma. Curr Opin Allergy Clin Immunol. 2005;5:161–166. doi: 10.1097/01.all.0000162309.97480.45. [DOI] [PubMed] [Google Scholar]
- 16.Kidd P. Th1/Th2 balance: the hypothesis, its limitations, and implications for health and disease. Altern Med Rev. 2003;8(3):223–246. [PubMed] [Google Scholar]
- 17.Lee S.Y., Bae C.S., Yh Choi, Seo N.S., Na C.S., Yoo J.C., Cho S.S., Park D.H. Opuntia humifusa modulates morphological changes characteristic of asthma via IL-4 and IL-13 in an asthma murine model. Food Nutr Res. 2017;61(1):1393307. doi: 10.1080/16546628.2017.1393307. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Lee S.Y., Bae C.S., Seo N.S., Na C.S., Yoo H.Y., Oh D.S., Bae M.S., Kwon M.S., Cho S.S., Park D.H. Camellia japonica oil suppressed asthma occurrence via GATA-3 & IL-4 pathway and its effective and major component is oleic acid. Phytomedicine. 2019;57:84–94. doi: 10.1016/j.phymed.2018.12.004. [DOI] [PubMed] [Google Scholar]
- 19.Galli S.J., Tsai M., Piliponsky A.M. The development of allergic inflammation. Nature. 2008;454(7203):445–454. doi: 10.1038/nature07204. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Locksley R.M. Asthma and allergic inflammation. Cell. 2010;140:777–783. doi: 10.1016/j.cell.2010.03.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Lee S.Y., Cho S.S., Li Y., Bae C.S., Park K.M., Park D.H. Anti-inflammatory effect of Curcuma longa and Allium hookeri co-treatment via NF-κB and COX-2 pathways. Sci Rep-UK. 2020;2020:6413491. doi: 10.1038/s41598-020-62749-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Wise J. Corticosteroids for asthma may suppress growth in children in first year of treatment, researchers say. BMJ. 2014;349 doi: 10.1136/bmj.g4623. g4623. [DOI] [PubMed] [Google Scholar]
- 23.Ciriaco M., Ventrice P., Russo G., Scicchitano M., Mazzitello G., Scicchitano F., Russo E. Corticosteroid-related central nervous system side effects. J Pharmacol Pharmacother. 2013;4(Suppl 1):S94–S98. doi: 10.4103/0976-500X.120975. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Her J. Bubinmunhwasa; Seoul: 2002. Dongui Bogan. [Google Scholar]
- 25.Kim J.E., Monmai C., Rod-In W., Jang A.Y., You S.G., Lee S.M., Jung S.K., Park W.J. Co-immunomodulatory activities of anionic macromolecules extracted from Codium fragile with red ginseng extract on peritoneal macrophage of immune-suppressed mice. J Microbiol Biotechnol. 2020;30(3):352–358. doi: 10.4014/jmb.1909.09062. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Yun I.S., Kim Y.S., Roh T.S., Lee W.J., Park T.H., Roh H., Lew D.H., Rah D.K. The effect of red ginseng extract intake on ischemic flaps. J Invest Surg. 2017;30(1):19–25. doi: 10.1080/08941939.2016.1215577. [DOI] [PubMed] [Google Scholar]
- 27.Choi J.H., Jang M., Kim E.J., Lee M.J., Park K.S., Kim S.H., In J.G., Kwak Y.S., Park D.H., Cho S.S. Korean red ginseng alleviates dehydroepiandrosterone-induced polycystic ovarian syndrome in rats via its anti-inflammatory and antioxidant activities. J Gingseng Res. 2020 doi: 10.1016/j.jgr.2019.08.007. In press. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Han M.J., Kim D.H. Effects of red and fermented ginseng and ginsenosides on allergic disorders. Biomolecules. 2020;10(4):e634. doi: 10.3390/biom10040634. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Lee D.Y., Park C.W., Lee S.J., Park H.R., Kim S.H., Son S.U., Park J., Shin K.S. Anti-cancer effects of Panax ginseng berry polysaccharides via activation of immune-related cells. Front Pharmacol. 2019;10:1411. doi: 10.3389/fphar.2019.01411. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Jeong E., Lim Y., Kim K.J., Ki H.H., Lee D., Suh J., So S.H., Kwon O., Kim J.Y. A systems biological approach to understanding the mechanisms underlying the therapeutic potential of red ginseng supplements against metabolic diseases. Molecules. 2020;25(8):e1967. doi: 10.3390/molecules25081967. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Cho I. Effects of Panax ginseng in neurodegenerative diseases. J Ginseng Res. 2010;36:342–353. doi: 10.5142/jgr.2012.36.4.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Jang M., Lee M.J., Kim C.S., Cho I.H. Korean Red ginseng extract attenuates 3-nitropropionic acid-induced Huntington’s-like symptoms. Evid Based Complement Alternat Med. 2013;2013:237207. doi: 10.1155/2013/237207. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Kim J.E., Park K.M., Lee S.Y., Seo J.H., Yoon I.S., Bae C.S., Yoo J.C., Bang M.A., Cho S.S., Park D.H. Anti-inflammatory effect of Allium hookeri on carrageenan-induced air pouch mouse model. PLosOne. 2017;12(12) doi: 10.1371/journal.pone.0190305. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Platts-Mills T.A.E. The role of immunoglobulin E in allergy and asthma. Am J Respir Crit Care Med. 2001;164:S1–S5. doi: 10.1164/ajrccm.164.supplement_1.2103024. [DOI] [PubMed] [Google Scholar]
- 35.Holgate S.T. Pathogenesis of asthma. Clin Exp Allergy. 2008;38(6):872–897. doi: 10.1111/j.1365-2222.2008.02971.x. [DOI] [PubMed] [Google Scholar]
- 36.Kim Y.G. Th1/Th2 imbalance Vs. T cell priming in asthma immunopathogenesis. BioWave. 2005;7(4):1–15. [Google Scholar]
- 37.Slejko J.F., Ghushchyan V.H., Sucher B., Globe D.R., Lin S.L., Globe G., Sullivan P.W. Asthma control in the United States, 2008-2010: indicators of poor asthma control. J Allergy Clin Immunol. 2014;133:1579–1587. doi: 10.1016/j.jaci.2013.10.028. [DOI] [PubMed] [Google Scholar]
- 38.Janeway Travers. 2nd ed. Churchill Livingstone; New York: 1996. Immunobiology. The immune system in health and disease. [Google Scholar]
- 39.Sigh A., Yamamoto M., Ruan J., Choi J.Y., Gauvreau G.M., Olek S., Hoffmueller U., Carlsten C., FitzGerald J.M., Boulet L.P. Th17/Treg ratio derived using DNA methylation analysis is associated with the late phase asthmatic response. Allergy Asthma Clin Immunol. 2014;10:32. doi: 10.1186/1710-1492-10-32. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Lukacs N.W., Strieter R.M., Chensue S.W., Widmer M., Kunkel S.I. TNF-alpha mediates recruitment of neutrophils and eosinophils during airway inflammation. J Immunol. 1995;154:5411–5417. [PubMed] [Google Scholar]
- 41.Zhu J., Jankovic D., Oler A.J., Wei G., Sharma S., Hu G., Guo L., Yagi R., Yamane H., Punkosdy G. The transcription factor T-bet is induced by multiple pathways and prevents and endogenous T helper-2 program during T helper-1 responses. Immunity. 2012;37(4):660–673. doi: 10.1016/j.immuni.2012.09.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Stirling R.G., Chung K.F. New immunological approaches and cytokine targets in asthma and allergy. Eur Respir J. 2000;16:1158–1174. doi: 10.1034/j.1399-3003.2000.16f24.x. [DOI] [PubMed] [Google Scholar]
- 43.Manetti R., Parronchi P., Giudizi M.G., Piccinni M.P., Maggi E., Trinchieri G., Romagnani S. Natural killer cell stimulatory factor (interleukin 12 (IL-12)) induces T helper type 1 (Th1)-specific immune responses and inhibits the development of IL-4-producing Th cells. J Exp Med. 1993;177:1199–1204. doi: 10.1084/jem.177.4.1199. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.Mattes J., Yang M., Mahalingam S., Kuehr J., Webb D.C., Simson L., Hogan S.P., Koskinen A., McKenzie A.N., Dent L.A. Intrinsic defect in T cell production of interleukin (IL)-13 in the absence of both IL-5 and eotaxin precludes the development of eosinophilia and airways hyperreactivity in experimental asthma. J Exp Med. 2002;195:1433–1444. doi: 10.1084/jem.20020009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Mosmann T.R., Coffman R.L. TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties. Annu Rev Immunol. 1989;7:145–173. doi: 10.1146/annurev.iy.07.040189.001045. [DOI] [PubMed] [Google Scholar]
- 46.Barnes P.J. Immunology of asthma and chronic obstructive pulmonary disease. Nat Immunol. 2008;8:183–192. doi: 10.1038/nri2254. [DOI] [PubMed] [Google Scholar]
- 47.Yagi R., Zhu J., Paul W.E. An updated view on transcription factor GATA3-mediated regulation of Th1 and Th2 cell differentiation. Int Immunol. 2011;23:415–420. doi: 10.1093/intimm/dxr029. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Rincon M., Irvin C.G. Role of IL-6 in asthma and other inflammatory pulmonary diseases. Int J Biol Sci. 2012;8(9):1281–1290. doi: 10.7150/ijbs.4874. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Berry M., Brightling C., Pavord I., Wardlaw A.J. TNF-α in asthma. Curr Opin Pharmacol. 2007;7:279–282. doi: 10.1016/j.coph.2007.03.001. [DOI] [PubMed] [Google Scholar]
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