Protective effects of luteolin on STZ-induced diabetic kidneys

AIM: To explore the protective effects of luteolin on the diabetic kidneys. METHODS: Male Sprague-Dawley rats were randomly divided into 5 groups: normal control group, diabetic model group and the groups of diabetic rats treated with luteolin at a low dose, a middle dose and a high dose. The diabetic model was induced by a single intraperitoneal injection of streptozotocin (STZ,65 mg/kg). Blood glucose, urine protein, the activity of superoxide dismutase and catalase in serum and kidney, and the content of malonaldehyde(MDA) in kidney were analyzed by biochemical methods. Western blotting was used to detect the protein expression of transforming growth factor-β₁(TGF-β₁) and plasminogen activator inhibitor-1(PAI-1) in the renal cortex. The morphological changes of the renal tissues were observed under microscope. RESULTS: Compared with diabetic model group, luteolin significantly reduced the level of blood glucose (P<0.01), the content of urine protein (P<0.01) and MDA (P<0.01) in the kidneys, and increased the activity of superoxide dismutase and catalase (P<0.01) in serum and kidneys in the diabetic rats. The protein levels of TGF-β₁ and PAI-1 in the renal cortex were dramatically decreased as the rats were treated with luteolin. CONCLUSION: Luteolin may exert an important protective effect on diabetic kidneys by relieving oxidative stress and inhibiting the protein expression of TGF-β₁ and PAI-1 in the renal tissues of STZ-induced diabetic rats.     

Effect of erlotinib on renal injury in rats with STZ-induced diabetic nephropathy

AIM: To investigate the effect of epidermal growth factor receptor (EGFR) inhibitor erlotinib on kidney injury in diabetic nephropathy (DN) rat and the underlying mechanism. METHODS: The rat model of DN was induced by intraperitoneal injection of streptozotocin (STZ) at dose of 55 mg/kg. One week after STZ injection, the rats with blood glucose level exceeding 16.7 mmol/L were identified as diabetic. Diabetic rats were randomly divided into 2 groups:STZ group and STZ+erlotinib group. In addition, the normal rats were used as control group. The rats in STZ+erlotinib group were treated with erlotinib at 100 mg·kg^-1·d^-1 for 4 weeks(5th~8th week). The fasting blood glucose (FBG), serum creatinine (SCr) and 24 h urine protein were measured. The pathological changes of the kidney were observed by HE staining and Masson staining. The protein levels of EGFR, p-EGFR, transforming growth factor β1 (TGFβ1), Smad2/3, p-Smad2/3, collagen Ⅳ (ColⅣ) and fibronectin in the kidney tissues were determined by Western blot. The reactive oxygen species (ROS) level and malondialdehyde (MDA) content in the renal tissues were futher analyzed. RESULTS: Compared with control group, the levels of FBG, 24 h urine protein and Scr were significantly increased in STZ group (P<0.01). Compared with STZ group, the levels of FBG, 24 h urine protein and SCr in STZ+erlotinib group were markedly decreased (P<0.05). In additon, the glomerular structure was restored to normal, the proliferative degree of mesangial cells markedly attenuated, and the epithelial cells were in alignment in STZ+erlotinib group. Moreover, erlotinib significantly inhibited the protein levels of p-EGFR, TGFβ1, p-Smad2/3, ColⅣ and fibronectin in the kidney tissues of STZ rats. In addition, erlotinib also significantly inhibited the levels of ROS and MDA in the kidney tissues of STZ rats. CONCLUSION: Erlotinib ameliorates STZ-induced diabetic nephropathy possibly through inhibiting the activation of EGFR/TGFβ1-Smad2/3 signaling pathway in association with suppression of fibrosis and oxidative stress.     

CXCL16 deficiency attenuates STZ-induced diabetic nephropathy in mice

AIM: To explore the effect of CXCL16 deficiency on streptozocin (STZ)-induced diabetic nephropathy in mice. METHODS: CXCL16 knockout (C16 KO) mice (8 years old) were used to build up diabetes model by treating with STZ.Age- and gender-matched wild-type (WT) C57BL/6J mice treated with STZ were used as control. All mice were fed with chow diets for 12 weeks, and the development of diabetic nephropathy was evaluated. RESULTS: Compared with the WT mice treated with STZ, C16 KO mice treated with STZ presented lower fasting glucose levels and better glucose tolerance power. C16 KO mice treated with STZ also had lower urine protein levels and smaller areas of glomerular injury as compared with WT mice treated with STZ. Furthermore, CXCL16 deficiency decreased the contents of renal reactive oxygen species (ROS), malondialdehyde (MDA) and oxidized low-density lipoprotein (ox-LDL) and the mRNA expression of lectin-like oxidized low-density lipoprotein receptor 1 (Lox-1), and attenuated the expression of renal inflammatory factors including tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), as well as chemokines including intercellular cell adhesion molecular 1 (ICAM-1) and chemokine C-X-C motif ligand 1 (CXCL1). CONCLUSION: CXCL16 deficiency obviously inhibits the development of STZ-induced diabetic nephropathy in mice.     

Protective effects of sulforaphane on retinal neurons in diabetic rats

AIM: To clarify whether sulforaphane (SF) has protective effects on retina neuronal cells in diabetic rats and to identify the related mechanisms involved in this process. METHODS: The diabetic rat model was induced by single intraperitoneal injection of streptozotocin (STZ). The protective effects of SF were evaluated by measuring the generation of reactive oxygen species (ROS), detecting apoptosis of retina neuronal cells with TUNEL staining and counting the survival retinal ganglion cells (RGCs). The nuclear translocation of nuclear factor E2-related factor 2 (Nrf2) and the protein expression of heme oxygenase-1 (HO-1) were examined by immunofluorescence analysis and Western blot. RESULTS: SF treatment significantly attenuated ROS generation, decreased the apoptosis of retina neuronal cells and increased the numbers of survival RGCs in the diabetic rats. Meanwhile, SF significantly increased the nuclear accumulation of Nrf2 and the protein level of HO-1 in the retinas of diabetic rats. However, HO-1 inhibitor, protoporphyrin IX zinc (Ⅱ) diminished the inhibitory effects of SF on RGCs apoptosis. CONCLUSION: SF partially exerts the beneficial neuroprotective effects via the activation of the Nrf2/HO-1 antioxidant pathway, therefore alleviating retinal oxidative stress and decreasing the apoptosis of retina neuronal cells.     

Protective effects of extract of Ginkgo biloba on diaphragm of diabetic rats

AIM: To investigate the effects of extract of Ginkgo biloba (EGb) on diaphragm from diabetic rats. METHODS: Sprague-Dauley rats were divided into three groups: normal control, diabetic group and EGb treatment group. The morphologic changes of diaphragm tissues were studied by light and electron microscopy, the activities of succinate dehydrogenase (SDH), superoxide dismutase (SOD), nitric oxide synthase (NOS) and contents of malondialdehyde (MDA), nitric oxide (NO₂^-/NO₃-) in the diaphragm mitochondria were assayed by spectophotometer, respectively. RESULTS: The activities of SOD, SDH decreased in diabetic diaphragm mitochondria, but the activitiy of NOS, the contents of NO₂^-/NO₃^-, MDA increased compared with control group. The activities of SOD, SDH were increased as well as NOS were decreased and the contents of NO₂^-/NO₃^-, MDA decreased in EGb treatment group compared with the diabetic group. CONCLUSION: EGb may protects the diaphragm mitochondria of diabetic rats by enhancing the function of respiratory chain, anti-oxidation and decreasing NO level.     

Expression of TGF-β1 and Smad2/3 in kidney of STZ-induced diabetic nephropathy rats

AIM: To study the role of TGF-β/Smad pathway in the development of renal fibrosis in diabetic nephropathy.METHODS: Rats were induced to diabetic nephropathy by using tail intravenous injection of STZ.The expression of TGF-β₁, Smad2/3 protein and mRNA in kidney were examined at 2, 4, 8 and 16 weeks after STZ induction.CTGF, collagen-Ⅲ, PAI-1 mRNA expression in kidney at 16 weeks of STZ-induced diabetic nephropathy and normal rats were studied by RT-PCR.RESULTS: Weak TGF-β₁, Smad2/3 protein were detected in normal renal tissues while strong TGF-β₁, Smad2/3 staining were observed in renal tissues of diabetic nephropathy (0.057±0.030/0.223±0.040;0.017±0.010/0.153±0.010, respectively, P<0.05).The TGF-β₁, Smad2/3 protein expression were constantly high with the development of diabetic nephropathy and fibrosis (0.153±0.010, 0.122±0.050, 0.141±0.070 and 0.216±0.030 for 2, 4, 8 and 16 weeks, respectively).The TGF-β₁, Smad2 mRNA expression also increased with the development of diabetic nephropathy (2.86, 3.25 fold compared to control, respectively).The expression of TGF-β₁, Smad2, CTGF, collagen-Ⅲ and PAI-1 mRNA were significantly higher in kidney of 16 week diabetic nephropathy rats than that in normal ones (3.92, 2.95, 1.57, 1.95 and 1.97 folds compare to control, respectively, P<0.05).CONCLUSION: The results indicate that TGF-β₁/ Smad2 pathway activity might play an important role in pathophysiological process of diabetic nephropathy.It may be involved in diabetic renal fibrosis through up-regulation of CTGF and PAI-1 to promote extracellular matrix deposition.     

Protective effects of sequoyitol on type 2 diabetic rats with liver inflammatory lesions

AIM：To investigate the possible protective effect of sequoyitol on type 2 diabetic rats with liver inflammatory lesions. METHODS：Type 2 diabetic rats were induced by feeding high-fat/high-sugar diet and injecting with a low dose of streptozotocin. Sequoyitol at doses of 12.5, 25 and 50 mg·kg-1·d-1 was orally administered in the model rats. At the end of the experiment, the rats were sacrificed. Serum levels of fasting blood glucose, alanine aminotransferase(ALT), aspartate aminotransferase(AST) and albumin(ALB) were determined. Liver wet was recorded and liver index was calculated. The levels of C-reactive protein(CRP),tumor necrosis factor α(TNF-α) and interleukin 6(IL-6) in the liver tissues were also measured. Real-time PCR was used to determine the mRNA expression of TNF-α. In addition, the pathological changes of the liver were observed with HE staining. RESULTS：Compared with the model rats, treatment with sequoyitol obviously decreased the levels of fasting blood glucose, ALT, AST, ALB, CRP, TNF-α and IL-6, reduced the liver index, down-regulated the mRNA expression of TNF-α in the liver, and ameliorated the pathologic changes of the liver. CONCLUSION：Sequoyitol attenuates liver lesions in type 2 diabetic rats through down-regulation of TNF-α and IL-6 expression.     

Renoprotective effect of L-carnitine on streptozotocin-induced diabetic nephropathy in rats

AIM: To investigate whether L-carnitine (LC) treatment confers renoprotection in a rat model of streptozotocin (STZ)-induced diabetic nephropathy (DN). METHODS: Diabetic animal model was established by intraperitoneal injection of STZ (65 mg/kg) in Sprague-Dawley rats. Diabetic rats were treated with LC (50 mg·kg^-1·d^-1 or 200 mg·kg^-1·d^-1 intravenously) daily for 12 weeks. The effects of LC on STZ-induced DN were evaluated by assessing renal function, urinary protein excretion, histopathological changes, macrophage infiltration, the expression of proinflammatory and prosclerotic cytokines, and the expression of nuclear factor-κB (NF-κB) and apoptosis-related gene. RESULTS: LC administration significantly decreased glomerulosclerosis, preserved the number of podocytes, and reduced macrophage infiltration. These changes were accompanied by improvements in urinary protein excretion and renal dysfunction. LC treatment suppressed the expression of proinflammatory and prosclerotic cytokines, and these changes were paralleled by significant attenuation of NF-κB and apoptosis-related gene expression. CONCLUSION: LC has a renoprotective effect against STZ-induced DN in rats.     

Protective effect of curcumin on myocardium in diabetic rats

AIM: To study the effects of curcumin (Cur) on diabetic cardiomyopathy (DCM) in rats. METHODS: Male Wistar rats (n=75) were divided into control group and diabetes model group, in which the rats were fed with high-fat diet and then intraperitoneally injected with streptozotocin (STZ, 40 mg/kg). Fasting blood glucose was measured 72 h and 1 week after STZ injection. The diabetic rats were diagnosed when sustained fasting blood glucose levels ≥ 11.6 mmol/L. The diabetic rats were randomly divided into DCM group, DCM+Cur 100 mg/kg group and DCM+Cur 200 mg/kg group. After treatment for 16 weeks, glutathione peroxidase (GSH-Px) activity and malondialdehyde (MDA) level were measured, and the level of cardiac troponin I (cTnI) in the serum was determined by enzyme-linked immunosorbent assay. The protein expression of protein kinase C (PKC) was detected by Western blotting. RESULTS: Curcumin significantly decreased the blood glucose level, increased the body weight, inhibited MDA content and up-regulated the GSH-Px activity in the diabetic rats. Furthermore, curcumin treatment inhibited the diabetes-induced protein expression of PKC. CONCLUSION: Curcumin may have a protective effect on diabetic cardiomyopathy by attenuating oxidative stress.     

Protective effects of Zhenwu decoction on kidney injury of diabetic rats induced by streptozotocin

AIM：To investigate the effects of Zhenwu decoction (ZWD) on the expression of α-smooth muscle actin (α-SMA) and NF-κB in diabetic nephropathy (DN) rats. METHODS：Diabetic rat model was induced by intrape-ritoneal injection of streptozotocin (STZ), and the animals were randomly divided into STZ group (n=22) and STZ+ZWD group (n=23). The normal rats served as control (n=16). All rats were sacrificed on 8 weeks after modeling. Biochemical assay and pathological observation (HE staining and transmission electron microscopy) were used to evaluate the effects of Zhenwu decoction on the renal function and pathological morphology. The body weight, renal index, blood glucose, total urinary protein in 24 h, and superoxide dismutase (SOD), malondialdehyde (MDA),inducible nitric oxide synthase (iNOS) were determined as well. Western blotting was used to observe the effects of Zhenwu decoction on the expression of α-SMA and NF-κB in diabetic nephropathy (DN) rats. RESULTS：Compared with normal group, the renal index, blood glucose concentration, total urinary protein in 24 h, blood urea nitrogen (BUN), serum creatinine (SCr) and MDA were significantly higher and body weight was lower in DN rats (P<0. 05). Pathological examination of the kidneys in DN group showed glomerular hypertrophy, glomerular basement membrane thickening, tubular epithelial cell degeneration, mesangial matrix proliferation, protein cast formation in some renal tubules. The protein expression levels of α-SMA and NF-κB were markedly increased (P<0.05). After ZWD treatment, the level of renal index, total urinary protein in 24 h, BUN, SCr and the expression of α-SMA and NF-κB at the protein level were significantly decreased (P<0.05). The renal histological injury in ZWD group was significantly ameliorated. CONCLUSION：Zhenwu decoction might protect kidney against STZ-induced injury via decreasing the expression of α-SMA and NF-κB.     

Therapeutic effects of losartan and astragalus membranaceus on diabetic nephropathy

AIM: To observe the protective effects of losartan and astragalus membranace on the kidney of diabetic rats, and to study their possible mechanisms. METHODS: The diabetic rats were induced by a single intraperitoneal injection of streptozotocin. At the end of 12th week,changes in urinary albumin excretion, urinary β₂-MG excretion, Ccr,NO,ET-1 levels in blood, urinary and renal tissue were observed. Serum and urinary TGF-β₁ concentration,average volume of glomeruler,average thickness of glomerular basement membrane were also measured. RESULTS: In the treated diabetic rats, urinary albumin excretion, urinary β₂-MG excretion, Ccr, urinary and renal tissue NO, urinary TGF-β₁, average volume of glomeruler, average thickness of glomerular basement membrane decreased obviously as compared with diabetic untreated rats. These effects were enhanced when losartan was combined with astragalus membranace. CONCLUSION: Losartan or astragalus membranace reversed the injury of renal structure and function in STZ-induced diabetic rats. The protective effects were enhanced when losartan was combined with astragalus membranace. The decrease in NO,ET,TGF-β₁ concentration in renal tissue may be one of mechanisms for this action.     

Protective effect of pyrrolidine dithiocarbamate on cardiac muscles in diabetic rats

AIM: To investigate the effect of pyrrolidine dithiocarbamate (PDTC) on reducing blood glucose level and its protective effect on cardiac muscles in diabetic rats.METHODS: Thirty-seven male Wistar rats were randomly divided into normal control (NC) group and the high-fat diet (HFD) group. After 8 weeks of feeding, the rats in high-fat diet group were given a single dose of streptozotocin (STZ, 27 mg/kg) by intraperitoneal injection to induce type 2 diabetes. The diabetic rats were randomly divided into diabetes mellitus (DM) group and PDTC treatment(PDTC) group. The rats in PDTC group were intraperitoneally injected with PDTC (50 mg/kg) once daily. The rats in NC group and DM group were injected with equivalent volume of saline in the same way. After 1-week treatment, the level of blood glucose was measured, and all animals were killed. The concentration of malondialdehyde (MDA) and the activity of superoxide dismutases (SOD) and glutathione peroxidase (GSH-Px) were determined using commercial kits. The ultrastructural changes of the cardiac tissues were observed under transmission electron microscope. The expression of inducible nitric oxide synthase(iNOS) and content of nitrotyrosine was examined by the method of immunohistochemistry.RESULTS: The levels of blood glucose and MDA were significantly higher, while the activity of SOD and GSH-Px was lower in DM group than those in NC group (P<0.01). Treatment with PDTC markedly decreased the blood glucose and MDA content, and increased the activity of SOD and GSH-Px. Severe degeneration, necrosis, mitochondrial damage and inflammatory cell infiltration were found in the cardiac tissues in DM group. Treatment with PDTC markedly attenuated mitochondrial damage. The expression of iNOS and content of nitrotyrosine in cardiac tissues were significantly higher in DM group than those in NC group, and those were reduced after administration of PDTC.CONCLUSION: High glucose induces oxidative stress, increases the expression of iNOS and content of nitrotyrosine, and impairs the structure and function of myocardium. PDTC reduces blood glucose level, decreases the expression of iNOS and content of nitrotyrosine, and delays or attenuates the development of diabetic cardiomyopathy in diabetic rats.     

Apocynin decreases cardiac cytokines in STZ-induced diabetic cardiomyopathy

AIM: This study was to investigate the effects of apocynin on the expression of IL-1β, IL-18, TNF-α and COX-2 mRNA in the diabetic cardiomyopathy heart.METHODS: Diabetes was induced in 8-week old C57 mice with one intraperitoneal injection of streptozotocin (STZ, 100 mg/kg). The experiments were divided into 4 groups: sham (n=6), apocynin control (Apo, n=6), diabetic cardiomyopathy (STZ, n=16) and apocynin treatment (STZ+Apo, n=16). At the end of 8 weeks after induction of diabetes, cardiac functions were evaluated by echocardiography. Cardiac tissue was analyzed for the expression of IL-1β, IL-18, TNF-α, COX-2 mRNA and phosphorylated Akt by real-time RT-PCR and Western blotting, respectively.RESULTS: The expression of IL-1β, IL-18, TNF-α and COX-2 mRNA increased in diabetic cardiomyopathy heart accompanied with cardiac dysfunction. Cardiac functions were improved with decreased levels of IL-1β, IL-18, TNF-α and COX-2 mRNA expression in apocynin-treated heart. Compared with reduction of phosphorylated Akt, apocynin significantly increased phosphorylation of Akt in diabetic cardiomyopathy heart.CONCLUSION: Apocynin decreases cardiac IL-1β, IL-18, TNF-α and COX-2 mRNA expression accompanied with improved cardiac function, which associates with the increase of phosphorylated Akt in diabetic cardiomyopathy heart.     

Influence of Tangshen formula on endothelial function and hemorheology in diabetic nephropathy rats

ATM: To explore the influence of Tangshen formula (TS) on endothelial function and blood rheology in diabetic nephropathy (DN) rats. METHODS: The DN rat model was established by intravenous injection of low-dose (30 mg/kg) streptozotocin (STZ) after having the high-fat/high-glucose diets for one month. The animals were divi-ded into DN model group, TS group and valsartan group. Fasting blood glucose (FBG), serum total cholesterol (TC), serum triglyceride (TG), renal cortex blood flow and hemorheology were monitored. The content of von Willebrand's factor (vWF) and plasminogen activator inhibitor-1 (PAI-1) in the serum was determined by ELISA. RESULTS: Compared with normal group, FBG,TC,TG, vWF and PAI-1 were increased in DN model group (P<0.05), and no significant difference of FBG was observed. Compared with normal group, plasma viscosity, Casson viscosity, whole blood high/medium/low-shear viscosity, erythrocyte aggregation index, erythrocyte rigidity index and erythrocyte electrophoresis time were increased, and erythrocyte deformation index was decreased in DN model group (P<0.01). Compared with DN model group, plasma viscosity, Casson viscosity, whole blood high/medium/low-shear viscosity, erythrocyte aggregation index, erythrocyte rigidity index and erythrocyte electrophoresis time were decreased (P<0.05), but there was no significant difference for erythrocyte deformation index in TS group. Compared with normal group, the renal cortex microcirculation blood flow in DN model group was significantly decreased. Compared with DN model group, the renal cortex microcirculation blood flow was significantly increased in TS group (P<0.05), and no significant change in valsartan group was found.CONCLUSION: Tangshen formula plays a protective role in the kidney of diabetic rats by improving the blood rheology and endothelial function, thus ameliorating the renal cortex microcirculation blood flow in experimental diabetic rats.     

Protective effect of pyrrolidine dithiocarbamate on kidneys in type 2 diabetic rats

AIM: To investigate the protective effect of pyrrolidine dithiocarbamate (PDTC) on the kidneys in type 2 diabetic rats. METHODS: High-fat diet and a small dose (27 mg/kg) of streptozotocin-induced diabetic rats were treated with or without PDTC (50 mg穔g^-1穌^-1, ip) for 1 week, and age-matched nondiabetic animals were also used for comparison. The concentration of malondialdehyde (MDA)and the activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were determined by commercial kit. The ratio of urine microalbumin/creatinine was measured by an automatic biochemical analyzer. The morphological changes of renal glomerulus were observed by HE/Masson staining and transmission electron microscopy. The expression of inducible nitric oxide synthase (iNOS) and nitrotyrosine (NT) in the renal tissues was examined by the method of immunohistochemistry. RESULTS: PDTC-treated rats had lower blood glucose level and urine microalbumin/creatinine ratio than those in untreated diabetic rats. The levels of tissue MDA in diabetic rats were significantly higher, and the activity of SOD and GSH-Px was lower than those in normal control rats (P<0.05). The renal damage in diabetic rats was significantly improved after PDTC treatment. PDTC administration markedly attenuated the expression of iNOS and the production of NT in renal glomerulus and tubule in diabetic rats. CONCLUSION: PDTC not only reduces blood glucose level, but also protects the diabetic rats from diabetic nephropathy by diminishing the expression of iNOS and the production of NT.     

Grape seed proanthocyanidin regulates expression of GSTM through Nrf2 in renal tissues of STZ-induced diabetic rats

AIM: To investigate the potential mechanisms of renoprotective effect of grape seed proanthocyanidin (GSP) on diabetic nephropathy.METHODS: Male Wistar rats were injected with 1% streptozotocin (STZ) intravenously to induce diabetes mellitus (DM). The diabetic rats were randomly divided into 2 groups: diabetes group (DM group) and GSP treatment group (GSP group, GSP 250 mg·kg^-1·d^-1). The normal Wistar rats served as control (C group). Body weight (BW), systolic pressure, kidney weight/body weight (KW/BW), fasting plasma glucose (FPG), blood urea nitrogen (BUN), serum creatinine (SCr), glycosylated hemoglobin (HbA1c) and 24 h urine protein were determined 24 weeks after STZ intervention. The pathological changes of the renal tissues were observed. The protein levels of glutathione S-transferase mu (GSTM) and nuclear factor-erythroid 2-related factor 2 (Nrf2) in the renal tissues were determined by Western blotting and immunohistochemistry. RESULTS: Compared with C group, BW in diabetic rats decreased (P<0.01). The levels of systolic pressure, FPG, HbA1c, KW/BW, 24 h urine protein, BUN and SCr in DM group were higher than those in C group (P<0.01). After treated with GSP, the levels of systolic pressure, KW/BW, 24 h urine protein, BUN and SCr in DM rats were lower than those in DM rats without treatment (P<0.01 or P<0.05). The pathological changes were ameliorated in GSP group. The expression of GSTM and Nrf2 was up-regulated in the kidneys of diabetic rats and down-regulated to the normal levels after GSP treatment. CONCLUSION: The renoprotective effect of GSP is associated with the down-regulation of GSTM through modulating the expression of Nrf2.