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<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Explor Drug Sci</journal-id>
<journal-id journal-id-type="publisher-id">EDS</journal-id>
<journal-title-group>
<journal-title>Exploration of Drug Science</journal-title>
</journal-title-group>
<issn pub-type="epub">2836-7677</issn>
<publisher>
<publisher-name>Open Exploration Publishing</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.37349/eds.2025.1008136</article-id>
<article-id pub-id-type="manuscript">1008136</article-id>
<article-categories>
<subj-group>
<subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>
<italic>Xymalos monospora</italic> leaf extract modulates antidiabetic activity and lipid profile in dexamethasone-induced diabetic rats</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Anguh</surname>
<given-names>Awah Adolf</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/">Conceptualization</role>
<role content-type="https://credit.niso.org/contributor-roles/investigation/">Investigation</role>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/">Writing—original draft</role>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing—review &amp; editing</role>
<xref ref-type="aff" rid="I1" />
</contrib>
<contrib contrib-type="author">
<name>
<surname>Gilles</surname>
<given-names>Mache Andre</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/">Conceptualization</role>
<role content-type="https://credit.niso.org/contributor-roles/investigation/">Investigation</role>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/">Writing—original draft</role>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing—review &amp; editing</role>
<xref ref-type="aff" rid="I1" />
</contrib>
<contrib contrib-type="author">
<contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0488-841X</contrib-id>
<name>
<surname>Foudjo</surname>
<given-names>Brice Ulrich Saha</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/">Conceptualization</role>
<role content-type="https://credit.niso.org/contributor-roles/investigation/">Investigation</role>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/">Writing—original draft</role>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing—review &amp; editing</role>
<xref ref-type="aff" rid="I1" />
</contrib>
<contrib contrib-type="author">
<contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2982-8007</contrib-id>
<name>
<surname>Navti</surname>
<given-names>Lifoter Kenneth</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/validation/">Validation</role>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing—review &amp; editing</role>
<role content-type="https://credit.niso.org/contributor-roles/supervision/">Supervision</role>
<xref ref-type="aff" rid="I1" />
<xref ref-type="corresp" rid="cor1">
<sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="editor">
<name>
<surname>Jin</surname>
<given-names>Weilin</given-names>
</name>
<role>Academic Editor</role>
<aff>The First Hospital of Lanzhou University, China</aff>
</contrib>
</contrib-group>
<aff id="I1">Department of Biochemistry, Faculty of Science, The University of Bamenda, Bambili P.O. Box 39, Cameroon</aff>
<author-notes>
<corresp id="cor1">
<bold>*Correspondence:</bold> Lifoter Kenneth Navti, Department of Biochemistry, Faculty of Science, The University of Bamenda, Bambili P.O. Box 39, Cameroon. <email>knavti@gmail.com</email></corresp>
</author-notes>
<pub-date pub-type="collection">
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>15</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>3</volume>
<elocation-id>1008136</elocation-id>
<history>
<date date-type="received">
<day>24</day>
<month>09</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>26</day>
<month>11</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>© The Author(s) 2025.</copyright-statement>
<license xlink:href="https://creativecommons.org/licenses/by/4.0/">
<license-p>This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">https://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.</license-p>
</license>
</permissions>
<abstract>
<sec>
<title>Aim:</title>
<p id="absp-1">Diabetes mellitus is a serious public health problem, and the condition is managed using herbal medicine by many African traditional healers. This study aimed to provide scientific evidence on the effects of aqueous and ethanol extracts of <italic>Xymalos monospora</italic> (<italic>X. monospora</italic>) leaves on some biochemical parameters in diabetic rats.</p>
</sec>
<sec>
<title>Methods:</title>
<p id="absp-2">This experiment included 63 male Wistar rats. Diabetes was induced for 10 days by intraperitoneal injection of dexamethasone (16 mg/kg) in overnight fasted rats. The diabetic rats were treated with aqueous (100 and 200 mg/kg) and ethanol (100 and 200 mg/kg) extracts of <italic>X. monospora</italic> leaves and metformin (40 mg/kg) for 15 days. Fasting blood glucose, serum lipid profile, atherogenicity indices (Castelli’s Risk Index, Atherogenic Coefficient, Atherogenic Index of Plasma), tumor necrosis factor alpha, and hepatic glycogen were evaluated.</p>
</sec>
<sec>
<title>Results:</title>
<p id="absp-3">Treatment with the aqueous extracts at 100 and 200 mg/kg significantly reduced fasting blood glucose by 29.2% (<italic>p</italic> = 0.016) and 35.9% (<italic>p</italic> = 0.009), respectively. Also, the ethanol extracts at 100 and 200 mg/kg significantly reduced fasting blood glucose by 20.7% (<italic>p</italic> = 0.038) and 31.2% (<italic>p</italic> = 0.027), respectively. The aqueous extract (200 mg/kg) significantly reduced total cholesterol and triglyceride concentrations by 31.5% (<italic>p</italic> = 0.017) and 30.7% (<italic>p</italic> = 0.023), respectively. There was a significant reduction in atherogenicity indices (<italic>p</italic> &lt; 0.05), and liver glycogen levels improved. The extracts reduced the levels of tumor necrosis factor alpha, but this was not significant (<italic>p</italic> &gt; 0.05). However, histopathological studies were not carried out, and the above findings may not directly translate to clinical efficacy.</p>
</sec>
<sec>
<title>Conclusions:</title>
<p id="absp-4">These findings demonstrate that the oral administration of aqueous and ethanol extracts of <italic>X. monospora</italic> leaves has significant antidiabetic effects, including a decrease in fasting blood glucose, improvement of serum lipid profile, and increased glycogen storage.</p>
</sec>
</abstract>
<kwd-group>
<kwd>diabetes mellitus</kwd>
<kwd>herbal medicine</kwd>
<kwd>
<italic>Xymalos monospora</italic>
</kwd>
<kwd>hyperglycemia</kwd>
<kwd>atherogenicity</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec id="s1">
<title>Introduction</title>
<p id="p-1">Diabetes mellitus is a long-term endocrine disorder characterized by disturbances in carbohydrate, fat, and protein metabolism, and currently remains a major global public health problem. The International Diabetes Federation (IDF) report of 2025 indicates that by 2050, the number of people with diabetes in Africa is going to increase by 142% [<xref ref-type="bibr" rid="B1">1</xref>]. There has been a slight decline in the prevalence of diabetes mellitus among adults in Cameroon from 6.5% in 2015 [<xref ref-type="bibr" rid="B2">2</xref>] to 5.8% in 2018 [<xref ref-type="bibr" rid="B3">3</xref>] and then to 5.6% in 2024 [<xref ref-type="bibr" rid="B1">1</xref>]. This decline could be attributed to increasing sensitization and awareness of long-term complications of the disease, which have led to changes in lifestyle among people living with diabetes.</p>
<p id="p-2">There are many commercially available antidiabetic drugs, which belong to various classes (biguanides, thiazolidinediones, sulphonylureas, and meglinides) that are used in the treatment of diabetes mellitus. However, these drugs exhibit different side effects, can affect other organs in the body, and interfere with other non-antidiabetic drugs when used for a long duration [<xref ref-type="bibr" rid="B4">4</xref>, <xref ref-type="bibr" rid="B5">5</xref>]. Also, the economic burden of the disease on those affected is immense. For instance, the estimated direct medical cost of diabetes for an individual in a month in Cameroon has been rising steadily from $123 in 2015 [<xref ref-type="bibr" rid="B2">2</xref>] to $148 in 2019 [<xref ref-type="bibr" rid="B6">6</xref>] and then to $252 in 2024 [<xref ref-type="bibr" rid="B1">1</xref>]. In order to avoid side effects and minimize cost, some patients are now considering the use of herbal medicine in the treatment of diabetes [<xref ref-type="bibr" rid="B7">7</xref>].</p>
<p id="p-3">There has been a growing interest in the use of herbal medicine globally [<xref ref-type="bibr" rid="B8">8</xref>], and it is no different in Cameroon [<xref ref-type="bibr" rid="B9">9</xref>]. Recent evidence reveals that herbal medicine is a safer alternative and can minimize complications associated with diabetes [<xref ref-type="bibr" rid="B7">7</xref>, <xref ref-type="bibr" rid="B10">10</xref>]. Herbal medicine from different plants has been shown to affect biochemical parameters that are associated with diabetes mellitus. For instance, previous reports on extracts of <italic>Vincor major</italic> [<xref ref-type="bibr" rid="B11">11</xref>] and <italic>Euphorbia thymifolia</italic> [<xref ref-type="bibr" rid="B12">12</xref>] significantly reduced fasting blood glucose (FBG) concentration and improved dyslipidemia in diabetic rats. The <italic>Euphorbia thymifolia</italic> extract was shown to increase hepatic glycogen concentration and decrease the HbA1c level in diabetic rats [<xref ref-type="bibr" rid="B12">12</xref>]. Also, an herbal formula (Mathurameha) in Thailand that included 26 medicinal plants was found to improve total cholesterol (TC) concentration and other biochemical parameters in diabetic rats. However, the rats had increased triglyceride (TG) levels, and the authors suggested that the formula may not be beneficial in lipid homeostasis [<xref ref-type="bibr" rid="B13">13</xref>]. In addition, extracts of <italic>Cornus mas</italic> L. significantly improved dyslipidemia and reduced the levels of atherogenic indices [Castelli’s Risk Index (CRI), Atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC)] in diabetic rats, thus reducing cardiovascular risk [<xref ref-type="bibr" rid="B14">14</xref>]. Moreover, the aqueous extract of <italic>Pterocarpus marsupium</italic> significantly decreased the elevated level of tumor necrosis factor alpha (TNF-α) in a diabetic rat model [<xref ref-type="bibr" rid="B15">15</xref>]. Previous reports have indicated that leaf extracts of <italic>Adenanthera pavonina</italic> [<xref ref-type="bibr" rid="B16">16</xref>] and some Nepalese medicinal plants (<italic>Acacia catechu</italic>, <italic>Dioscorea bulbifera</italic>, and <italic>Swertia chirata</italic>) [<xref ref-type="bibr" rid="B17">17</xref>] exhibited α-amylase inhibitory activity.</p>
<p id="p-4">In Cameroon, many plants have been documented for the treatment of diabetes mellitus and its complications. For example, a previous ethnomedical survey revealed one hundred and three (103) plant species that are used in the treatment and management of diabetes mellitus [<xref ref-type="bibr" rid="B18">18</xref>]. Other reports had identified eighty-five, forty-one, and forty-nine plant species used in the treatment of diabetes, obesity, hypertension, and cardiovascular ailments in the South [<xref ref-type="bibr" rid="B19">19</xref>], Littoral [<xref ref-type="bibr" rid="B20">20</xref>], and West [<xref ref-type="bibr" rid="B21">21</xref>] regions of Cameroon, respectively. In the North West Region of Cameroon, <italic>Xymalos monospora</italic> (<italic>X. monospora</italic>) is used by some traditional practitioners in the treatment of diabetes and its complications. There is a paucity of data on the scientific exploitation of this plant. However, a recent study revealed that green tea produced from the leaves of <italic>X. monospora</italic> has comparable nutritional properties to commercially available green tea [<xref ref-type="bibr" rid="B22">22</xref>].</p>
<p id="p-5">To the best of our knowledge, there is no scientific evidence on the use of <italic>X. monospora</italic> in the treatment of diabetes mellitus and its complications, and it does not feature amongst the enlisted plant species in the above ethnomedical studies in Cameroon. The aim of this study, therefore, is to investigate the effect of oral administration of aqueous and ethanol extracts of <italic>X. monospora</italic> leaves on some biochemical parameters in dexamethasone-induced diabetes in male Wistar rats.</p>
</sec>
<sec id="s2">
<title>Materials and methods</title>
<sec id="t2-1">
<title>Chemicals</title>
<p id="p-6">Metformin tablets (500 mg, Chemical Abstracts Service—CAS number 657-24-9, manufacturer’s name: Aetos Pharma Private Limited, purity: ~ 99%), dexamethasone (4 mg/mL, CAS number 50-02-2, manufacturer’s name: Jeil Pharma, purity: ≥ 98%), diazepam (5 mg/mL, CAS number 439-14-5, manufacturer’s name: Pfizer, purity: ≥ 98%), and ketamine hydrochloride (50 mg/mL, CAS number 6740-88-1, manufacturer’s name: Pfizer, purity: &gt; 99%) were purchased from a pharmacy in Bamenda, North West Region of Cameroon.</p>
</sec>
<sec id="t2-2">
<title>Collection and authentication of plant material</title>
<p id="p-7">The fresh leaves of <italic>X. monospora</italic> were harvested from Oshie in Njikwa sub-Division, North West Region of Cameroon, and authenticated by a botanist in the Department of Biological Sciences at the University of Bamenda. A sample of the plant material was forwarded to the Natural Herbarium Center in Yaoundé, Cameroon, and authenticity was confirmed as <italic>Xymalos monospora</italic> (Harv.) Baill ex Warb with reference number 50557/HNC.</p>
</sec>
<sec id="t2-3">
<title>Preparation of aqueous extract</title>
<p id="p-8">Three kilograms (3 kg) of fresh leaves were weighed using a weighing balance, washed with clean tap water, and chopped into smaller pieces using a knife. The chopped leaves were ground using a domestic mixer (Philips, HL7505, India). Distilled water was added to the ground leaves, and the mixture was allowed to soak for 24 h. After 24 h, the mixture was filtered through Whatman No. 1. The extract was dried in an oven (Memmert UF, Germany) for 24 h at a temperature of 50°C to obtain 60.4 g of powder. The extract was kept in an air-tight container and stored in a laboratory refrigerator (Fison, FM-LRF-A203, UK) at 4°C until use [<xref ref-type="bibr" rid="B13">13</xref>].</p>
</sec>
<sec id="t2-4">
<title>Preparation of ethanol extract</title>
<p id="p-9">Three kilograms (3 kg) of fresh leaves were processed as mentioned above. This was followed by the addition of 70% ethanol, and the whole was allowed to macerate for 24 h. After 24 h, the mixture was filtered through Whatman No. 1, and the extract was concentrated using a vacuum in a rotatory evaporator (Buchi Rotavapor R-300, Switzerland) at 50°C [<xref ref-type="bibr" rid="B17">17</xref>]. The extract obtained was 57.9 g and was kept in an air-tight container and stored in a laboratory refrigerator at 4°C until use.</p>
</sec>
<sec id="t2-5">
<title>Experimental animals</title>
<p id="p-10">The experimental rats used in this study included 63 healthy eight-week-old male Wistar albino rats of body weight ranging from 190 to 220 g. The rats were obtained from the animal house of the Faculty of Science, the University of Bamenda. The rats were kept in plastic cages that were covered with mesh and included facilities for food and water. The rats were monitored under standard conditions (ambient temperature 25 ± 2°C) and a 12-hour light/dark cycle in a well-ventilated section of the animal house of the Faculty of Science, the University of Bamenda. The rats also had free access to food and water ad libitum under good hygienic conditions. The rats were acclimatized for two weeks before the experiment.</p>
</sec>
<sec id="t2-6">
<title>Induction of diabetes</title>
<p id="p-11">After the acclimatization period, type 2 diabetes was induced for 10 days by daily intraperitoneal injection of dexamethasone (16 mg/kg b.w.) [<xref ref-type="bibr" rid="B23">23</xref>] to overnight fasted experimental rats. Wistar rats with FBG concentration &gt; 200 mg/dL) were considered to be type 2 diabetic [<xref ref-type="bibr" rid="B24">24</xref>].</p>
</sec>
<sec id="t2-7">
<title>Experimental animal groups and treatment</title>
<p id="p-12">The 63 rats were randomly assigned into seven groups of 9 rats each, and oral treatment was carried out for 15 days, as shown in <xref ref-type="table" rid="t1">Table 1</xref> below:</p>
<table-wrap id="t1">
<label>Table 1</label>
<caption>
<p id="t1-p-1">
<bold>Description of experimental animal groups and treatment.</bold>
</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th>
<bold>Groups</bold>
</th>
<th>
<bold>Description with dose</bold>
</th>
</tr>
</thead>
<tbody>
<tr>
<td>Group 1</td>
<td>Normal control: non-diabetic rats receiving distilled water (10 mL/kg b.w.)</td>
</tr>
<tr>
<td>Group 2</td>
<td>Diabetic control: diabetic rats receiving distilled water (10 mL/kg b.w.)</td>
</tr>
<tr>
<td>Group 3</td>
<td>Standard drug control: diabetic rats treated with metformin (40 mg/kg b.w.)</td>
</tr>
<tr>
<td>Group 4</td>
<td>Diabetic rats treated with <italic>X. monospora</italic> aqueous leaf extract—XMAq (100 mg/kg b.w.)</td>
</tr>
<tr>
<td>Group 5</td>
<td>Diabetic rats treated with <italic>X. monospora</italic> aqueous leaf extract—XMAq (200 mg/kg b.w.)</td>
</tr>
<tr>
<td>Group 6</td>
<td>Diabetic rats treated with <italic>X. monospora</italic> ethanol leaf extract—XMEt (100 mg/kg b.w.)</td>
</tr>
<tr>
<td>Group 7</td>
<td>Diabetic rats treated with <italic>X. monospora</italic> ethanol leaf extract—XMEt (200 mg/kg b.w.)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p id="t1-fn-1">b.w.: body weight; <italic>X. monospora</italic>: <italic>Xymalos monospora</italic>; XMAq: diabetic rats treated with <italic>X. monospora</italic> aqueous leaf extract; XMEt: diabetic rats treated with <italic>X. monospora</italic> ethanol leaf extract.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p id="p-13">The above doses of the extracts were chosen based on previous studies on the antidiabetic activity of extracts of leaves from different plants, in which the doses ranged from 20 mg/kg b.w. to 250 mg/kg b.w. [<xref ref-type="bibr" rid="B25">25</xref>].</p>
</sec>
<sec id="t2-8">
<title>Blood and liver samples</title>
<p id="p-14">Blood samples were collected from overnight fasted rats the day before commencement of treatment (day 0), and during treatment days (day 1, day 5, day 10, and day 15), and FBG was determined. At the end of the 15 days of treatment, the rats were anesthetized by intraperitoneal injection of diazepam (10 mg/kg b.w.) combined with ketamine hydrochloride (10 mg/kg b.w.). Following anesthesia, the animals were sacrificed humanely by cervical dislocation [<xref ref-type="bibr" rid="B26">26</xref>]. Blood samples were collected from each rat by cardiac puncture and transferred into non-heparinized centrifugal tubes. The blood samples were kept for 30 min to clot. Centrifugation was later carried out at 1,005 × <italic>g</italic> for 30 min to obtain the serum fraction. The serum was separated, preserved in a deep freezer at –20°C, and subsequently used for analysis of biochemical parameters. The liver was also collected after appropriate dissection, washed in cold saline, dried with filter paper, weighed, and preserved at –20°C for subsequent analysis.</p>
</sec>
<sec id="t2-9">
<title>Biochemical parameters of diabetic rats</title>
<p id="p-15">FBG: FBG was determined using a glucometer and diagnostic strips (Accu-Check Performa, Roche Diagnostics GmbH, Germany). The readings were recorded in triplicate.</p>
<p id="p-16">Serum lipids and atherogenicity indices: The serum lipid profile [TC; TG; and high-density lipoprotein cholesterol (HDL-C)] was determined enzymatically with test kits using an automated biochemical analyzer (Randox Laboratories, England). Also, the Friedewald equation [<xref ref-type="bibr" rid="B27">27</xref>] was used to calculate the low-density lipoprotein cholesterol (LDL-C) concentration. Atherogenicity indices were calculated as follows: CRI-I = TC/HDL-C; CRI-II = LDL-C/HDL-C; AC = (TC – HDL-C)/HDL-C [<xref ref-type="bibr" rid="B28">28</xref>], and AIP = log (TG/HDL-C) [<xref ref-type="bibr" rid="B29">29</xref>].</p>
<p id="p-17">TNF-α: The concentration of TNF-α in serum was estimated by using the enzyme-linked immunosorbent assay (ELIZA) technique, which employs the Rat ELISA kit (R&amp;D Systems, USA). The procedure indicated by the manufacturer was followed, and the readings were recorded in pg/mL.</p>
<p id="p-18">Hepatic glycogen: For hepatic glycogen content, 50 mg of each liver sample was placed in centrifuge tubes containing 1 mL of 30% potassium hydroxide. The tubes were closed and placed in a boiling water bath for 20 min. The tubes were allowed to cool, and 1.5 mL of 95% ethanol was added to each tube and stirred using a stirring rod. The solution in the tube was gently brought to a boil in a boiling water bath. The tubes were allowed to cool and then centrifuged at 1,005 × <italic>g</italic> for 15 min. The supernatant was decanted, and the centrifuge tubes were well drained. The precipitate in each tube was re-dissolved in 2 mL of distilled water, reprecipitated by adding 1.5 mL of 95% ethanol, centrifuged, and supernatant decanted. The pellet in each tube was dissolved in 2 mL of distilled water, and the tubes were agitated, and glycogen was measured using the anthrone reagent [<xref ref-type="bibr" rid="B30">30</xref>]. Glycogen content was expressed as milligrams per gram of liver tissue (mg/g).</p>
</sec>
<sec id="t2-10">
<title>Statistical analysis</title>
<p id="p-19">Statistical analysis was carried out using IBM-SPSS for Windows version 27.0 (Armonk, New York, USA). Continuous data has been presented using mean ± standard error of the mean. Differences in means of body weight gain, atherogenicity indices, TNF-α, liver glycogen, and serum lipid concentrations were compared between experimental groups using one-way ANOVA with Bonferroni’s test for multiple comparisons. The comparison of mean FBG between the different animal groups and across the treatment days was carried out using a univariate general linear model followed by Bonferroni’s multiple comparisons test. Statistical significance was considered at <italic>p</italic> &lt; 0.05.</p>
</sec>
</sec>
<sec id="s3">
<title>Results</title>
<sec id="t3-1">
<title>The effects of extracts of <italic>X. monospora</italic> leaves on body weight</title>
<p id="p-20">Body weight was monitored during treatment, and the mean weight gain in each group is presented in <xref ref-type="fig" rid="fig1">Figure 1</xref>. Weight gain in the diabetic control group (14.9 g) was significantly (<italic>p</italic> &lt; 0.05) lower than the normal control group (39.6 g). There was no significant difference in weight gain between the metformin group and the normal control group. The rats that received metformin (40 mg/kg), XMAq (100 mg/kg), XMAq (200 mg/kg), and XMEt (100 mg/kg) significantly gained more weight (ranging from 23.1–29.3 g) than those in the diabetic control group (14.9 g). However, the weight gain was still lower than the normal control group. Weight gain was not significantly different between the metformin (40 mg/kg), XMAq (100 mg/kg), XMAq (200 mg/kg), XMEt (100 mg/kg), and XMEt (200 mg/kg) groups.</p>
<fig id="fig1" position="float">
<label>Figure 1</label>
<caption>
<p id="fig1-p-1">
<bold>Effects of aqueous (XMAq at 100 and 200 mg/kg) and ethanol (XMEt at 100 and 200 mg/kg) extracts of <italic>X.</italic> <italic>monospora</italic> leaves and metformin (40 mg/kg) on weight gain in dexamethasone-induced diabetes in rats.</bold> <sup>a</sup><italic>p</italic> &lt; 0.05 compared to the normal control group, <sup>b</sup><italic>p</italic> &lt; 0.05 compared to the diabetic control group. XMAq: diabetic rats treated with <italic>X. monospora</italic> aqueous leaf extract; XMEt: diabetic rats treated with <italic>X. monospora</italic> ethanol leaf extract.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="eds-03-1008136-g001.tif" />
</fig>
</sec>
<sec id="t3-2">
<title>Effects of extracts of <italic>X. monospora</italic> leaves on FBG</title>
<p id="p-21">
<xref ref-type="fig" rid="fig2">Figure 2</xref> shows that rats in all groups (except those in the normal control group) were diabetic on day 1, at the commencement of treatment. The FBG remained high in the diabetic control group, ranging from 228.1–246.1 mg/dL throughout the experiment when compared to the corresponding treatment days in the normal control group (94.3–98.1 mg/dL). Also, FBG significantly (<italic>p</italic> &lt; 0.05) reduced from 244.3 mg/dL to 200.1, 172.1, and 140.6 mg/dL on days 5, 10, and 15, respectively, in the metformin group when compared to the corresponding days of the diabetic control group. A similar decline in FBG was observed in the XMAq (200 mg/kg) group (from 232.9 mg/dL to 149.2 mg/dL). In the XMAq (100 mg/kg) and XMEt (100 and 200 mg/kg) groups, a significant decrease in FBG was observed on days 10 and 15 when compared to the corresponding days in the diabetic control group. However, the values remained significantly higher than those in the normal control group. During the experiment, animals in the metformin (40 mg/kg), XMAq (100 mg/kg), XMAq (200 mg/kg), XMEt (100 mg/kg), and XMEt (200 mg/kg) groups experienced a significant decrease in FBG, with <italic>p</italic>-values for trends: 0.002, 0.016, 0.009, 0.038, and 0.027, respectively.</p>
<fig id="fig2" position="float">
<label>Figure 2</label>
<caption>
<p id="fig2-p-1">
<bold>Effects of aqueous (XMAq at 100 and 200 mg/kg) and ethanol (XMEt at 100 and 200 mg/kg) extracts of <italic>X.</italic> <italic>monospora</italic> leaves and metformin (40 mg/kg) on fasting blood glucose in dexamethasone-induced diabetes in rats.</bold> <sup>a</sup><italic>p</italic> &lt; 0.05 compared to the normal control group, <sup>b</sup><italic>p</italic> &lt; 0.05 compared to the diabetic control group. XMAq: diabetic rats treated with <italic>X. monospora</italic> aqueous leaf extract; XMEt: diabetic rats treated with <italic>X. monospora</italic> ethanol leaf extract.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="eds-03-1008136-g002.tif" />
</fig>
</sec>
<sec id="t3-3">
<title>Effects of extracts of <italic>X. monospora</italic> leaves on atherogenic lipids</title>
<p id="p-22">The changes in TC, TG, LDL-C, and HDL-C concentrations in the different groups are presented in <xref ref-type="fig" rid="fig3">Figure 3</xref>. TC was significantly (<italic>p</italic> &lt; 0.05) higher in the diabetic control group (141.2 mg/dL) compared to the normal control group (88.6 mg/dL). There was a significant decrease in the concentrations of TC in the metformin (40 mg/kg), XMAq (100 and 200 mg/kg), and XMEt (100 and 200 mg/kg) groups when compared to the diabetic control group. Similarly, in diabetic rats, the concentrations of TG (136.7 mg/dL) and LDL-C (86.8 mg/dL) were significantly increased when compared to rats in the corresponding normal control groups (87.6 and 30.6 mg/dL, respectively). Treatment with metformin (40 mg/kg), XMAq (100 and 200 mg/kg), and XMEt (100 and 200 mg/kg) resulted in a significant decrease in TG and LDL-C when compared to the diabetic control groups. The untreated rats had a significantly lower HDL-C concentration (32.9 mg/dL) when compared to the normal rats (60.2 mg/dL). After treatment of diabetic rats with metformin (40 mg/kg), XMAq (100 mg/kg), XMAq (200 mg/kg), XMEt (100 mg/kg) and XMEt (200 mg/kg), the HDL-C concentrations increased to 53.8, 47.3, 52.1, 45.4 and 46.8 mg/dL respectively when compared to rats in the diabetic control group (32.9 mg/dL).</p>
<fig id="fig3" position="float">
<label>Figure 3</label>
<caption>
<p id="fig3-p-1">
<bold>Effects of aqueous (XMAq at 100 and 200 mg/kg) and ethanol (XMEt at 100 and 200 mg/kg) extracts of <italic>X.</italic> <italic>monospora</italic> leaves and metformin (40 mg/kg) on serum lipids in dexamethasone-induced diabetes in rats.</bold> <sup>a</sup><italic>p</italic> &lt; 0.05 compared to the normal control group, <sup>b</sup><italic>p</italic> &lt; 0.05 compared to the diabetic control group. XMAq: diabetic rats treated with <italic>X. monospora</italic> aqueous leaf extract; XMEt: diabetic rats treated with <italic>X. monospora</italic> ethanol leaf extract.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="eds-03-1008136-g003.tif" />
</fig>
</sec>
<sec id="t3-4">
<title>Effects of extracts of <italic>X. monospora</italic> leaves on atherogenicity indices</title>
<p id="p-23">The value of the CRI-I was significantly (<italic>p</italic> &lt; 0.05) higher in untreated diabetic rats (3.96) when compared to rats in the normal control group (1.47). A similar finding was observed for CRI-II. The diabetic rats that received metformin (40 mg/kg), XMAq (100 and 200 mg/kg), and XMEt (100 and 200 mg/kg) had significantly lower CRI values when compared to untreated diabetic rats (<xref ref-type="fig" rid="fig4">Figure 4A</xref> and <xref ref-type="fig" rid="fig4">4B</xref>). Similarly, a significant decrease in AIP and AC was observed in rats treated with metformin (40 mg/kg), XMAq (100 and 200 mg/kg), and XMEt (100 and 200 mg/kg) when compared to the corresponding diabetic control groups (<xref ref-type="fig" rid="fig4">Figure 4C</xref> and <xref ref-type="fig" rid="fig4">4D</xref>). However, the values remained significantly higher in the groups of rats that received extracts of <italic>X. monospora</italic> than the corresponding values in the normal control groups.</p>
<fig id="fig4" position="float">
<label>Figure 4</label>
<caption>
<p id="fig4-p-1">
<bold>Effects of aqueous (XMAq at 100 and 200 mg/kg) and ethanol (XMEt at 100 and 200 mg/kg) extracts of <italic>X.</italic> <italic>monospora</italic> leaves and metformin (40 mg/kg) on atherogenicity indices (A, Castelli’s Index I; B, Castelli’s Index II; C, Atherogenic Index of Plasma and D, Atherogenic Coefficient) in dexamethasone-induced diabetes in rats.</bold> <sup>a</sup><italic>p</italic> &lt; 0.05 compared to the normal control group, <sup>b</sup><italic>p</italic> &lt; 0.05 compared to the diabetic control group. XMAq: diabetic rats treated with <italic>X. monospora</italic> aqueous leaf extract; XMEt: diabetic rats treated with <italic>X. monospora</italic> ethanol leaf extract.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="eds-03-1008136-g004.tif" />
</fig>
</sec>
<sec id="t3-5">
<title>Effects of extracts of <italic>X. monospora</italic> leaves on TNF-α</title>
<p id="p-24">
<xref ref-type="fig" rid="fig5">Figure 5</xref> indicates that TNF-α was higher in the diabetic control group (12.1 pg/mL) when compared to the normal control group (9.5 pg/mL). However, this difference was not statistically significant (<italic>p</italic> &gt; 0.05). A decrease in TNF-α concentration was observed in rats treated with metformin (40 mg/kg), XMAq (100 and 200 mg/kg), and XMEt (100 and 200mg/kg) when compared to untreated rats. However, the decrease (8.9 pg/mL) was statistically significant only in animals treated with XMEt (100 mg/kg).</p>
<fig id="fig5" position="float">
<label>Figure 5</label>
<caption>
<p id="fig5-p-1">
<bold>Effects of aqueous (XMAq at 100 and 200 mg/kg) and ethanol (XMEt at 100 and 200 mg/kg) extracts of <italic>X.</italic> <italic>monospora</italic> leaves and metformin (40 mg/kg) on TNF-α in dexamethasone-induced diabetes in rats.</bold> <sup>a</sup><italic>p</italic> &lt; 0.05 compared to the normal control group, <sup>b</sup><italic>p</italic> &lt; 0.05 compared to the diabetic control group. XMAq: diabetic rats treated with <italic>X. monospora</italic> aqueous leaf extract; XMEt: diabetic rats treated with <italic>X. monospora</italic> ethanol leaf extract.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="eds-03-1008136-g005.tif" />
</fig>
</sec>
<sec id="t3-6">
<title>The effects of extracts of <italic>X. monospora</italic> leaves on liver weight and liver glycogen</title>
<p id="p-25">There was no significant difference (<italic>p</italic> &gt; 0.05) in liver weight of rats in all experimental groups (<xref ref-type="fig" rid="fig6">Figure 6A</xref>). The liver glycogen in untreated diabetic rats was significantly (<italic>p</italic> &lt; 0.05) lower (9.2 mg/g) than that of the normal control rats (46.7 mg/g). The liver glycogen level in rats that received metformin (40 mg/kg), XMAq (100 and 200 mg/kg), and XMEt (100 and 200 mg/kg) significantly increased when compared to the diabetic rats that were not treated. However, these values remained significantly lower than the normal control group (<xref ref-type="fig" rid="fig6">Figure 6B</xref>).</p>
<fig id="fig6" position="float">
<label>Figure 6</label>
<caption>
<p id="fig6-p-1">
<bold>Effects of aqueous (XMAq at 100 and 200 mg/kg) and ethanol (XMEt at 100 and 200 mg/kg) extracts of <italic>X.</italic> <italic>monospora</italic> leaves and metformin (40 mg/kg) on liver weight (A) and liver glycogen (B) in dexamethasone-induced diabetes in rats.</bold> <sup>a</sup><italic>p</italic> &lt; 0.05 compared to the normal control group, <sup>b</sup><italic>p</italic> &lt; 0.05 compared to the diabetic control group. XMAq: diabetic rats treated with <italic>X. monospora</italic> aqueous leaf extract; XMEt: diabetic rats treated with <italic>X. monospora</italic> ethanol leaf extract.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="eds-03-1008136-g006.tif" />
</fig>
</sec>
</sec>
<sec id="s4">
<title>Discussion</title>
<p id="p-26">This study set out to investigate the effects of aqueous and ethanol extracts of <italic>X. monospora</italic> leaves on some biochemical parameters in diabetic rats. The study reveals that the extracts of <italic>X. monospora</italic> have the potential to significantly reduce hyperglycemia and improve body weight, dyslipidemia, atherogenicity indices, and liver glycogen levels in dexamethasone-induced diabetic rats. The extracts also reduced the levels of TNF-α, but this was not statistically significant.</p>
<p id="p-27">Previous reports indicate that dexamethasone induces diabetes in rats primarily through mechanisms that cause insulin resistance and hyperglycemia. It reduces insulin sensitivity by disrupting insulin signaling pathways, including downregulating insulin receptors in skeletal muscle, resulting in decreased glucose uptake [<xref ref-type="bibr" rid="B31">31</xref>]. Also, dexamethasone increases hepatic gluconeogenesis and alters lipid metabolism, contributing to elevated glucose levels and dyslipidemia [<xref ref-type="bibr" rid="B32">32</xref>]. In addition, chronic administration can lead to changes in glucagon-like peptide 1 (GLP-1) levels and dipeptidyl peptidase 4 (DPP-4) activity, aggravating hyperglycemia [<xref ref-type="bibr" rid="B33">33</xref>].</p>
<p id="p-28">In this study, the rats that received the extracts of <italic>X. monospora</italic> significantly gained more weight than the rats in the diabetic control group. This is similar to the findings of a report in which rats treated with <italic>Perila fructescens</italic> seed residue extract gained more weight than untreated rats, which progressively lost weight [<xref ref-type="bibr" rid="B34">34</xref>]. The decrease in body weight observed in this study could be because the administration of dexamethasone was associated with muscle atrophy, leading to weight loss or reduced weight gain [<xref ref-type="bibr" rid="B35">35</xref>], especially in the untreated diabetic rats.</p>
<p id="p-29">This study reveals that the administration of dexamethasone resulted in hyperglycemia in rats. However, the treatment with metformin and the <italic>X. monospora</italic> extracts resulted in a significant decrease in FBG. Similar findings were obtained with extracts of <italic>Vincor major</italic> [<xref ref-type="bibr" rid="B11">11</xref>] and <italic>Euphorbia thymifolia</italic> [<xref ref-type="bibr" rid="B12">12</xref>]. Metformin reduces blood glucose levels in diabetes mainly by inhibiting hepatic gluconeogenesis and reducing intestinal glucose absorption. It decreases glucose production in the liver while enhancing insulin sensitivity [<xref ref-type="bibr" rid="B36">36</xref>] by increasing the expression and translocation of glucose transporter type 4 (GLUT4) to the plasma membrane, facilitating glucose uptake in peripheral tissues [<xref ref-type="bibr" rid="B37">37</xref>]. In addition to the above, it is possible that treatment of rats with the extracts of <italic>X. monospora</italic> activated adenosine monophosphate-activated protein kinase (AMPK), which plays a crucial role in insulin signaling pathways, improving insulin-mediated glucose disposal and reducing hepatic glucose production [<xref ref-type="bibr" rid="B38">38</xref>].</p>
<p id="p-30">The results in <xref ref-type="fig" rid="fig3">Figure 3</xref> indicate that the administration of dexamethasone resulted in abnormal serum lipid concentrations (dyslipidemia) in diabetic rats. The increase in TC, TG, and LDL-C observed in this study could be due to an increase in cholesterolgenesis, fatty acid absorption, and deposition as TG in the liver [<xref ref-type="bibr" rid="B39">39</xref>]. However, the treatment with metformin and <italic>X. monospora</italic> leaf extracts showed significant lipid-lowering activity, and these findings are consistent with previous studies on different plant extracts [<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B13">13</xref>]. The improvement in dyslipidemia observed in this study can be explained by different mechanisms. For instance, it may be due to the fact that metformin and the extracts modulate cholesterol metabolism via the carbohydrate-responsive element-binding protein (ChREBP), linking glucose and lipid homeostasis [<xref ref-type="bibr" rid="B40">40</xref>]. It is also possible that the reduction in TG and LDL-C is mediated by the modulation of lipid metabolism pathways, including the suppression of the proprotein convertase subtilisin/kexin type 9 (PCSK9), a key regulator of LDL-C receptors, thereby increasing the absorption of LDL-C [<xref ref-type="bibr" rid="B41">41</xref>]. In addition, treatment with metformin and the <italic>X. monospora</italic> leaf extracts could enhance the clearance of very-low-density lipoprotein (VLDL).</p>
<p id="p-31">TG by promoting their uptake in adipose tissue, thus increasing lipolysis and fatty acid oxidation [<xref ref-type="bibr" rid="B42">42</xref>]. Moreover, the treatments could positively affect HDL-C levels in diabetic rats by inhibiting glycation and oxidative modification of HDL-C, thus improving its functionality [<xref ref-type="bibr" rid="B40">40</xref>]. However, the reduction in TG levels observed was slight.</p>
<p id="p-32">The treatments with <italic>X. monospora</italic> leaf extracts significantly decreased the atherogenicity indices, which are important predictors of the risk of atherosclerosis and cardiac complications. For instance, the CRI-I and CRI-II were significantly decreased, reflecting a reduction in coronary plagues in diabetes [<xref ref-type="bibr" rid="B14">14</xref>]. Also, the AIP decreased significantly after treatment with extracts, and this reflects a reduction in the risk of hypertension and coronary events [<xref ref-type="bibr" rid="B43">43</xref>]. In addition, the AC decreased after treatment, and this could contribute to a reduction of the atherogenic potential of the lipoprotein fraction in blood [<xref ref-type="bibr" rid="B14">14</xref>]. Although all atherogenicity indices reduced after the 15 days of treatment, the values remained significantly higher than those of the diabetic control group. This suggests that treatment for a longer duration may reduce the atherogenicity indices to acceptable levels.</p>
<p id="p-33">In this experiment, the levels of TNT-α in the diabetic rats were numerically elevated but statistically not significant when compared to rats in the normal control group. A study carried out by Lestari et al. [<xref ref-type="bibr" rid="B44">44</xref>] on <italic>Phaleria macrocarpa</italic> (Scheff.) Boerl leaf extract resulted in similar results. A previous report showed that TNF-α plays a crucial role in the development of insulin resistance and inflammation in diabetes. Elevated levels of TNF-α have been linked to obesity-induced insulin resistance, mainly through mechanisms that alter insulin signaling pathways, such as increased serine phosphorylation of the insulin receptor substrate-1 (IRS-1) and the reduction of GLUT4 expression in skeletal muscle and adipose tissue [<xref ref-type="bibr" rid="B45">45</xref>, <xref ref-type="bibr" rid="B46">46</xref>]. Treatment of the rats with metformin and extracts of <italic>X. monospora</italic> leaves resulted in reduced levels of TNF-α, though not significantly. This can be explained by the fact that metformin and the extracts decreased the secretion of TNF-α from adipose tissue, which is often elevated in diabetes, thus improving insulin sensitivity [<xref ref-type="bibr" rid="B44">44</xref>]. Also, the treatments could counteract the TNF-α-induced serine phosphorylation of IRS-1, thus restoring the function of the insulin receptor [<xref ref-type="bibr" rid="B45">45</xref>].</p>
<p id="p-34">Rats that received metformin and the extracts had significantly higher liver glycogen than untreated diabetic rats. Previous studies found similar results with the extracts from <italic>Euphorbia thymifolia</italic> [<xref ref-type="bibr" rid="B14">14</xref>] and <italic>Lithocarpus polystaachyus</italic> Rehd [<xref ref-type="bibr" rid="B47">47</xref>]. This could be because the treatments upregulate the expression of the insulin receptor β (IRβ) and improve the phosphorylation of IRS-2, leading to an increase in glycogen synthase activity and a decrease in glycogen phosphorylase activity. Additionally, the treatments could inhibit hepatic gluconeogenesis via AMPK and mitochondrial inhibition, which alters the cellular energy state to favor glycogen synthesis over glucose production [<xref ref-type="bibr" rid="B38">38</xref>, <xref ref-type="bibr" rid="B48">48</xref>]. However, experiments are needed to determine if the extracts exhibit the above mechanisms.</p>
<p id="p-35">It is worth noting that liver glycogen improved but remained below normal in all treatment groups. This partial restoration of glycogen had been observed in a previous study, which used ethanol extract of <italic>Grewia asiatica</italic> Linn. bark [<xref ref-type="bibr" rid="B49">49</xref>]. The extracts used in the current study may not have fully restored normal insulin function or all pathways of glycogen synthesis. It is also possible that the dose of the extracts and duration of treatment could explain this partial restoration of liver glycogen. No significant difference in liver weight was observed between the experimental groups.</p>
<p id="p-36">This study has some limitations worth mentioning. The small sample may affect the variability of parameters assessed, and the selected doses and duration of treatment may not capture the long-term effects of the extracts. Also, histopathological studies were not carried out, and this limits direct clinical extrapolation of the findings.</p>
<sec id="t4-1">
<title>Conclusion</title>
<p id="p-37">In conclusion, this study has revealed that the aqueous and ethanol extracts of <italic>X. monospora</italic> leaves have the potential to reduce FBG, improve dyslipidemia, reduce atherogenicity indices, and increase hepatic glycogen storage in dexamethasone-induced diabetes in rats. Further investigations need to exploit different doses as well as the histopathological activities of the extracts.</p>
</sec>
</sec>
</body>
<back>
<glossary>
<title>Abbreviations</title>
<def-list>
<def-item>
<term>AC</term>
<def>
<p>Atherogenic Coefficient</p>
</def>
</def-item>
<def-item>
<term>AIP</term>
<def>
<p>Atherogenic Index of Plasma</p>
</def>
</def-item>
<def-item>
<term>AMPK</term>
<def>
<p>adenosine monophosphate-activated protein kinase</p>
</def>
</def-item>
<def-item>
<term>CRI</term>
<def>
<p>Castelli’s Risk Index</p>
</def>
</def-item>
<def-item>
<term>FBG</term>
<def>
<p>fasting blood glucose</p>
</def>
</def-item>
<def-item>
<term>GLUT4</term>
<def>
<p>glucose transporter type 4</p>
</def>
</def-item>
<def-item>
<term>HDL-C</term>
<def>
<p>high-density lipoprotein cholesterol</p>
</def>
</def-item>
<def-item>
<term>LDL-C</term>
<def>
<p>low-density lipoprotein cholesterol</p>
</def>
</def-item>
<def-item>
<term>TC</term>
<def>
<p>total cholesterol</p>
</def>
</def-item>
<def-item>
<term>TG</term>
<def>
<p>triglyceride</p>
</def>
</def-item>
<def-item>
<term>TNF-α</term>
<def>
<p>tumor necrosis factor alpha</p>
</def>
</def-item>
</def-list>
</glossary>
<sec id="s5">
<title>Declarations</title>
<sec id="t-5-1">
<title>Acknowledgments</title>
<p>The authors are grateful to the staff of the Animal House and Laboratory of the Faculty of Science at the University of Bamenda for their technical contributions to the realization of this study.</p>
</sec>
<sec id="t-5-2">
<title>Author contributions</title>
<p>AAA: Conceptualization, Investigation, Writing—original draft, Writing—review &amp; editing. MAG: Conceptualization, Investigation, Writing—original draft, Writing—review &amp; editing. BUSF: Conceptualization, Investigation, Writing—original draft, Writing—review &amp; editing. LKN: Validation, Writing—review &amp; editing, Supervision. All authors read and approved the submitted version.</p>
</sec>
<sec id="t-5-3" sec-type="COI-statement">
<title>Conflicts of interest</title>
<p>The authors declare that they have no conflicts of interest.</p>
</sec>
<sec id="t-5-4">
<title>Ethical approval</title>
<p>All the animals used in this study were treated in accordance with the ‘Guidelines for the Care and Use of Laboratory Animals’. Approval for this study was granted by the Ethical Review Committee/Institutional Review Board of the University of Bamenda (Ref. No. 2024/0113H/UBa/IRB).</p>
</sec>
<sec id="t-5-5">
<title>Consent to participate</title>
<p>Not applicable.</p>
</sec>
<sec id="t-5-6">
<title>Consent to publication</title>
<p>Not applicable.</p>
</sec>
<sec id="t-5-7" sec-type="data-availability">
<title>Availability of data and materials</title>
<p>The datasets generated/analyzed in the current study are available from the corresponding author upon reasonable request.</p>
</sec>
<sec id="t-5-8">
<title>Funding</title>
<p>Not applicable.</p>
</sec>
<sec id="t-5-9">
<title>Copyright</title>
<p>© The Author(s) 2025.</p>
</sec>
</sec>
<sec id="s6">
<title>Publisher’s note</title>
<p>Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.</p>
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