Online Submissions:http://www.journaltcm.
com J Tradit Chin Med 2013 April 15; 33(2): 170-175
info@journaltcm.com
Perilla oil and exercise decrease expressions of tumor necrosis fac-
tor-α, plasminogen activator inhibitor-1 and highly sensitive C-reac-
tive protein in patients with hyperlipidemia
Minggang Wei, Peihua Xiong, Ling Zhang, Mei Fei, Aiping Chen, Fengling Li
aa
Minggang Wei, Peihua Xiong, Ling Zhang, Mei Fei, Aip-
ing Chen, Fengling Li, the First Affiliated Hospital to Sooch-
ow University, Suzhou 215006, China
Correspondence to: Prof. Minggang Wei, the First Affiliat-
ed Hospital of Soochow University, Suzhou 215006, China.
weimg@sina.com
Telephone: +86-13812791993
Accepted: November 14, 2012
Abstract
OBJECTIVE: To verify the effects of perilla oil on the
regulation of blood lipid levels in patients with hy-
perlipidemia.
METHODS: Blood was taken from patients prior to
and 8 weeks following treatment with perilla oil.
Different ways to test for indexes which correlate to
hyperlipidemia were performed. Some indexes,
which correlate with inflammation and injury to en-
dothelial cells, were tested using enzyme linked im-
munosorbent assays.
RESULTS: Serum lipid levels [triglyceride (TG), total
cholesterol (TC), and low-density lipoprotein-cho-
lesterol (LDL-C)] changed significantly after 56 days
of treatment. Differences were noted as early as 28
days after treatment began (P<0.05). Treatment
with perilla oil showed statistically significant recov-
ery levels of high-density lipoprotein-cholesterol
(HDL-C) after 28 and 56 days of treatment. Plasma
lipids levels were significantly lower after 56 days of
treatment (P<0.05). Perilla oil reduced blood lipid
levels in patients, and the regulation of cell signal-
ing factor levels had no adverse effects on patients'
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ISSN 0255-2922
© 2013 JTCM. All rights reserved.
CLINICAL STUDY
TOPIC
liver or kidney function, or blood routine examina-
tions.
CONCLUSION: Perilla oil treatment is safe in clinical
use, can regulate blood lipid levels and protects
the function of endothelial cells.
© 2013 JTCM. All rights reserved.
Key words: Fructus perillae; Tumor necrosis fac-
tor-alpha; Plasminogen activator inhibitor 1; C-reac-
tive protein; Hyperlipidemias
INTRODUCTION
Lipid-lowering therapy has been proven to give surviv-
al benefits to patients with hypercholesterolemia by
preventing both primary and secondary cardiovascular
disease.1 The mechanisms of these beneficial effects can
be, in part, explained by a reduction in plasma lipid
levels.2-4 Non-lipid mechanisms may possibly involve re-
ducing inflammation, decreasing thrombogenicity, pla-
quing stabilization and reversing endothelial dysfunc-
tion.5 Statins are currently the most common drugs dis-
playing the best results for lowering low-density lipo-
protein (LDL) cholesterol.5 Statins also possess anti-in-
flammatory properties,6,7 and have a positive effect on
reducing arterial stiffness.8,9 However, two major ad-
verse effects accompany statin therapy: hepatic dysfunc-
tion and muscular toxicity.
Perilla oil is extracted from Fructus Perillae. A soft cap-
sule of perilla oil is produced by Sanai (Fujian) Pharma-
ceutical Co., Ltd. (production lot: 080803, 081101,
081102). Perilla oil is a new product to be extracted
from a Chinese herb, and does not impair dietary pro-
cesses nor does it affect the absorption of triglycerides
170 April 15, 2013 | volume 33 | Issue 2 |
 Wei MG et al. / Clinical Study
or fat-soluble vitamins. Perilla oil is effective treatment
as therapy or as an adjunctive therapy in combination
with statins. It is well tolerated in clinical trials with no
demonstrable adverse systemic events.10 The effects of
perilla oil on arterial stiffness have not yet been investi-
gated.
The aim of the present study is to assess the effect of
perilla oil therapy on highly sensitive C-creative pro-
tein (hs-CRP) and endothelial function.
MATERIALS AND METHODS
Patient selection
Inclusive criteria: men or women aged 18-75 years with
a baseline total cholesterol (TC) ≥6.22 mmol/L or tri-
glyceride (TG) ≥2.26 mmol/L or high density lipopro-
tein-cholesterol (HDL-C)≤1.04 mmol/L or low-density
lipoprotein-cholesterol (LDL-C)≥4.14 mmol/L were in-
volved in the study. Patients were required to stop tak-
ing any medication for a minimum of 7 days before
the study commenced.
Exclusion criteria: patients were excluded if they
showed clinical evidence of previous cardiovascular dis-
ease (defined as a past history of myocardial infarction,
percutaneous transluminal coronary angioplasty or a
coronary artery bypass graft); had had a failed organ
transplant or malignant tumor requiring treatment in
the last two years; showed active hepatic or renal dys-
function; showed any type of connective tissue disease,
chronic inflammatory disease, malignancy or history of
malignancy; showed any acute illness, leukocytosis or
thrombocytosis, anemia or diabetes mellitus; or were
taking corticosteroids. The use of tobacco, which in-
creases C-reactive protein (CRP), and aspirin, which
decreases CRP, was outside the exclusion criteria as pa-
tients controlled their own behavior.
Test subjects were instructed to avoid using non-steroi-
dal anti-inflammatory agents. Patients' medical regi-
mens were not changed throughout the study period.
The study was approved by the ethics committee of the
second hospital affiliated to Tianjin University of Tradi-
tional Chinese Medicine. All participants gave written
informed consent in accordance with the Declaration
of Helsinki.
Study design
The study used a prospective, random control design.
All patients were randomly allocated into 3 groups us-
ing the random number table method. Thirty-six pa-
tients with elevated blood lipids defined by the Nation-
al Preventing Program for the Chinese adult with high
blood lipids: Adult Treatment Guideline 2007.12
Eligible patients (n=36) gave informed consent and
were randomly divided into: 1) an exercise group (EG)
(n=12); 2) a medicine group (MG) (n=12), which
were treated with perilla oil capsules; and 3) an exercise
and medicine group (EMG) (n=12). The patients first
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underwent clinical examinations and blood tests to es-
tablish a baseline, and were then again subject to exami-
nations and blood tests after 4 and 8 weeks of treat-
ment. Perilla oil capsules were taken 4 grain/time,
twice/day. Eight weeks was defined as a course of treat-
ment.
Hs-CRP levels of patients with high blood fat were
measured before treatment and again after 56 days of
treatment. The levels of TC, TG, LDL-C and HDL-C
were measured to establish a baseline and again after
28 and 56 days of treatment. Acute-phase reactant tu-
mor necrosis factor-α (TNF-α) and plasminogen acti-
vator inhibitor-1 (PAI-1) were measured on the same
days as hs-CRP.
After a 12 h limosis, potential patients were screened
and underwent a phlebotomy for liver function tests in-
cluding total bilirubin, aspartate aminotransferase
(AST), alanine aminotransferase (ALT), alkaline phos-
phatase, blood urea nitrogen (BUN), creatinine, glu-
cose, complete blood count, electrocardiogram (ECG),
and a urinalysis. The EG group was only treat by with
exercise, MG group was only treat by perilla oil cap-
ules, EMG group was treat by both exercise and perilla
capules.
Following the guidelines for protecting and treating
high blood plasma for Chinese adults, patients were giv-
en oral and written instructions to perform 30-60 min
of brisk walking per day at least 4 days per week, with
an interval of no more than 2 consecutive days.11,12 Pa-
tients were also encouraged to increase their daily activ-
ities. The main goal for each individual was to accumu-
late more than 150 min per week of self-directed, mod-
erate-intensity physical activity. Exercises intensities, in-
cluding walking, cycling and calisthenics, were individ-
ualized. The intensity of each session gradually in-
creased to 50%-70% of a patient's peak oxygen con-
sumption and up to 60 min duration for the first 4
weeks. After that, the exercise parameters remained
constant.
Sample collection
Venous blood was drawn from patients who had an
empty stomach for at least 8 h before treatment, and
again after 28 and 56 days of clinical intervention. Sera
was immediately centrifuged for 5 min at 2000 rpm to
remove cells and debris, and then stored at –80℃ for
no more than 4 months before measurement. For clini-
cal safety, urine, serum creatinine (Scr), ALT and ECG
were tested before treatment and again after 56 days of
clinical intervention.
Enzyme-linked immunosorbent assay (ELISA)
ELISA was used to detect TNF-α and PAI-1 in sera.
Briefly, plates were blocked and incubated at room tem-
perature for 2 h, washed with wash buffer 4-6 times
and dried with filter paper. Biotinylated antibodies
were added to samples (100 μL per hole) and incubat-
ed for 1 h at 37℃. Washing and the addition of bioti-
nylated antibodies was performed in duplicate. Reac-
171 April 15, 2013 | volume 33 | Issue 2 |
 Wei MG et al. / Clinical Study

tions were stopped by the addition of stop solution
(100 uL per hole). Plates were read at a wavelength of
450 nm on a microplate reader (JETLIA-962 System,
Beijing, China). Liver and renal functions (ALT and
Scr) were tested using an automatic biochemistry ana-
lyzer (Olympus AU-2700, Tokyo, Japan). hs-CRP was
tested using the rate dispersion turbidity method with
a special protein analysis instrument (Beckman-Array
360, Danvers, Massachusetts, USA).
Statistical analyses
Statistical analyses were performed with SPSS software
（SPSS, Chicaga, IL, USA), version 15. Significance
tests were 2-sided. A value of 0.05 was considered sta-
tistically significant. All data are expressed as the mean
± SEM.
RESULTS
General condition
Serum lipid levels (TG, TC and LDL-C) changed sig-
nificantly after 56 days of treatment. Differences were
noted as early as 28 days after treatment began (P<
0.05) (Table 1). Treatment with perilla oil showed sta-
tistically significant recovery levels of HDL-C after 28
and 56 days of treatment. Plasma lipids levels were sig-
nificantly lower after 56 days of treatment (P<0.05)
(Table 1). There was no statistical differences in levels
of hs-CRP, PAI-1, TNF-α or plasma lipid between the
EG, EM and EMG groups.
Effects of perilla oil on hs-CRP, PAI-1 and TNF-α
The results of Table 1-2 indicate that: 1) exercising and
taking perilla oil can regulate plasma lipid levels,
hs-CRP, PAI-1 and TNF-α; 2) there is a significant dif-
ference between EG, MG and EMG; 3) the levels of
Table 1 Level of blood lipids at different times (mmol/L, xˉ ± s )
Time
Group n TC
(week)
EG 0 12 6.2±0.8ab
TG, TC, hs-CRP, PAI-1, TNF-α and cell signaling fac-
tors in EMG show greater change than both EG and
MG; and a better curative effect is achieved in EMG
than in the other two groups; 4) by comparing the cu-
rative effect of regulating plasma lipids between EG,
MG and EMG after 56 days of treatment, the curative
effect of both exercise and perilla oil in EMG is better
than that in the other two groups; 5) perilla oil can reg-
ulate and protect endothelial cells through regulation
of the levels of hs-CRP, PAI-1 and TNF-α; and there is
no side-effects, such as hepatic dysfunction or muscu-
lar toxicity; and 6) both exercise and perilla oil regulate
plasma lipid levels and protect endothelial cell func-
tion, but integrating them together in clinical practice
would give better benefits to patients.
Safety indexes
We tested the levels of white blood cells (WBC), AST,
ALT, BUN and Scr as the markers of safety indexes. All
safety index levels fluctuated around the normal range
before and after the study (Table 3).
DISCUSSION
Chronic heart diseases are often complicated by dyslip-
idemia in many patients in clinical practice. Lipid ab-
normalities include increases in serum TG-associated li-
poproteins (intermediate density lipoproteins and very
low density lipoproteins) and LDL, and decreases in
HDL-C. The leading cause of death in patients with
chronic heart disease is coronary artery disease. Athero-
sclerosis is the principle cause of vascular lesions of the
coronary artery and gradually develops to coronary ar-
tery disease. The highest rate of morbidity and mortali-
ty in patients with coronary artery disease is seen in
those patients with hyperlipidemia. Hyperlipidemia is
an important risk factor contributing to coronary ar-
TG HDL-C LDL-C
3.4±0.9ab 1.4±0.4ab 3.9±0.8ab

MG 0 12 6.2±0.8 3.3±0.8 1.4±0.4 3.9±0.8

EMG 0 12 6.2±0.7 3.4±0.8 1.4±0.4 4.0±0.8

EG 4 12 5.7±0.7c 3.2±0.8c 1.5±0.4b 3.5±0.9

MG 4 12 5.8±0.7 3.2±0.8 1.5±0.5 3.5±0.8

EMG 4 12 5.6±0.6 3.1±0.6 1.6±0.6 3.5±0.7

EG 8 12 5.5±0.6 3.1±0.7 1.5±0.5 3.2±0.7

MG 8 12 5.5±0.5 3.0±0.8 1.6±0.6 3.2±0.7

EMG 8 12 5.3±0.9 2.8±0.7 1.6±0.6 3.1±0.7

Notes: EG: exercise groups; MG: medicine group; EMG: exercise and medicine group; TC: total cholesterol; TG: triglyceride; HDL-C:
high density lipoprotein-cholesterol; LDL-C: low-density lipoprotein-cholesterol. aP<0.05 compared with the datum in the same group
after 4 weeks; bP<0.05 compared with the datum in the same group after 8 weeks; cP>0.05 compared with the datum in the same group
after 4 weeks.

JTCM | www. journaltcm. com 172 April 15, 2013 | volume 33 | Issue 2 |
 Wei MG et al. / Clinical Study

Table 2 Level of the cell factors at different times ( xˉ ± s )

Time hs-CRP PAI-1 TNF-α
Group n
(week) (mg/L) (ng/mL) (ng/mL)
EG 0 12 3.41±0.63a 38.87±6.18a 1.21±0.19a
MG 0 12 3.38±0.55 39.24±6.23 1.23±0.24

EMG 0 12 3.43±0.58 37.79±5.98 1.23±0.19

EG 8 12 2.74±0.53 33.56±5.88 0.97±0.18

MG 8 12 2.77±0.61 34.19±6.12 0.94±0.22

EMG 8 12 2.76±0.54 33.89±5.93 0.88±0.21

Notes: EG: exercise groups; MG: medicine group; EMG: exercise and medicine group; hs-CRP: highly sensitive C-creative protein; PAI-1:
plasminogen activator inhibitor-1; TNF-α: tumor necrosis factor-α. aP<0.05 as compared with the datum in the same group after 8 weeks.
Table 3 Saftey index levels before and after the study ( xˉ ± s )
Time WBC ALT Scr
Group
(week) (a109/L) (μ/L) (mmol/L)
EG 0 7.6±2.1b 22.5±10.9b 64.2±13.2b

MG 0 7.0±1.5 24.2±9.8 67.3±13.0

EMG 0 7.14±2.1 23.6±11.0 66.3±13.1

EG 8 6.7±1.4 24.5±14.2 62.4±11.2

MG 8 7.0±1.6 26.4±12.2 65.2±8.0

EMG 8 8.2±1.6 25.8±15.2 64.3±8.8

Notes: EG: exercise groups; MG: medicine group; EMG: exercise and medicine group; WBC: white blood cells; ALT: alanine
aminotransferase; Scr: serum creatinine. aP>0.05 as compared with the datum in the same group after 4 weeks; bP>0.05 as compared with
the datum in the same group after 4 weeks.
tery disease and subsequent myocardial infarction.
The formation of atherosclerosis shows a complicated
pathological course. The metabolic disorder lipidemia
can lead to the development of atherosclerosis. Endo-
thelial cells are the target cells of lipidemia. Endothelial
cells form a barrier between blood and smooth muscle
cells of blood vessels. Endothelial cell involvement in the
formation of atherosclerosis has been reported,13,14and
damage to endothelial cells has been recognized as be-
ing a precursor to the formation of atherosclerosis.15 It
is therefore very important to maintain intact endothe-
lial cells to prevent the formation of atherosclerosis.
High blood pressure can also contribute by damaging
blood vessels and endothelial cells.
Clinical trials with fibric acid derivatives have demon-
strated an improvement in cardiovascular end points
and coronarystenosis.16 These direct vascular effects
may contribute to cardiovascular event reduction and
explain the clinical benefits observed in these trials.
Endothelial dysfunction associated with metabolic syn-
drome and other insulin-resistant states are character-
ized by impaired nitric oxide release from endotheli-
um.17 Improvement in endothelial function is therefore
predicted to improve insulin sensitivity. This may be
one mechanism by which fenofibrate decreases the inci-
dence of coronary heart disease.
Excessive body fat is frequently associated with dyslip-
idemia, metabolic syndrome and atherosclerotic vascu-
lar diseases.18
PAI-1 is produced and secreted by endothelial cells.
PAI-1 combine with tissue plasminogen activator (tPA)
to form the composition in blood. So PAI-1 could in-
hibit tPA to resolve the fibrin. The normal lexel of
PAI-1 and tPA may determine the balance between he-
mostasia and thrombosis. Damage to endothelial cells
may cause these cells to secret PAI-1, increasing the lev-
els of PAI-1 in the blood. In turn, high levels of PAI-1
may inhibit tPA from resolving fibrin accumulation,
which will let the form of thrombosis easily than nor-
mal. Levels of PAI-1 in the sera could therefore be used
as a marker to evaluate whether endothelial cells are
damaged or not. However, PAI-1 is also one of the
acute reaction proteins, and its active function could in-
crease the incidence rate at some kinds of cardiovascu-
lar disease.19
TNF-α is a cell signaling factor which is produced and
secreted by many cells, including natural killer cells
and T cells. TNF-α can induce the expression of endo-
thelial cell adhesion molecules. TNF-α can also induce
endothelial cells to secrete platelet-derived growth fac-
tor, and improves the proliferation of endothelial and
smooth muscle cells of blood vessels. Endothelial cells
have a receptor for TNF-α, making endothelial cells
one of the target cells of TNF-α. This may be why
TNF-α can hurt EC in the blood vessel. The higher
the TNF-α level, the more severe the damage to endo-
thelial cells will be. There appears to be a direct ratio
between damage to an artery and the formation of ath-

JTCM | www. journaltcm. com 173 April 15, 2013 | volume 33 | Issue 2 |
 Wei MG et al. / Clinical Study
erosclerosis.
Inflammation plays a major role in the various stages
of atherosclerosis, from development of the initial fatty
streak, to plaque rupture, to resultant thrombosis. Cur-
rent prevention and treatment guidelines for coronary
artery disease depend on the assessment of an individu-
al's risk of cardiovascular events using algorithms such
as the Framingham risk model. An accurate estimate of
the cardiovascular risk is therefore of paramount impor-
tance.
The association between CRP and coronary artery dis-
ease was first described more than two decades ago.20,21
Since then, CRP has been the focus of intense investi-
gation and has been proposed as an important and in-
dependent risk factor for coronary artery disease. Mea-
surement of CRP is thought to further aid risk assess-
ment by stratifying individuals classified at an interme-
diate risk level.22,23 CRP levels are related to cardiovascu-
lar disease. CRP levels will be higher with the develop-
ment of cardiovascular disease. CRP is associated with
atherosclerosis through its stimulation of endothelial
cells.24 Recent studies have suggested that hs-CRP is
more effective at forecasting heart events than ordinary
CRP.25 Some studies have suggested that hs-CRP is one
of the markers which indirectly demonstrate the degree
of cardiovascular disease.26-29
Perilla oil is extracted from seeds of herbs of the genus
Perilla. Perilla oil can regulate vital energy, disperse
phlegm, degrade blood fat and promote blood circula-
tion; and is used in the treatment of patients with high
blood fat and showing symptoms such as cerebaria,
chest distress, disgorging sputamentum and extremity
numbness.
Both the level of CRP and endothelial function inti-
mately related to AS, there maybe liner correlation
among them. The higher the CRP level, the more se-
vere the endothelial function and the more obvious ath-
erosclerosis will be. The level of CRP may therefore de-
termine the condition of atherosclerosis. Perilla oil, as a
single therapy, can reduce CRP levels. Endothelial func-
tion (assessed with forearm blood flow) has shown im-
provement following sole use with perilla oil.10,30
The results of this study suggest that exercising and tak-
ing perilla oil in combination can regulate plasma lipid
and CRP levels, PAI-1 and TNF-α more effectively
than either one individually. It is also suggested that pe-
rilla oil can protect endothelial cells and reduce the pos-
sibility of the development of atherosclerosis. Perilla oil
has also shown a good safety coefficient throughout
this study.
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