The protective roles of Eugenol on type 1 diabetes mellitus through NRF2 mediated oxidative stress pathway

Reviewer #1 (Public Review):

Summary

Type 1 diabetes mellitus (T1DM) progression is accelerated by oxidative stress and apoptosis. Eugenol (EUG) is a natural compound previously documented as anti-inflammatory, anti-oxidative, and anti-apoptotic. In this manuscript by Jiang et al., the authors study the effects of EUG on T1DM in MIN6 insulinoma cells and a mouse model of chemically induced T1DM. The authors show that EUG increases nuclear factor E2-related factor 2 (Nrf2) levels. This results in a reduction of pancreatic beta-cell damage, apoptosis, oxidative stress markers, and a recovery of insulin secretion. The authors highlight these effects as indicative of the therapeutic potential of EUG in managing T1DM.

Strengths

Relevant, timely, and addresses an interesting question in the field. The authors consistently observe enhanced beta cell functionality following EUG treatment, which makes the compound a promising candidate for T1DM therapy.

Weaknesses

The in vivo experiments have too few biological replicates. With an n=3 (as all figure legends indicate) in complex mouse studies such as these, drawing robust conclusions becomes challenging. It is important to reproduce these results in a larger cohort, to validate the conclusions of the authors. Another big concern is the lack of quantifications and statistical analysis throughout the manuscript. Although the authors claim statistical significance in various experiments, the limited information provided makes it difficult to verify. The authors use vague and minimal descriptions of their experiments, which further reduces the reader's comprehension and the reproducibility of the experiments. Finally, the use of Min6 cells as a model for pancreatic beta cells is a strong limitation of this study. Future studies should seek to reproduce these findings in a more translational model and use more relevant in vitro cell systems (eg. Islets).

Reviewer #2 (Public Review):

Summary:

In this manuscript, the authors consider the effects of eugenol (EUG), a plant-produced substance known to reduce oxidative stress in various cellular contexts via Nrf2, in alleviating the effects of streptozotocin (STZ), a known rodent beta cell toxin. They claim that EUG treatment would be useful for T1D therapy.

Strengths:

The experiments shown are sufficiently clear and rather convincing in documenting that eugenol can revert the effects of streptozotocin on animal physiology as well as beta cell oxidative stress and cell death via activation of Nrf2.

Weaknesses:

In my view, there are major concerns with the basic premises of the manuscript.

(1) While oxidative stress may be implicated in T1D they are neither the primary nor the main reason for autoimmune beta cell destruction. In T1DM, ER stress rather than oxidative stress is the main intracellular mediator of cell death. Thus, the abstract statement that 'oxidative stress plays a major role in T1D' is an exaggeration.

(2) Streptozotocin induces beta cell death through mechanisms that only partially overlap with autoimmune beta cell destruction. The main players ie beta cell / immune system crosstalk and T-cell mediated cell death are not present in the STZ model.

In short, because the interplay between the immune system and beta cell-intrinsic factors that trigger and accelerate the disease is completely missing, STZ treatment cannot be used as a T1DM model when beta cell demise mechanisms are concerned. The statement that STZ-treated mice are, in this context, a T1DM model, is misleading.

There are inconsistencies in the manuscript. Mechanistically, the manuscript remains at a rather superficial level demonstrating that the eugenol effects are mediated by Nrf2 upregulation and a downregulation of its partner inhibitor protein Keap1. How is eugenol penetrating the cell, is there a receptor that could be potentially targeted? Are there intermediary proteins that convey the effect to the Nrf2/Keap1 complex or is eugenol directly disrupting their interaction? What are direct downstream Nrf2 effectors? Besides, streptozotocin is also a powerful DNA alkylating agent. Are these effects mitigated by EUG?

Reviewer #3 (Public Review):

Summary:

This study by Jiang et al. aims to establish the streptozotocin (STZ)-induced type 1 diabetes mellitus (T1DM) mouse model in vivo and the STZ-induced pancreatic β cell MIN6 cell model in vitro to explore the protective effects of Eugenol (EUG) on T1DM. The authors tried to elucidate the potential mechanism by which EUG inhibits the NRF2-mediated anti-oxidative stress pathway. Overall, this study is well executed with solid data, offering an intriguing report from animal studies for a potential new treatment strategy for T1DM.

Strengths:

The in vivo efficacy study is comprehensive and solid. Given that STZ-induced T1DM is a devastating and harsh model, the in vivo efficacy of this compound is really impressive.

Weaknesses:

The Mechanism is linked with the anti-oxidant property of the compound, which is common for many natural compounds, such as flavonoids and polyphenol. However, rarely, this kind of compound has been successfully developed into therapeutics in clinical usage. Indeed, if that is the case, Vitamin C or Vitamin E could be used here as the positive control.