Endocrine, Metabolic & Immune Disorders-Drug Targets (Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders) - Volume 21, Issue 6, 2021

Berberine (BBR) is a botanic alkaloid extracted from Coptis chinensis (Huanglian), which has various properties, compassing anti-hyperglycemia, anti-obesity, anti-inflammation, and improves insulin resistance, etc. Several researches have confirmed that BBR has effective actions in treating glycolipid metabolic abnormalities. BBR is also beneficial in regulating intestinal flora. Metabolic diseases are strongly associated with metabolic disorders, which are growing in the population and dramatically impacting human health, which also have been considered as a leading cause of diseases and death globally. This review is to evaluate the metabolic properties of BBR, and its potential application to the treatment of metabolic diseases by its effective actions on metabolic disorders.

Biomarkers are increasingly recognized to have significant clinical value in early identification and progression of various cardiovascular diseases. There are many heart conditions, such as congestive heart failure (CHF), ischemic heart diseases (IHD), and diabetic cardiomyopathy (DCM), and cardiac remodeling, in which the severity of the cardiac pathology can be mirrored through these cardiac biomarkers. From the emergency department (ED) evaluation of acute coronary syndromes (ACS) or suspected acute myocardial infarction (AMI) with cardiac marker Troponin to the diagnosis of chronic conditions like Heart Failure (HF) with natriuretic peptides, like B-type natriuretic peptide (BNP), N-terminal pro-B- type natriuretic peptide (Nt-proBNP) and mid regional pro-atrial natriuretic peptide (MR- proANP), their use is continuously increasing. Their clinical importance has led to the discovery of newer biomarkers, such as the soluble source of tumorigenicity 2 (sST2), galectin-3 (Gal-3), growth differentiation factor-15 (GDF-15), and various micro ribonucleic acids (miRNAs). Since cardiac pathophysiology involves a complex interplay between inflammatory, genetic, neurohormonal, and biochemical levels, these biomarkers could be enzymes, hormones, and biologic substances showing cardiac injury, stress, and malfunction. Therefore, multi-marker approaches with different combinations of novel cardiac biomarkers, and continual assessment of cardiac biomarkers are likely to improve cardiac risk prediction, stratification, and overall patient wellbeing. On the other hand, these biomarkers may reflect coexisting or isolated disease processes in different organ systems other than the cardiovascular system. Therefore, knowledge of cardiac biomarkers is imperative. In this article, we have reviewed the role of cardiac biomarkers and their use in the diagnosis and prognosis of various cardiovascular diseases from different investigations conducted in recent years.

Nature has the potential to reduce metal salts to their relative nanoparticles. Traditionally, physical and chemical methods were used for the synthesis of nanoparticles but due to the use of toxic chemicals, non-ecofriendly methods and other harmful effects, green chemistry approaches are now employed for synthesizing nanoparticles which are basically the most cost effective, ecofriendly and non-hazardous methods. In this review, we aimed to evaluate and study the details of various mechanisms used for green synthesis of silver nanoparticles from plants, their size, shape and potential applications. A total of 150 articles comprising both research and review articles from 2009 to 2019 were selected and studied in detail to get in-depth knowledge about the synthesis of silver nanoparticles specifically through green chemistry approaches. Silver ions and their salts are well known for their antimicrobial properties and have been used in various medical and non-medical applications since the emergence of human civilization. Miscellaneous attempts have been made to synthesize nanoparticles using plants and such nanoparticles are more efficient and beneficial in terms of their antibacterial, antifungal, antioxidant, anti-biofilm and cytotoxic activities than nanoparticles synthesized through physical and chemical processes. Silver nanoparticles have been studied as an important research area due to their specific and tunable properties and their application in the field of biomedicine such as tissue and tumor imaging and drug delivery. These nanoparticles can be further investigated to find out their antimicrobial potential in cell lines and animal models.

Old age is associated with a loss of motor functions and a general progressive decline in cognitive functions. Physical exercise is one of the ways in which inflammatory levels in general can be reduced, and therefore physical exercise can be considered a biological aging decelerator. In this article, we examine the relationships between physical exercise and inflammatory markers reported for the different physical exercise protocols that have been used in studies with older individuals, as well as the effects of these regimens. The different types of exercises programmed, and methods used to implement them were very heterogeneous in the articles we analysed. Both, the aerobic exercise and resistance training protocols produced a decrease in plasma levels of IL-6, CRP and TNF-α, and an increase of IL-10 plasma levels as a chronic effect. However, the acute-response of physical exercise appeared to be an initial increase in IL-6 expression and plasma IL-6 levels. Continuing with these exercise programs usually subsequently achieved a chronic response in which there was a decrease in both the basal levels of IL-6, CRP and TNF-α, and the IL-6 produced as acute responses. Regardless of the type of exercise performed, it seems that the exercise parameters, intensity, duration, subject variables, fitness, and level of inflammation are key factors in achieving the expected balance between proinflammatory and anti-inflammatory cytokines.

Background and Objective: Cancer and diabetes are two highly prevalent diseases worldwide and greatly influence quality of life of those suffering from it. The study aimed to compare quality of life in patients diagnosed with cancer and diabetes with those without diabetes both undergoing chemotherapy and to investigate the factors responsible for the difference between the two groups. Methods: A convenience sample of 101 participants who had cancer and type 2 diabetes and 99 who had cancer without diabetes were used. Results: Patients with comorbid diabetes were divided based on their diabetes duration and whether they had glycaemic control or not. Diabetic cancer patients without glycaemic control had lower scores in global health status and in physical and emotional functioning compared to diabetic cancer patients with glycaemic control and patients without diabetes (p < .05). After adjusting for demographic characteristics, the differences between the group with diabetes and without glycaemic control and the other two groups regarding global health status were statistically significant (p < .05). Patients with more than a 7-year history of diabetes had a significantly lower emotional functioning than the no diabetes group and lower global health status score than both of the other groups (p < .05). After adjusting for clinical and demographic characteristics, only the difference between the ≥ 7 years diabetes duration group and the no diabetes groups remained significant. Conclusion: The presence of diabetes in cancer patients who underwent chemotherapy seems to negatively influence certain domains of quality of life and this may be affected by the duration of diabetes and whether glycaemic control has been achieved or not.

Background: College students may have a risk of fat-soluble vitamin deficiencies due to unhealthy dietary habits, especially for vitamin A and E. They are important members of the human antioxidant network; deficiencies of these vitamins may increase the risk of many critical diseases. Objective: The current study was undertaken to determine the status of vitamin A and E in college students. Methods: Healthy college students were recruited, and fasting blood samples of them were collected and used for determining serum levels of retinol and α-tocopherol by the HPLC method. Results: We found that there was no vitamin A deficiency in college students. However, vitamin E deficiency existed in 34.5% of college students, especially in males. All the students had no vitamin E adequacy. In addition, our findings showed that BMI was inversely associated with serum α-- tocopherol, but not serum retinol. Conclusion: These results suggest that vitamin E deficiency in college students should be given more attention, and it is necessary to consider using vitamin E supplements.

Background: Tylophora hirsuta (Wall) has long been used as traditional medicine for the treatment of diabetes. The current study is designed to evaluate the anti-diabetic and anti-inflammatory activity of different extracts of aerial parts of Tylophora hirsuta. Methods: Sequential maceration was conducted to obtain extracts. Total phenolic contents were determined by the Folin-Ciocalteau method. The anti-oxidant activity was assessed by DPPH free radical scavenging assay. The extracts were tested for its inhibitory activity against α-amylase in-vitro. In-vivo anti-diabetic assay was conducted using alloxan-induced diabetic model and OGTT was conducted on normal rats. ELISA was used to determine the pro-inflammatory cytokines (TNF-α and IL-6). The polyphenolic composition of the extract was analyzed using an HPLC system. Results: Aqueous extract exhibited highest total phenolic contents (985.24± 3.82 mg GAE/100 g DW), antioxidant activity (IC50 = 786.70 ± 5.23 μg/mL), and alpha-amylase inhibition (IC50 =352.8 μg/mL). The aqueous extract of Tylophora hirsuta showed remarkable in-vivo anti-diabetic activity. Results were compared with standard drug glibenclamide. Alloxan induced diabetic mediated alterations in liver function enzymes, renal function determinants, and lipid parameters were significantly restored in aqueous extract treated diabetic rats. A significant reduction in pro-inflammatory cytokines (p<0.001) was observed when compared to the control group. HPLC analysis confirms the presence of quercetin, gallic acid, cinnamic acid, and p-coumaric acid. Conclusion: These results showed that Tylophora hirsuta possesses strong anti-diabetic and anti-inflammatory potentials and justify its folklore use for the management of diabetes.

Aim: The aim of the study was to assess the antihyperglycemic activity of Brassica oleracea. Background: Collard green or Brassica oleracea var. viridis which belongs to Brassicaceae family is ranked at 10th place of “powerhouse” vegetables, and it is commonly used traditionally for the treatment of diabetes in Morocco. Objective: This current investigation aimed to assess the antihyperglycemic capacity of the aqueous extract of Collard green leaves. Methods: The effect of a single (6 hours) and repeated (seven days of treatment) oral administration of Collard green aqueous extract (CGAE) at a dose of 60 mg/kg on glucose and lipid profile was examined in normal and streptozotocin-induced diabetic rats. Additionally, histopathological examination of liver was carried out according to the Hematoxylin-Eosin method. Furthermore, a preliminary phytochemical screening, and the quantification of phenolic, flavonoid and tannins contents as well as the antioxidant activity using DPPH assay were carried out. Results: The results demonstrated that Collard green A.E. (CGAE) exhibited a significant antihyperglycemic effect and positive improvement liver histology in diabetic rats. After a single oral administration of CGAE, blood glucose levels were lowered from 15±2 mM to 4.9±1 mM (p<0.0001) at the sixth hour in diabetic rats but no change was observed in normal rats. Repeated CGAE administration was able to reduce blood glucose levels from 15±2 mM to normal values (5±1 mM at the seventh day, p<0.0001) while the extract had no effect in normal rats. In addition, we revealed that CGAE is rich in several phytochemical compounds and exerts an important antioxidant activity. Conclusion: In conclusion, this study demonstrates that Collard green possesses a beneficial effect against diabetes and can be used in the program diet of diabetic patients.

Objective and Background: Diabetic retinopathy is amongst the most common microvascular complications associated with diabetes. Controlling blood glucose level alone cannot manage diabetes associated complications. Thus, mechanisms that additionally prevent diabetes associated complications are the need of the hour, driving the researchers towards herbal therapies. Terminalia catappa is renowned for its anti-inflammatory, antioxidant, anti-hyperglycemic and anti-angiogenic activity. The current study explores the effect of Terminalia catappa fruit extract on streptozotocin-induced diabetic retinopathy in rats. Methods: Streptozotocin-induced chronic diabetic rat model was utilized in the study. The hydroalcoholic fruit extract of T. catappa in 20mg/kg, 30mg/kg and 40mg/kg dose and standard anti-diabetic drug, glibenclamide (10mg/kg) was given orally. Retinopathy was evaluated by monitoring lenticular, fundus images and measuring arteriole and venule tortuosity index. Oxidative, angiogenic and inflammatory biomarkers were assessed at the 12th week in the retinal homogenate. Histopathological changes in the retina were also examined. Data was analyzed using one-way Repeated Measure ANOVA followed by the Mann-Whitney test. Results: The hydro-alcoholic fruit extract of T. catappa significantly decreased blood glucose (p<0.001) in a dose-dependent manner in diabetic rats. Cataract lens was observed in all experimental groups and became clear (grade 0) with 40mg/kg and with 40mg/kg along with glibenclamide at the eighth and sixth week, respectively. The hydro-alcoholic fruit extract in all three doses significantly reduced (p<0.01) arteriole and venule tortuosity in diabetic rats. T. catappa in all three doses in diabetic rats showed a modulatory effect in oxidative, angiogenic and inflammatory biomarkers. Conclusion: T. catappa reverses diabetes-induced retinopathy by anti-hyperglycemic, anti-oxidant, anti-angiogenic and anti-inflammatory actions, and thus has a potential to be used in diabetes-induced retinopathy.

Objective: To determine the circulatory miRNA expression levels in patients with Hashimoto thyroiditis (HT) at the time of diagnosis and follow-up period compared with healthy controls. Methods: We collected blood samples from 34 patients with HT (4 males and 30 females) at the time of first diagnosis (Group P) and euthyroid period (Group E). Thirty-three healthy controls (Group H) blood samples were also included in the study. Expression levels of five different circulating miRNAs (miR-22, miR-141, miR-155, miR-375, miR-451) were evaluated using real-time polymerase chain reaction. Results: There was a significant difference in miR-375 levels between the groups P and H. Also, for miR-451, there was a significant difference between the P and E groups. Finally, there was a moderate positive correlation between thyroid-stimulating hormone values and miR-22 expression levels for the P group. Conclusion: miRNAs have important roles at all stages of the diseases. More studies must be performed in all thyroid diseases and autoimmune diseases, including HT.

Background and Objective: Rheumatoid Arthritis (RA) is an autoimmune disease characterized by failure of spontaneous resolution of inflammation with lifetime perseverance, becoming principal cause of inactivity. Many conventional therapies are in use but the side effects associated with them are equally problematic. Therefore, an urge to explore advanced therapeutic approaches with least adverse events has seeded the idea of discovering newer herbal drugs and their respective constituents in management of RA. The current research explores anti-arthritic activity of Terminalia catappa fruits hydroalcoholic extract in CFA induced Wistar rats. Methods: The fruits were obtained, washed, dried and processed to obtain hydroalcoholic powdered extract which was dissolved in water and given orally to the rats. Wistar rats of either sex were used in the study. The animals were injected with 0.1 ml of complete freund’s adjuvant (CFA) in footpad of left hind paw. The treatment was initiated from day 0 by oral dosing of Terminalia catappa fruit extract in doses of 40 mg/kg and 80 mg/kg followed by CFA administration to day 21 and behavioral, hematological parameters besides histopathological screening were assessed simultaneously. Results: The arthritic symptoms were observed to gradually decrease in treatment groups when compared against disease control groups. The parameters like body weight and pain latency were increased whereas paw volume and arthritic score were found to significantly decrease in treatment groups as compared to disease control group. The hematological parameters were also modified and were studied in treatment groups. The histopathological estimation depicted extent of damage in joint tissue of diseased rat comparable to normal, standard and combination therapy group. Conclusion: The fruits possess anti-arthritic properties and significantly reduced paw volume, arthritic score and increased pain threshold and body weight gain besides theory hematological effects like increase in Hb and RBC and decrease in WBC, platelets and ESR levels simultaneously. The histopathological estimation confirmed decreased deterioration of joint tissue in treatment groups as compared to disease control group hence proving to be an emerging therapeutic option in management of RA.

Background: Calcineurin-inhibitors (CNI) are used in renal transplant patients (RTX) to prevent rejection. CNI mainly suppress T-cell mediated immunity but very little is known about the impact of long-term treatment with CNI on T-cell function. Objective: We investigated the immunological effects of long-term CNI intake in RTX patients in comparison to short-term CNI administration in healthy controls (HC). Methods: Blood was drawn from 30 RTX patients with long-term CNI treatment. In addition, blood was sampled from HC with short-term CNI treatment (four dosages) before the first and 2 hours after the last CsA intake. T-cells were analyzed for cytokine production, proliferation, and CD25 expression. Results: Short-term CNI reduced T-cell derived IL-2 and IFNγ as well as T-cell proliferation in HC. IFNγ was not suppressed in patients with long-term CNI treatment. IL-2 production, CD25 expression, and T-cell proliferation were enhanced in long-term CNI patients. Conclusion: Suppression of IFNγ/IL-2 and T-cell proliferation is weaker during long-term CNI treatment in patients compared to short-term treatment in healthy subjects. Enhanced CD25 expression may lower the threshold for T-cell activation during long-term CNI treatment.

Background and Aims: To study the prevalence of deranged metabolic parameters in patients with gout. Methods: This was a prospective, cross-sectional observational study conducted at a tertiary level rheumatology center in Nepal. Patients over 18 years and diagnosed as gout using the ACR/EULAR 2015 classification criteria were included in the study. Known cases of chronic kidney disease, liver disease and heart diseases were excluded. Baseline demographic data along with records of weight, waist circumference, lipid profile, glucose profile, blood pressure measurement, serum uric acid level and inflammatory markers were taken. Diagnosis of metabolic syndrome (MS) was made according to the National Cholesterol Education Program criteria. Approval was obtained from the ethical review board of the National Center for Rheumatic Diseases. Results: A total of 523 patients with gout were enrolled in the study, out of which 97.0% were male. The mean age at diagnosis was 49.1±12.8 years. Most of the patients were overweight with a mean BMI of 27.0±3.6 kg/m2. About 8.1% had preexisting diabetes mellitus, 24.6% had hypertension, 5.1% had hypothyroidism and 45.1% had dyslipidemia. Patients fulfilling 2 out of 5 criteria of MS were 60.6% whereas 30.6% fulfilled 3 out of 5 criteria. Conclusion: Gout was commonly observed in middle-aged men. The prevalence of metabolic syndrome and its components was high in patients with gout. Management of gout should also include screening and management of the metabolic syndrome.

Background: The common antihypertensive angiotensin-converting enzyme (ACE) inhibitor captopril was reported to possess anti-oxidant and anti-inflammatory effects in different experimental models. Diabetic vascular complications arise from increased vascular endothelial inflammation and oxidative stress as well as decreased nitric oxide bioavailability in the vessel walls due to poor glycemic control. Objective: This study aimed to evaluate the role of captopril and gliclazide in decreasing diabetes mellitus (DM) vascular complications caused by decreased cellular glucose uptake and impaired endothelial nitric oxide metabolism, as well as examine the effects of the combination on diabetic renal complication and plasma lipid profile. Methods: Adult male Wister rats received captopril (25 mg/kg/day) and/or gliclazide (10 mg/kg/- day) by oral gavage daily for one month after induction of DM using streptozotocin (50 mg/kg, i.p., once). Serum glucose and insulin levels, inflammatory mediators like TNF-α, oxidative stress biomarkers like glutathione and nitric oxide, and plasma lipid profile were measured. Besides, histopathological examination of the thoracic aorta and kidney tissues, Western blot assessed the expression of nitric oxide synthase (NOS) subtypes in the thoracic aorta. Results: Captopril significantly improved vascular architecture and oxidative stress and modulated nitric oxide synthesis via regulation of nitric oxide synthases, as well as decreased inflammation via down-regulating TNF-α, decreased systolic and diastolic blood pressure, and improved serum lipid profile in diabetic rats. Gliclazide increased serum insulin and decreased serum glucose, as well as its anti-oxidant and anti-inflammatory effects. Conclusion: Captopril showed a promising protective effect against DM vascular complications, at least via nitric oxide modulating effect, anti-oxidant effect, and anti-inflammatory activity that appeared in biochemical and histopathological findings, lipid profile, renal function, and architecture improvements. Combining gliclazide with captopril gives an additive effect through enhanced glycemic control and increased anti-oxidant and anti-inflammatory properties above captopril alone.

Background: Compared to the data available for developed countries, there is a marked scarcity of information on the levels and symptomology of vitamin B12 deficiency in developing countries, particularly in the Middle Eastern region. Objective: To explore (a) the risk factors associated with a deficiency of vitamin B12, and (b) the baseline (cut-off) serum level of vitamin B12 for a clinically-symptomatic deficiency in the Jordanian adult population. Methods: A total of 485 subjects were included in this study. Blood samples were drawn for biochemical analysis and data regarding socio-demographics, general health, anthropometric measures, and past medical, surgical, and medication history were collected. To explore the cut-off point, we compared all parameters included in a standard complete blood count as well as the main symptoms reported to be associated with B12 deficiency between groups of different B12 cut-off values, consisting of those above and below 200, 175, 150 and 125 pg/ml. Results: Low dairy intake habits, age, recurrent headaches, heartburn, and peptic ulcer disease were found to be significantly associated with lower vitamin B12 levels. Surprisingly, daily smoking was associated with significantly higher B12 levels. The results revealed that none of the included potential indicators of B12 deficiency could be considered an indicative feature of deficiency. There were no significant differences neither in the symptoms nor in the CBC parameters between any of the tested study groups. Conclusion: Low dairy intake, older ages, recurrent headaches, heartburn, and peptic ulcer disease all could be considered as risk factors of having low vitamin B12 levels within the Jordanians. Also, they tend to have lower levels of vitamin B12 levels, in comparison to countries in the West, without necessarily having deficiency symptoms. The cut-off value to diagnose functional B12 deficiency could be less than 125 pg/ml for the Jordanians. More local studies are needed to establish an accurate vitamin B12 cut-off value for the population in Jordan.

Background and Aims: Due to the lack of an effective vaccine and complexity of the control measures against vectors and reservoir hosts, the control of leishmaniasis depends primarily on chemotherapy. This study was aimed to assess the snake venom, Naja naja oxiana fraction 11(NNOVF11) on Leishmania infantum and its broad mode of action. Methods: A wide range of in vitro advanced assays including high-performance liquid chromatography (HPLC), MTT (3-[4, 5-Dimethylthiazol-2-yl]-2, 5diphenyltetrazolium bromide; Thiazolyl blue), macrophage assays, quantitative real-time polymerase chain reaction (qPCR), flow cytometry and enzyme- linked immunosorbent assay (ELISA) on L. infantum promastigote and amastigote stages were used. IC50 values of L. infantum stages, CC50 value, and apoptosis were also analyzed. Results: The NNOV-F11 demonstrated strong antileishmanial activity against L. infantum stages in a dose-dependent manner compared to the untreated control group. Interleukin (IL)-12, TNF-α, and iNOS genes expression as the indicators of T helper(h)1 response significantly increased; in contrast, the expression level of IL-10, as the representative of Th2 response significantly decreased (p < 0.001). Reactive oxygen species (ROS) detection showed a significant increase (p < 0.001) after treatment with different concentrations of NNOV-F11, unlike arginase (ARG) activity, which displayed a significant reduction (p < 0.001). Conclusion: NNOV-F11 possessed a potent inhibitory effect on L. infantum stages with the multifunctional and broad mode of actions, which promoted the immunomodulatory role, induced ROS production, stimulated apoptotic–like mechanisms, and inhibited L-ARG activity, which collectively led to the parasite death. Further studies are crucial to assess the effect of the NNOV-F11 on animal models or clinical settings.

Aim: Favism is characterized as acute anemia, due to Glucose-6-phosphate dehydrogenase (G6PD) deficiency as a result of fava beans intake. It is associated with paleness, jaundice, and hemoglobinuria. In this study, signs, symptoms and therapeutic findings of the patients with hemolysis due to G6PD deficiency were investigated in Shahid Madani Hospital of Khorramabad, Lorestan. Methods: This is a single-center cross-sectional descriptive study that was conducted on all children with G6PD deficiency-induced hemolysis. Results: 308 children (64.3% male and 35.7% female) were included in this study. The most common complaint was jaundice (82.5%) and the most common cause of hemolysis was the intake of fava bean (85.7%). 68% of the children were treated with hydration/fluid therapy. Blood transfusion was conducted in 36.36% of the cases and the mean of blood administered was 18.9 cc/kg. Conclusion: In this study, hydration therapy was performed in most of the children presenting favism. Also, the incorrect calculation of the amount of blood needed for transfusion increased the frequency of blood transfusions and prolonged hospitalization time.

Aim: The current study was carried out in order to assess the antihyperglycemic effect of Scorzonera undulata (S. undulata). Backgroud: Scorzonera undulata subsp. deliciosa (DC.) Maire is used in the Moroccan pharmacopeia for managing diabetes. Objective: The objective of the study was to evaluate the anithyperglycemic activity in normal and streptozotocin (STZ)-induced diabetic rats as well as the acute toxicity of the aqueous extract of the roots of Scorzonera undulata (S. undulata). Methods: This study investigated the effects of the root aqueous extract of Scorzonera undulata (AERSU) at a dose of 20 mg/kg on blood glucose levels in normal and streptozotocin(STZ)-induced diabetic rats and the acute toxicity of AERSU was examined. Histopathological examination, preliminary phytochemical investigation, determination of glycogen content and evaluation of α-amylase were also performed. Results: Both single and repeated oral doses of AERSU (20 mg/kg) produced a significant reduction in blood glucose levels in normal and diabetic rats. Furthermore, repeated oral administration of AERSU during 15 days increased the glycogen content in the liver in both normal and diabetic rats, inhibited α- amylase activity and improved the histological architecture of the liver and pancreas in treated diabetic rats and ameliorated some biochemical parameters such as ALT and AST. In addition, the preliminary phytochemical investigation showed the richness of the roots of S. undulata in certain phytochemicals particularly in polyphenols. Conclusion: AERSU exhibits an evident antihyperglycemic activity. This pharmacological effect may be due to the protection of surviving pancreatic β cells and hepatocytes, effect of α-amylase and the improvement of glycogen storage in the liver. The dose used in this study seems to be free of any toxicity.

Background: Atrial Fibrillation (AF) is a common complication following Coronary artery bypass graft (CABG) Surgery, which may be due to oxidative stress, necrosis and inflammation during CABG and can lead to increases the length of hospital stay and the risk of morbidity and mortality. Melatonin is a hormone with anti-oxidant and anti-inflammatory properties in the cardiovascular system. This study assessed the efficacy of sublingual consumption of melatonin in reducing necrosis and inflammation, in patients undergoing CABG with respect to C-reactive protein (hs-CRP), Creatine Kinase-Muscle-Brain subunits (CK-MB) and cardiac Troponin T (cTnT) levels. Methods: One hundred and two patients were enrolled and twenty-six patients were excluded during the study process and finally seventy-six patients undergoing CABG surgery randomly assigned to melatonin group (n = 38, 12 mg sublingual melatonin the evening before and 1 hour before surgery, or the control group which did not receive Melatonin, n = 38). Three patients in the melatonin group and three patients in the control group were excluded from the study because of discontinued intervention and lost to follow up. The samples were collected before and 24 hours after surgery. hs-CRP, CK-MB, and cTnT levels were measured in all patients with the Elisa method. Results: There was no significant difference in influencing variables among the groups at the baseline. The incidence of AF following CABG surgery was not statistically significant between the two groups, (p-value = 0.71). However, the duration of AF (p-value = 0.01), the levels of hs-CRP (p-value = 0.001) and CK-MB (p-value = 0.004) measured, 24 hours after surgery were significantly lower in the melatonin group. cTnT levels measured 24 hours post-CABG did not show any significant difference in both groups (p-value = 0.52). Conclusion: Our findings suggest that the administration of melatonin may help modulate oxidative stress, based on the reduction of the levels of hs-CRP, CK-MB, and the duration of AF following CABG surgery.