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Research Article

Anti-cytokine storm activity of fraxin and quercetin, alone and in combination, and their possible molecular mechanisms via TLR4 and PPAR-γ signaling pathways in lipopolysaccharide-induced RAW 264.7 cell line

[version 1; peer review: 1 approved with reservations, 1 not approved]
PUBLISHED 08 Sep 2023
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

This article is included in the Cell & Molecular Biology gateway.

Abstract

Background: Cytokine storm syndrome (CSS) is a leading cause of morbidity and mortality in patients with late-stage coronavirus disease 2019 (COVID-19), causing multiple organ failure and death. According to prior research, fraxin, and quercetin have anti-inflammatory, antioxidant, antimicrobial, and antiviral properties. Therefore, this study aimed to investigate the anti-cytokine storm activity of fraxin and quercetin, their combination, and the molecular mechanism behind this activity in Lipopolysaccharide (LPS)-induced RAW 264.7 cells.
Methods: LPS-induced macrophage cells were treated with fraxin, quercetin, or their combinations at various doses for cytotoxicity, anti-cytokine assays, and gene expression analyses. An enzyme-linked immunosorbent assay was used to quantify the levels of proinflammatory cytokines, interleukin 1 beta (IL1β), interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α), and RT-PCR was used to measure the gene expression of PPAR-γ and Toll-like receptor 4 (TLR-4) concerning GAPDH as a reference gene.
Results: The results revealed a slight decrease in cell viability only when higher concentrations were applied to the cells. Fraxin, quercetin, and their combination reduced the generation of proinflammatory cytokines. The combination (fraxin + quercetin (FQ)) reduced the levels of IL-1β, IL-6, and TNF-α by 56.2%, 58.5%, and 70.6% respectively, compared to the LPS-only control; pretreatment of cells with farxin, quercetin, and their combination resulted in significant inhibition of TLR-4 gene expression by 89%, 82%, and 93% respectively, compared to the control (P˂ 0.05); FQ upregulated PPAR-γ expression up to 60-fold compared to the control, while fraxin and quercetin increased PPAR-γ by 17.6 and 8.6-folds, respectively.
Conclusions: Based on these findings, fraxin, quercetin and their combination might be considered anti-cytokine storm agents, which could lay the groundwork for future research into other combinations of fraxin and quercetin, as well as the pathways involved in the molecular mechanisms underlying the synergistic anti-cytokine-storm-activity.

Keywords

Fraxin, Quercetin, Anti-Cytokine Storm, RAW 264.7 Murine Macrophage Cell Line, Lipopolysaccharide, Proinflammatory Cytokines, PPAR Γ, TLR-4, Tnfα, IL1β, IL6, Synergistic Combination, MTT Assay

Introduction

A cytokine storm is a condition of uncontrolled systemic hyperinflammation caused by excess cytokines, leading to multiorgan failure.1 Cytokine storms may occur for many reasons, including malignancy, rheumatoid arthritis, and sepsis. Recently, cytokine storms were found to be related to mortality and morbidity in many cases of coronavirus disease 2019 (COVID-19).2 Since coronavirus disease is characterized by hyperinflammation and an excessive immune response, the need to develop anti-cytokine drugs has increased.3 Lipopolysaccharide (LPS), a component of the outer membrane of gram-negative bacteria, signals toll-like receptor 4 (TLR 4) to activate macrophages, which stimulates several intracellular signaling pathways, including those for nuclear transcription factor kappa-B (NF-B) and mitogen-activated protein kinases (MAPKs). Interleukin IL-6, IL-1, and tumor necrosis factor (TNF-α) are proinflammatory cytokines activated macrophages release.4

Fraxin, a coumarin derived from the plant Fraxinus and Cortex fraxin, is referred to as 7,8-Dihydroxy-6-methoxy coumarin, 8-D glucopyranoside.5 Fraxin possesses different pharmacological activities, including as an anticancer, antiviral, anti-inflammatory, and antioxidant.6 For this vast potential, fraxin is a target for further immunomodulating studies.

Quercetin is a bioflavonoid widely distributed in apples, berries, grapes, and onions. Quercetin was reported in previous studies as having a wide range of biological actions, such as anti-inflammatory properties due to the inhibition of inflammation-related enzymes, cyclooxygenase (COX), and lipoxygenase (LOX).7 RAW 264.7, a standard monocyte/macrophage cell line, is mainly used to study the anti-inflammatory activity of plant-derived extracts and their active constituents by evaluating the reduction in the production of inflammatory mediators, cytokines, and chemokines in LPS-stimulated RAW 264.7 cells (RAW 264.7 a macrophage cell line that was established from a tumor in a male mouse induced with the Abelson murine leukemia virus).8

Peroxisome proliferator-activated receptor γ (PPAR-γ) is a nuclear hormone receptor and a ligand-activated transcription factor family member. Increasing evidence indicates promising anti-inflammatory properties of cancer cells exerted by activating PPARγ by synthetic ligands.9

PPAR-γ agonists have been thought to inhibit the production of monocyte inflammatory cytokines and the expression of inducible nitric oxide synthase (iNOS), which has been observed in response to synthetic anti-diabetic thiazolidinedione drugs (such as BRL 49653 and ciglitizone), and negatively regulates the expression of proinflammatory genes and suppresses tumor cell growth.10

Drug combinations have been previously used as a new approach for treating many diseases. Their beneficial effects appear to be enhancing pharmacological activity and minimizing the dose to avoid any unwanted side effects of drugs without compromising their efficacy.11 Furthermore, previous literature mentioned that both fraxin and quercetin possess some antioxidant and anti-inflammatory activity in different disease models. In this research, we aim to investigate fraxin and quercetin anti-cytokine storm effects through suppression of the production of proinflammatory cytokines from the LPS-induced murine macrophage RAW 264.7 cell line, the possible mechanism underlying it, through changes in expression of TLR4 and PPAR-γ signaling pathways, and if there is a potential synergy between them when combined using isobolographic analysis, based on the median effect principle.12

Methods

Ethical consideration

The investigations followed the guidelines established by the Ethics Committee of Al-Nahrain University, College of Medicine (approval number Nah. Co). Pha.12 on 27 June 2022.

Chemicals and reagents

Quercetin hydrated 2-(3,4-dihydroxy phenyl)-3,5,7-trihydroxy-4Hchromenen-4-one dihydrate (purity ≥ 96%), fraxin (7,8-Dihydroxy-6-methoxy coumarin-8-beta-D-glucoside) (purity ≥ 98%), dexamethasone (purity ≥ 98%), and lipopolysaccharide (LPS) (Escherichia coli, 055: B5) were purchased from Hangzhou-Hyper Chem. Limited/China, dimethyl sulfoxide (DMSO) from Thomas Baker/India, Mouse Interleukin1β (IL-1β), (IL-6), and (TNF-α) enzyme-linked immunosorbent assay (ELISA) kits were purchased from MyBiosource, USA, RAW 264.7, (TIB-71) murine macrophage cell line (ATCC® TIB-71™), and Dulbecco’s modified Eagle’s medium (DMEM) from American Type Culture Collection (ATCC, USA), fetal bovine serum (10% FBS), Trypsin- EDTA, penicillin/streptomycin solution from Capricorn Scientific/Germany, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) kit from MyBioSource, USA; TRIazol® reagent (Invitrogen); RT-PCR primers: glyceraldehyde 3-phosphate dehydrogenase (GAPDH), PPAR-γ, and TLR-4 from OriGene/USA, LightCycler® FastStart™ SYBR® Green master kit/Roche, Germany, Revert AidTM first strand Complementary Deoxyribonucleic acid (cDNA) synthesis kit/Thermo Scientific, USA (Tables 1 and 2).

Table 1. Kits and equipment summary.

CHEMICALS AND EQUIPMENTPROVIDERBATCH, LOT, CAS NO.PRODUCTION AND EXPIRY
QUERCETIN HYDRATEDHANGZHOU-HYPER CHEM. LIMITED/CHINACAS NO. 849061-97-8
LOT NO. C0508275
PROD: 1 DEC 2021
EXP: 30 NOV 2023
FRAXINHANGZHOU-HYPER CHEM. LIMITED/CHINACAS NO. 524-30-1
BATCH NO. DSTQ000701
PROD: 3 JUNE 2021
EXP: 2 JUNE 2023
DEXAMETHASONEHANGZHOU-HYPER CHEM. LIMITED/CHINACAS NO. 50-02-2
BATCH RH278006
PROD: 17 JULY 2021
EXP: 12 JULY 2023
LPS (LIPOPOLYSACCHARIDE) ESCHERICHIA COLI, 055: B5HANGZHOU-HYPER CHEM. LIMITED/CHINABATCH NO. 0000114326PROD: 29 DEC 2020
EXP: DEC. 2026
DMSO (DIMETHYL SULFOXIDE)THOMAS BAKER/INDIACAS NO. 67-68-5
HSN-29309099
PROD: MARCH 2021
EXP: FEB 2026
DULBECCO'S MODIFIED EAGLE'S MEDIUM (DMEM)AMERICAN TYPE CULTURE COLLECTION (ATCC, USA)CAT NO. ATCC® 30-2002EXP: JULY 2023
FETAL BOVINE SERUM 10%CAPRICORN, GERMANYCAT NO. FBS-12B
LOT NO. CP22-5255
EXP: JUNE 2027
TRYPSIN- EDTA (0.05%) WITH PHENOL REDCAPRICORN, GERMANYCAT NO. TRY-4BEXP: JUNE 2023
PENICILLIN/STREPTOMYCIN SOLUTIONCAPRICORN, GERMANYCAT NO. PS-B
LOT NO. CP21-4278
EXP: JULY 2023
MOUSE INTERLEUKIN1B (IL-1B)MY BIOSOURCE, USACAT NO. MBS2021142EXP: JULY 2023
MOUSE INTERLEUKIN (IL-6),MY BIOSOURCE, USACAT NO. MBS450807EXP: JULY 2023
MOUSE INTERLEUKIN (TNF-A)MY BIOSOURCE, USACAT NO. MBS2500421EXP: JULY 2023
RAW 264.7 (TIB-71) MURINE MACROPHAGE CELL LINE (ATCC® TIB-71™)FROM AMERICAN TYPE CULTURE COLLECTION (ATCC, USA)CAT NO. ATCC® TIB-71™NA
3-(4,5-DIMETHYLTHIAZOL-2-YL)-2,5-DIPHENYLTETRAZOLIUM BROMIDE (MTT)MY BIOSOURCE, USACAT NO. MBS2557032
LOT NO. DP19BPX83816
PROD: NOV 2021
ELISA READER
HUMAREADER HS
HUMAN, GERMANYCAT. NO. 16670NA
ELISA WASHER, COMBIWASH HUMANHUMAN, GERMANYCAT NO. 18460NA
TRIAZOL® REAGENT(INVITROGEN), USACAT NO. 15596018
LOT NO. 423910
PROD: SEP 2022
EXP: SEP 2023
GAPDH MOUSE QPCR PRIMER PAIR (NM_008084)ORIGENE, USACAT NO. MP205604EXP: SEP 2023
PPARG MOUSE QPCR PRIMER PAIR (NM_011146)ORIGENE, USACAT NO. MP210761EXP: SEP 2023
RT-PCR PRIMERS TLR-4
TLR4 MOUSE QPCR PRIMER PAIR (NM_021297)
ORIGENE, USACAT NO. MP217025EXP: SEP 2023
LIGHTCYCLER® FASTSTARTTM DNA MASTER SYBER GREEN I KITROCHE, GERMANYCAT NO. 03003230001EXP: MARCH 2023
REVERT AID™ FIRST STRAND CDNA SYNTHESIS KIT/THERMO SCIENTIFIC, USACAT NO. K1621
LOT NO. 2682573
EXP: 30 SEP 2024
DULBECCO’S PBS (1X), WITHOUT CA & MG, WITHOUT PHENOL RED (PHOSPHATE-BUFFERED SALINE, PBS)CAPRICORN SCIENTIFIC/GERMANYCAT NO. PBS-1A
Corning cell lifterSigma-AldrichCAT NO. CLS3008
CHLOROFORMMERCK/GERMANYCAT NO. 107024
ISOPROPANOLMERCK/GERMANYCAT NO. 109634
ETHANOL 75%MERCK/GERMANYCAT NO. 100983
RNASE-FREE WATERSIGMA-ALDRICH/CAT NO. W4502
ULTRAPURE™ SODIUM DODECYL SULFATE (SDS)THEMO SCIENTIFIC™/USACAT NO. 15525017
CENTRIFUGE 5425 REPPENDORF/GERMANYCAT NO. 5406000640
EPPENDORF SAFE-LOCK TUBESEPPENDORF/GERMANYCAT NO. 022363212
WATER BATHTHEMO SCIENTIFIC™/USACAT NO. TSGP02
NANODROP™ SPECTROPHOTOMETERTHEMO SCIENTIFIC™/USACAT NO. ND-2000
LIGHTCYCLER® FASTSTART
DNA MASTER SYBR
GREEN
LIFE SCIENCE/ROCHE/SWITZERLANDCAT NO. 03003230001
EXICYCLER™384 REAL – TIME PCR SYSTEMBIONEER/REPUBLIC OF KOREACAT NO. A-2061

Table 2. Kits types and sources.

Kit nameAntibodySpecies/TypePolyclonal or Monoclonal
Mouse Interlukin-6 Elisa KitCapture AntibodyRatMonoclonal
Mouse Interlukin-6 Elisa KitImmunogenMouse Protein Corresponding To Uniprot… ..
Mouse Interlukin-6 Elisa KitDetection AntibodyGoatPolyclonal
Mouse Interlukin-6 Elisa KitStandardE. coli Expressed Recombinant Protein Corresponding To Amino Acids 25-211… … ..
Mouse Interlukin-1 Beta Elisa KitCapture AntibodyRabbitPolyclonal
Mouse Interlukin-1 Beta Elisa KitImmunogenRecombinant Partial-Length Protein Corresponding To Amino Acids Val118-Ser269, Of Uniprot, Via E. coli----------
Mouse Interlukin-1 Beta Elisa KitDetection AntibodyRabbitPolyclonal
Mouse Interlukin-1 Beta Elisa KitStandardRecombinant Partial-Length Protein Corresponding To Amino Acids Val118-Ser269, Of Uniprot, Via E. coli.----------
Mouse TNF-Alpha Elisa KitCapture AntibodyRatMonoclonal
Mouse TNF-Alpha Elisa KitImmunogenRecombinant Partial-Length Protein Corresponding To Amino Acids 80-235, Of Uniprot ID P06804, Via E. coli.---------
Mouse TNF-Alpha Elisa KitDetection AntibodyRabbitPolyclonal
Mouse TNF-Alpha Elisa KitStandardRecombinant Partial-Length Protein Corresponding To Amino Acids 80-235, Of Uniprot ID P06804, Via E. coli.----------

Cell culture

The RAW264.7 TIB-71 murine macrophage cell line was maintained in Dulbecco’s Modified Eagle Medium (Capricorn Scientific) with 10% fetal bovine serum (FBS) 1% penicillin-streptomycin and then kept in an incubator at 37°C with 5% carbon dioxide until confluent. Trypsin-EDTA was used to clean and harvest cells.13

Method of trypsinization, cell harvesting using trypsin-EDTA

The trypsinization procedure was performed in a laminar flow hood using proper aseptic technique. Trypsin, media, and phosphate buffer solution (PBS) were warmed in a 36°C water bath for at least 20 minutes prior to the procedure. All growth media was aspirated from the cell culture flask, washed once with PBS, and gently shaken with the PBS around the flask and aspirated. Half of the culture volume of trypsin was ejected directly onto cells, which was enough to cover the cells. The cells were incubated for 5 minutes at 37°C. cells were quite adherent to the flask. Cell lifter was needed at this point, trypsin was neutralized with serum containing medium (half of culture volume + 0.5 mL); warm media was directly ejected onto cells and a cell lifter was used gently to scrape cells off the flask. The cell suspension was collected from the flask and centrifuged for 4 minutes at 2500 rpm, after which the trypsin-containing supernatant was then discarded, and the cell pellet was resuspended with fresh medium, and counted or cultured as desired.13

Cell viability assay (MTT assay)

Cell viability in RAW264.7 was evaluated using the MTT assay after treatment with quercetin, fraxin, and fraxin + quercetin (FQ). RAW264.7 cells were plated at a density of 1 × 104 cells/well in a 96-well plate and allowed to grow for 24 h. before the medium was removed. Then the cells were treated with fraxin, quercetin, and FQ in a ratio of 1:1 in serial dilutions (200, 100, 50, 25, 12.5, and 6.25 μg/ml), each concentration in tri-replicate, for 2 h. from the treatment. First, LPS (1 μg/ml) was added to each well and incubated for 24 h. Next, 20 μL of MTT (5 mg/mL) was added to each well, followed by incubation for 4 h at 37°C with 5% CO2. After removing the media, 150 μL of dimethyl sulfoxide (DMSO) was added to each well to dissolve the insoluble formazan crystals in viable cells. The ELISA plate reader read an absorbance of 540 nm. Cell viability was calculated relative to the untreated control cells, which were considered to have 100% viability. The following formula was used to determine cell viability:

Cell viability%=absorbance of sample/absorbance of control×100.

Experiments were performed in triplicate, and the data are presented as mean ± standard error of the mean.

Sample preparation

Quercetin hydrated 2-(3,4-dihydroxy phenyl)-3,5,7-trihydroxy-4Hchromenen-4-one dihydrate (purity ˃ 96%), Fraxin (7,8-Dihydroxy-6-methoxy coumarin-8-beta-D-glucoside) (purity ˃ 98%), and LPS (lipopolysaccharide) (Escherichia coli, 055: B5) were all purchased from Hangzhou-Hyper Chem. Limited/China. Both quercetin and fraxin were dissolved using DMSO (Dimethyl sulfoxide, from Thomas Baker/India), and LPS was dissolved and diluted in PBS for preparation of 1 μg/ml solution. Each agent (quercetin and fraxin) was dissolved in DMSO and then diluted to final volume with (Mg2+, Ca2+)-free PBS buffers at pH 7.4 to prepare a stock solution of 1 mg/ml for each fraxin and quercetin. Serial dilutions were freshly prepared at the same day of the experiment from the stock solution. Agents were tested at concentrations of 200, 100, 50, 25, 12.5, and 6.25 μg/ml and for FQ (half the concentration was tested for each agent in the same well), cells were supplemented with 200 μl of fresh medium along with the tested agent. The concentration of DMSO used (<0.1%) did not influence the performed assays.

Calculation of combination index (CI)

The results of the MTT assay were analyzed using the isobologram equation for the median effect/combination index (CI) by Chou (2006) and Chou and Talalay (1984). A dose-response curve can be generated by experimenting with different concentrations of each drug and its combination. For example, D is the dose, and Dm is the dose for a 50% effect; in this case, it is equal to IC50%. The parameters of the dose-effect curves were calculated with the help of a computer program (Compusyn), which then determines the CI values using the general combination index equation, from which we can infer that synergism, additive effects, and antagonism are present if the CI value is less than one, equal to one, or more than one, respectively.12

Cytokine levels measurement

In comparison with dexamethasone as a positive control drug, the anti-cytokine storm activity of fraxin, quercetin, and FQ was evaluated by measuring levels of proinflammatory cytokines IL-1β, IL-6, and TNF-α in RAW 264.7 cells induced with (1 μg/ml) LPS. A 96-well plate was seeded with RAW264.7 cells at a density of 1 × 104 cells/well and incubated for 24 h. Cells were pretreated with fraxin (concentration 25 μg/ml), quercetin (concentration 12.5 μg/ml), and FQ (concentration 6.25 μg/ml). These concentrations were selected according to the MTT assay results, and dexamethasone (5 μg/ml) was used as a positive control drug. All treatments were performed in triplicate; untreated cells were considered a negative control. After 2 hours adding treatment, LPS was added to all wells in the plate and incubated for 24 h at 37 °C in a humidified CO2 5% incubator. After that the medium was collected and centrifuged at 2000xg for 10 min. Culture supernatants were collected to quantify proinflammatory cytokines by enzyme-linked immunosorbent assay (ELISA) kits for the targeted cytokines IL-1β, IL-6, and TNF-α. All reagents, and dilutions were prepared on instructions provided by the manufacturer (My BioSource, USA). From each, 100 μl of dilution of standards, blank, and the collected samples were added to each well in a 96-well plate then covered, gently shaken, and incubated at 37°C for 60 minutes. The liquid was removed from each well, without washing. A volume of. 100 μl of detection reagent A was added to each well and incubated at 37°C for 60 minutes. The washing was repeated three times, 100 μl detection reagent B was added to each well, and was incubated for 30 minutes at 37°C. The washing was repeated five times, 90 μl substrate Solution was added to each well and incubated for 10–20 minutes at 37°C. Away from light, the liquid turned blue, 50 μl stop Solution was added and the liquid turned yellow. Under 450 nm wavelength, the optical density (OD) was calculated. The linear regression equation of the standard curve was computed based on concentrations of standards and related OD values. Then the concentration of the corresponding sample was calculated, and the levels of IL-1β, IL-6, and TNF-α in cell culture supernatants were expressed as pg/ml. The OD was calculated at a wavelength of 450 nm. The linear regression equation of the standard curve was computed based on the concentrations of the standards and corresponding OD values. Then the attention of the corresponding sample was calculated, and the levels of IL-1β, IL-6, and TNF-α in cell culture supernatants were expressed as pg/ml.

Gene expression analysis

Each well of a 6-well plate was inoculated with 1 × 106 cells and incubated for 24 hours. Fraxin (25 μg/ml), quercetin (12.5 μg/ml), and FQ (6.25 μg/ml) were applied to cells in triplicate (1 μg/ml). After Two hours,cells were treated with fraxin, quercetin, and FQ, LPS was added. The cells were then incubated at 37°C for 24 hours in a humidified CO2 5% incubator. Prior to harvesting, the cells were rinsed three times with PBS. The cells were pre-treated with fraxin (25 μg/ml), quercetin (12.5 μg/ml), and FQ (6.25 μg/ml) all in triplicate, (1μg/ml) LPS was added after 2 h. Subsequently, cells were incubated for 24 h at 37 °C in a humidified CO2 5% incubator. The cells were washed three times with PBS before being harvested. The growth media was then removed. To lyse the cells, 1 mL of TRIzol™ Reagent was added directly. The lysate was pipetted up and down several times to homogenize, then incubated for 5 minutes at room temperature before 0.2 mL of chloroform was added, then thoroughly mixed by shaking and incubated for 2–3 minutes at room temperature. The sample was centrifuged at 12,000 × g at 4°C for 15 minutes. The mixture separated into a lower red phenol-chloroform, an interphase, and a colorless upper aqueous phase. By angling the tube at 45° and pipetting the solution out, the aqueous phase containing the RNA was transferred to a new tube. After 0.5 mL of isopropanol was added to the aqueous phase, it was incubated for 10 minutes at 4°C before being centrifuged for 10 minutes at 12,000 × g at 4°C. The total RNA precipitated formed a white gel-like pellet at the bottom of the tube, and the supernatant was discarded with a micro pipettor. The pellet was resuspended in 1 mL of 75% ethanol, briefly vortexed then centrifuged for 5 minutes at 7500 × g at 4°C. The supernatant was discarded with a micro pipettor, and the RNA pellet was vacuumed or air dried for 5–10 minutes. By pipetting up and down, the pellet was resuspended in 20–50 μL of RNase-free water, 0.1 mM EDTA, or 0.5% SDS solution, incubated in a water bath at 55–60°C for 10–15 minutes, then proceeded to downstream applications, or stored the RNA at -70°C. Total RNA was extracted from stimulated cells using TRIzol® reagent, and the first strand of cDNA was produced using a commercial kit according to the manufacturer’s instructions, the detailed steps were as the following: after thawing, the kit’s components were mixed and briefly centrifuged. The following reagents were added to an ice-cold sterile, nuclease-free tube in the following order:

  • a - Template RNA (total RNA) 0.1 ng – 5 μg

  • b - Primer (Random Hexamer primer) 1 μL

  • c - Water, nuclease-free added to make the total volume of 12 μL

- Total volume 12 μL

This was gently mixed, briefly centrifuged and incubated at 65°C for 5 min then placed on ice for 1 min. The following components were added in the indicated order:

  • 5× Reaction Buffer 4 μL

  • RiboLock RNase Inhibitor (20 U/μL) 1 μL

  • 10 mM dNTP Mix 2 μL

  • Revert Aid M-MuLV RT (200 U/μL) 1 μL

Total volume 20 μL

This was gently mixed, and centrifuged briefly, incubated for 5 min at 25°C followed by 60 min at 42°C. The reaction was terminated by heating at 70°C for 5 min.

RNA yield determination

Total nucleic acid content is determined by 260 nm absorbance, while sample purity is determined by 280 nm absorbance. Because free nucleotides, RNA, ssDNA, and dsDNS absorb at 260 nm, they all contribute to the sample’s total absorbance. Using the NanoDropTM spectrophotometer, RNA samples can be quantified by absorbance without prior dilution. In the reaction tube, 18 μl of SYBR Green PCR mix containing nuclease-free water, reverse and forward primers, SYBR Green I dye, 1U Taq DNA polymerase, 1.25 mM MgCl2, PCR buffer, and 100 μM Deoxynucleotide triphosphate (dNTP) was added to 2 μl cDNA template to accomplish PCR in 20 μl of the reaction mixture. Primers were used for amplification, and their sequences (5′–3′) are listed in Table 3.

Table 3. Gene and primer sequence.

GenePrimer sequence (5′–3′)
PPAR-γForward: ATCTACACGATGCTGGC
Reverse: GGATGTCCTCGATGGG
TLR4Forward: TAGCCATTGCTGCCAACATC
Reverse: CCTCAGCAGGGACTTCTCAA
GAPDHForward: TGCTGAGTATGTCGTGGAGT
Reverse: GTTCACACCCATCACAAACA

The amplification conditions were as follows: the RT-PCR reaction began with one cycle at 95°C for 3 min, followed by one process at 95°C for 25 s, 55°C for 25 s, and 40 cycles at 95 °C for 25 s each to prevent the amplification of non-specific products. A melting curve assay was performed from 60 to 94°C at a transition rate of 1°C/s. The relative expression ratio of each target gene in the experimental group relative to the control group was computed using the 2−△△Ct method and normalized against GAPDH, which was used as an internal reference gene. The results are expressed as fold-changes compared to the control.

Statistical analysis

All tests were performed in triplicate, and the results are presented as mean ± standard error of the mean (SEM), analyzed by one-way ANOVA-Tukey post hoc test for multiple comparisons. SPSS (RRID: SCR_013726) version 25 was used for statistical analysis; P < 0.05, was considered significant.

Results

Cell viability assay

The MTT assay determined the cell viability of RAW 264.7 cells35; Figure 1 illustrates the effects of fraxin, quercetin, and FQ on cell viability (expressed as a percentage compared to the control-untreated cells-considered 100% cell viability) in the presence of LPS. A reduction in cell viability was noticeable with higher concentrations of both fraxin and quercetin. While FQ exhibited the highest cytotoxicity among all three treatment groups, the viability of cells was decreased in a dose-dependent manner.

d528e35a-ba15-4b45-bc7f-084ec0c43ae1_figure1.gif

Figure 1. Effects of fraxin, quercetin, and fraxin + quercetin on RAW 264.7 cell viability.

Cell viability was determined using an MTT assay. The lower red line indicates that cells were subjected to different concentrations of all treatment groups with the presence of lipopolysaccharide (LPS) (1 μg/ml), and the upper red line represents 70% cell viability in all treatments. Cell viability was expressed as a percentage compared with the control, which was considered 100% cell viability, and data are presented as mean ± SEM.

Half-maximal inhibitory concentration (IC50) values were 248, 54, and 26.5 for fraxin, quercetin, and FQ, respectively. Based on these results, the threshold for cell viability was set at 70% or higher for the anti-cytokine storm assay,8 and the concentrations (25, 12.5, 6.25 μg/ml) for fraxin, quercetin, and FQ were selected, respectively, for the cytokine storm assay following assay.

Calculation of combination index (CI)

The combination index (CI) for FQ in a 1:1 ratio was calculated using CompuSyn based on the MTT results. Dose-effect and median-effect curves were plotted for each drug and its combination. The Results showed that FQ in a 1:1 ratio exhibited synergism, with CI values of 0.297 at IC50 and CI values of 0.409, 0.333, 0.332, 0.267, 0.265, and 0.276 at the following concentrations FQ (200, 100, 50, 25, 12,5, 6.25 g/ml).

Anti-cytokine storm assay

Fraxin, quercetin, and FQ in concentrations of 25, 12.5, 6.25 μg/ml, respectively, significantly suppressed the production of IL-1β, IL-6, and TNF-α (P ˂ 0.01) in a dose-dependent manner when compared to control (cells treated with LPS only). LPS significantly upregulated production of proinflammatory cytokines compared to the control group (P ˂ 0.05). The highest inhibition activity was recorded with dexamethasone (5 μg/ml) (positive, treated group) which significantly (P ˂ 0.05) suppressed IL-1β, IL-6, and TNF-α by 75.7%, 69%, and 79% respectively compared with the LPS treated control. In the case of the combination, FQ, the levels of IL-1β, IL-6, and TNF-α reduced by 56.2%, 58.5%, and 70.6% respectively, suggesting it is more effective in inactivating cytokine production than each drug alone. The results are shown in Figure 2A, B, and C).

d528e35a-ba15-4b45-bc7f-084ec0c43ae1_figure2.gif

Figure 2. A: Effects of fraxin, quercetin, and fraxin + quercetin on cytokine levels (IL-1) in RAW 264.7 cells at varied doses (25, 12.5,6.25 g/ml), 2 hours apart. Subsequently, all the cells were exposed to lipopolysaccharide (LPS) (1 μg/ml) for 24 h. All data are presented as mean ± SEM. * P ˂ 0.01 vs. LPS group, ** P ˂ 0.05 vs. control. B: Effects of fraxin, quercetin, and fraxin + quercetin on cytokine levels (IL-6) in RAW 264.7 cells at various doses (25, 12.5,6.25 g/ml) after 2 hours. Subsequently, all cells were exposed to lipopolysaccharide (LPS) (1 μg/ml) for 24 h. *P ˂ 0.01 vs. LPS group, **P ˂ 0.05 vs. control. C: Effects of fraxin, quercetin, and fraxin + quercetin on cytokines levels (TNF-α) in RAW 264.7 cells using different concentrations (25, 12.5,6.25 μg/ml), after 2 h. Later all cells were exposed to LPS (1 μg/ml) for 24 h. All data are presented as mean ± SEM. *P ˂ 0.01 vs. LPS group, **P ˂0.05 vs. control.

Gene expression analysis

When compared to the control, pretreatment of RAW 264.7 cells with farxin (25 μg/ml), quercetin (12.5 μg/ml), and FQ (6.25 μg/ml) for 2 hours before LPS (1 μg/ml) resulted in significant (P ˂ 0.05) suppression of TLR-4 gene upregulation by (89%, 82%, and 93%, respectively). Treatment with LPS activated the TLR-4 pathway, as shown in Figure 3A, and treatment with fraxin, quercetin, and FQ successfully counteracted the stimulatory impact of LPS on RAW 264.7 cells. Furthermore, compared to either treatment alone, the combination synergistically reversed the impact of LPS on cells.

d528e35a-ba15-4b45-bc7f-084ec0c43ae1_figure3.gif

Figure 3. A: The effects of treatment on the gene expression of Toll-like receptor 4. Cells were pretreated with fraxin (25 μg/ml), quercetin (12.5 μg/ml), and quercetin + fraxin (6.25 μg/ml) for 2 h. Cells were then treated with lipopolysaccharide (LPS) (1 μg/ml) and incubated for 24 h. **P < 0.001; compared with the control, each graph has been represented as Mean. B: The effects of treatment on gene expression of PPAR-γ, RAW 264.7 Cells were pretreated with fraxin (25 μg/m), quercetin (12.5 μg/m), and quercetin + fraxin (6.25 μg/m) for 2 h. Cells were treated with lipopolysaccharide (LPS) (1 μg/ml) and incubated for 24 h. **P < 0.001; compared with the control, each graph has been represented as Mean.

While Figure 3B reveals that there is a considerable stimulatory impact on the PPAR-γ pathway, this effect is shown as enhanced gene expression. FQ increased up to 60-fold relative to the control, whereas fraxin and quercetin (17.6, 8.6-folds, respectively) decreased proinflammatory cytokines (Figure 3B), indicating a mechanism by which fraxin, quercetin, and their combination reduce proinflammatory cytokines.

Discussion

The devastating epidemic caused by SARS-CoV-2 in 2019 prompted researchers to make a considerable effort to search for a possible solution to limit infection. Following the demonstration of the pathological role of the “cytokine storm”, evidence for a cytokine release syndrome can be seen in increased proinflammatory cytokines in late-stage COVID-19. As seen in previous epidemics caused by SARS-CoV and MERS-CoV, dysregulated cytokine production and an influx of inflammatory myeloid cells can cause lung infiltration, septic shock, respiratory failure, acute respiratory distress syndrome (ARDS), multiorgan failure, and death.14,15 Gram-negative bacteria’s outer membrane lipopolysaccharide (LPS) is used in inducing a cytokine storm model both in vivo and in in vitro studies. The stimulation of macrophages with LPS can cause the excessive release of proinflammatory cytokines by activating the nuclear factor κB (NF- κB) and mitogen-activated protein kinase (MAPK) signaling pathways, increasing (COX-2) and (iNOS).16 RAW 264.7 cells induced by LPS is the most widely used model for evaluating anti-cytokines in vitro. For centuries, plants have been used as a natural remedy for numerous illnesses. Hong et al. (2012) reported a dose-dependent reduction in cell spreading and pseudopodia production after treatment with an ethanol extract of Fraxinus rhynchophylla bark on LPS-stimulated macrophages.17 Whang et al. (2005) suggested in their study that fraxin and fraxin-related chemicals improved cell survival rate in human umbilical vein endothelial cells (HUVECs) when exposed to hydrogen peroxide (H2O2) mediated oxidative stress; other previous studies discussed the effect of quercetin on cell migration, which plays a vital role in the development of cancer.18 Quercetin strongly inhibited LPS-induced macrophage adhesion and migration in a dose-dependent manner.19 Previous research has highlighted the various biological activities of fraxin and quercetin, including anti-inflammatory and antioxidant effects, raising the need for additional investigation into their role in cytokine storms. Our study observed that fraxin, quercetin, and fraxin + quercetin exerted low cytotoxic activity on RAW 264.7, and only when cells were exposed to higher concentrations of fraxin and quercetin, which was in agreement with a study by Cui et al. that suggested that only the highest concentration of quercetin reduced macrophage viability when administered together with LPS (1 μg/mL).19 Other previous studies compatible with our study support that the cell viability of RAW 264.7 was not compromised by the presence or absence of LPS.17,20

Li et al. (2019) concluded that fraxin confers protection against LPS-induced lung injury and the inflammatory response in A549 cells.20 In an approach to modulate virus hyperinflammation such as chronic systemic symptoms, the anti-inflammatory effects of quercetin were investigated in mouse macrophage cells exposed to polyinosinic-polycytidylic acid (poly (I:C) as an experimental model for viral inflammation by Kim YJ and Park W. (2016). They found that quercetin might suppress poly (I:C)-induced inflammation by reducing the levels of inflammatory mediators.

Our findings support previous research that found that both fraxin and quercetin were effective at suppressing the release of proinflammatory mediators from LPS-induced RAW 264.7, the mechanism underlying which may be related to interference with various inflammatory signaling pathways, including the TLR signaling system. Following their activation, proinflammatory molecules (such as IL-1, IL-6, and TNF-α) are abundantly generated, and NF-κB phosphorylation, nuclear translocation, and upregulated transcription of proinflammatory factors are all results of TLR-4 activation.16,21

In numerous macrophage models, PPAR-γ has been shown to exert anti-inflammatory effects by suppressing the expression of multiple proinflammatory genes, such as IL-6, TNF-α, and IL-12.22 From earlier studies, fraxin, isolated from the roots of Ulmus macrocarpa Hance, significantly suppressed the expression of iNOS and COX-2, increased PPAR-γ expression, activated the nuclear factor erythroid 2-related factor 2/heme oxygenase-1 (HO-1) (Nrf2/HO-1) pathway, and inhibited NF-κB and ERK1/2 in a dose-dependent manner The neuroprotective and anti-inflammatory effects of fraxin were also diminished by treatment with GW9662 which is a PPAR-γ antagonist.23,24

In LPS-induced ARDS in mice, fraxin reduced the production of TNF-α, IL-1β, IL-6, Reactive oxygen species (ROS), and Malondialdehyde (MDA), increased Super oxide dismutases (SOD), and suppressed NF-κB and MAPK signaling.25

Li et al., 2019 discovered that pretreatment with fraxin decreased protein expressions of NF-κB and nucleotide-binding domain, leucine-rich–containing family, pyrin domain–containing-3 (NLRP3) activated in response to lipopolysaccharide (LPS).26 Aesculin, a hydroxycoumarin, is the 6-O-beta-D-glucoside of esculetin, another organic compound isolated from Cortex fraxini that is structurally related to fraxin. Furthermore, studies in the peritoneum and macrophages demonstrated that aesculin inhibits the production of inflammatory mediators such as iNOS, IL-1, and TNF-α via the PPAR-γ/NF-κB pathway.27

While quercetin inhibits liver inflammation mainly through NF-κB/TLR/NLRP3, it also inhibits LPS-stimulated NO increase by suppressing iNOS.28,29 In addition, in differentiated human acute monocyte leukemia cell line (THP-1), quercetin might lower cholesterol levels in macrophages with elevated PPAR-γ expression. Quercetin metabolites, such as quercetin-3-glucuronide (Q3G) and quercetin-3′-sulfate, also upregulated PPAR-γ in A549 lung cancer cells.30,31

Flavonoids, such as quercetin and kaempferol, increase PPAR-γ-mediated gene expression through a mechanism distinct from conventional PPAR-γ agonists.32

Dihydroquercetin activates AMPK/Nrf2/HO-1 signaling in macrophages, which mediates its anti-inflammatory effects.33

Our results were consistent with previous studies supporting that fraxin and quercetin upregulated PPAR-γ expression and downregulated TLR-4, stimulated by LPS treatment in macrophage RAW 264.7 cells.

Fraxin + quercetin showed synergistic activity when combined, which may be due to multiple targets involved when coming to their anti-inflammatory mechanism, resulting in suppression of proinflammatory mediators IL-1, IL-6, TNF-α and suppression of other pathways like iNOS, COX-2, Nrf2/HO-1, NF-κB, NLRP3, TLR-4, and upregulation of PPAR-γ,

A study described the synergistic combination of two bioflavonoids: quercetin and catechin; this combination caused inhibition of the LPS-activated upregulation of iNOS and COX-2.20 Previous studies have shown that drug combinations, especially in phytopharmaceuticals, may activate entirely different sets of genes than those started by each drug alone.34 This may provide another theoretical explanation for the synergistic activity between fraxin and quercetin, despite the differences in their chemical structures.

Conclusions

Our study showed that fraxin, quercetin, and their combination exert anti-cytokine storm activity on LPS-induced RAW246.7 cells by targeting multiple signaling pathways and suppressing TLR-mediated NF-κB. Upregulation of PPAR-γ mediated gene expression (Figure 3A and B) may serve as a foundation for future research into other combinations of fraxin and quercetin and pathways involved in their molecular mechanisms explaining the synergistic anti-cytokine storm activity.

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S. Shaker N, B. Sahib H, A. Hussein Z and J. Tahseen N. Anti-cytokine storm activity of fraxin and quercetin, alone and in combination, and their possible molecular mechanisms via TLR4 and PPAR-γ signaling pathways in lipopolysaccharide-induced RAW 264.7 cell line [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2023, 12:1120 (https://doi.org/10.12688/f1000research.133145.1)
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Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
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Reviewer Report 22 Feb 2025
Fan Jiang, Qilu Hospital of Shandong University, Shandong, China 
Not Approved
VIEWS 12
1. In this study, the authors reported that fraxin, quercetin, and their combination inhibited cytokine release in LPS-stimulated RAW264.7 cells and increased the expression of PPAR-γ. Overall, these data are too preliminary, without further mechanistic or translational investigations. 

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Jiang F. Reviewer Report For: Anti-cytokine storm activity of fraxin and quercetin, alone and in combination, and their possible molecular mechanisms via TLR4 and PPAR-γ signaling pathways in lipopolysaccharide-induced RAW 264.7 cell line [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2023, 12:1120 (https://doi.org/10.5256/f1000research.146120.r365339)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Reviewer Report 29 Jun 2024
Dr. Amany Ghazy, Jouf University, College of Medicine, Sakaka, Saudi Arabia 
Approved with Reservations
VIEWS 11
Dear Authors
The current manuscript presents a good point for further research and is presented well. However, I have a few comments:
- Authors link the cytokine storm to COVID-19 only but it can be generalized particularly, it ... Continue reading
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Ghazy DA. Reviewer Report For: Anti-cytokine storm activity of fraxin and quercetin, alone and in combination, and their possible molecular mechanisms via TLR4 and PPAR-γ signaling pathways in lipopolysaccharide-induced RAW 264.7 cell line [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2023, 12:1120 (https://doi.org/10.5256/f1000research.146120.r257418)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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