Gene expression signatures for phlegm-dampness constitution of Chinese medicine

A new method for identification of traditional Chinese medicine constitution based on tongue features with machine learning

BACKGROUND

The theory of Chinese medicine (TCM) constitution contributes to the optimisation of individualised healthcare programmes. However, at present, TCM constitution identification mainly relies on inefficient questionnaires with subjective bias. Efficient and accurate TCM constitution identification can play an important role in individualised medicine and healthcare.

OBJECTIVE

Building an efficient model for identifying traditional Chinese medicine constitutions using objective tongue features and machine learning techniques.

METHODS

The DS01-A device was applied to collect tongue images and extract features. We trained and evaluated five machine learning models: Support Vector Machine (SVM), Decision Tree (DT), Random Forest (RF), LightGBM (LGBM), and CatBoost (CB). Among these, we selected the model with the best performance as the base classifier for constructing our heterogeneous ensemble learning model. Using various performance metrics, including classification accuracy, precision, recall, F1 score, and area under curve (AUC), to comprehensively evaluate model performance.

RESULTS

A total of 1149 tongue images were obtained and 45 features were extracted, forming dataset 1. RF, LGBM, and CB were selected as the base learners for the RLC-Stacking. On dataset 1, RLC-Stacking1 achieved an accuracy of 0.8122, outperforming individual classifiers. After feature selection, the classification accuracy of RLC-Stacking2 improved to 0.8287, an improvement of 0.00165 compared to RLC-Stacking1. RLC-Stacking2 achieved an accuracy exceeding 0.85 for identifying each TCM constitution type, indicating excellent identification performance.

CONCLUSION

The study provides a reliable method for the accurate and rapid identification of TCM constitutions and can assist clinicians in tailoring individualized medical treatments based on personal constitution types and guide daily health care. The information extracted from tongue images serves as an effective marker for objective TCM constitution identification.

The Integrated Bioinformatic Assay of Genetic Expression Features and Analyses of Traditional Chinese Medicine Specific Constitution Reveal Metabolic Characteristics and Targets in Steatosis of Nonalcoholic Fatty Liver Disease

Purpose

In this study, our primary aim is to analyze the genetic expression feature and analyze specific Traditional Chinese medicine (TCM) constitution distribution in non-alcoholic fatty liver disease (NAFLD) and reveal the metabolic characteristic of NAFLD.

Materials and Methods

For revealing genetic features, we obtained the gene expression data from the Gene Expression Omnibus (GEO) database of the National Center for Biotechnology Information (NCBI). The genetic data on NAFLD were analyzed by identifying differentially expressed genes (DEGs), associated pathways, co-expressed genetic networks, and gene set enrichment function. Concurrently, we assessed specific constitution distributions among local NAFLD patients through established TCM constitution models and determined the independent variable, including specific constitution to the NAFLD via the regression analyses.

Results

The analyses on GEO datasets showed that simple steatosis in NAFLD is strongly associated with HOMA-insulin resistance (HOMA-IR). Analyses of GEO datasets revealed significantly altered genetic expression profiles between NAFLD and normal populations. For TCM constitution analyses, we demonstrated a decline in yin-yang harmony (YYH) and yang-asthenia (YAAC) constitution, whereas there was an increase in qi-stagnation (QSC) and phlegm-dampness (PDC) in NAFLD. The binary logistic regression analysis indicated that besides other metabolic parameters, YYH, qi asthenia (QAC), YYAC, and yin-asthenia (YAC) were the independent variables of NAFLD, while YAC was the independent variables of T2D. The multilinear regression analyses suggested that NAFLD, DM, BMI, waist, TC, TG, hypertension, ALT, AST, and YAC were the significant determinators of the FPG.

Conclusion

This study presents a relatively comprehensive metabolic profile in steatosis of NAFLD, revealed by significant genetic expression feature alterations and different TCM constitution distribution in NAFLD. Through this method, the study intends to associate the genetic feature with the phenotype of TCM constitution. The results could be applied to assist integrative medicine research in exploring the appropriate personalized approaches for NAFLD.

DIA-PRM Proteomic Analysis of Phlegm-Dampness Constitution with Glucolipid Metabolic Disorders by the Intervention of Hua Tan Qu Shi Recipe

Background

Phlegm-dampness constitution as one of nine constitutions in traditional Chinese medicine (TCM) has been a high risk factor for glucolipid metabolic disorders (GLMD). Based on our previous findings, Hua Tan Qu Shi recipe (HTQSR) could effectively improve metabolic indicators of GLMD by targeting on phlegm-dampness constitution. However, the proteomic mechanisms of GLMD with the treatment of HTQSR targeting on phlegm-dampness constitution remain unknown.

Methods

Clinical participants from phlegm-dampness constitution with the prediabetic state (T), phlegm-dampness constitution with marginally elevated blood lipids (Z), and phlegm-dampness constitution before sickness (W) were included in this study, who orally took HTQSR for 12 weeks and, respectively, marked AT, AZ, and AW. Data-independent acquisition (DIA) and parallel reaction monitoring (PRM) were performed to identify the differential proteins; then, Venn analysis was used to investigate coexpressed and coregulated proteins. In addition, ingenuity pathway analysis (IPA) software was utilized to explore the related pathways and diseases and biofunctions.

Results

LXR/RXR activation, acute phase response signaling, and production of nitric oxide and reactive oxygen species in macrophages were obviously activated between the T and AT groups, as well as the Z and AZ groups. In contrast, these three pathways were inhibited between the W and AW groups. Importantly, one coexpressed and coregulated differential protein, B2MG, was validated by PRM among all groups.

Conclusions

This work firstly reported the underlying proteomic mechanisms of GLMD with the treatment of HTQSR targeting on phlegm-dampness constitution, indicating that intervention of phlegm-dampness constitution might be a novel strategy for the preventive treatment of GLMD.

The Role of Qi-Stagnation Constitution and Emotion Regulation in the Association Between Childhood Maltreatment and Depression in Chinese College Students

Background

Childhood maltreatment is known as a significant risk factor for later depression. However, there remains a lack of understanding about the mechanisms through which childhood maltreatment confers risk for depression. This study explores how Qi-stagnation constitution (QSC) and emotion regulation affect the link between childhood maltreatment and depressive symptoms in Chinese college students.

Methods

We recruited 2,108 college students aged 18-25 years between November 2020 and December 2021. Participants were required to complete four self-report questionnaires, including the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Qi-Stagnation Constitution (QSC) subscale of the simplified Chinese Medicine Constitution Questionnaire, Difficulties in Emotion Regulation Scale (DERS), and the Beck Depression Inventory-II (BDI-II). Moderated mediation analyses were conducted.

Results

There was a positive correlation between childhood maltreatment and QSC, while the QSC partially mediated the effect of childhood maltreatment on depressive scores in college students. In addition, emotion dysregulation moderated the association between QSC and depressive scores.

Conclusion

These results enhance understanding of key factors influencing the link between childhood maltreatment and depressive symptoms among college students by combining the theory of TCM constitution with psychological processes. The development of strategies to prevent biased Qi-stagnation constitution and emotion dysregulation may help to improve college students' mental health and strengthen the resilience of individuals to depression.

Epigenetic Studies of Chinese Herbal Medicine: Pleiotropic Role of DNA Methylation

Accumulating knowledge has been achieved on DNA methylation participating in numerous cellular processes and multiple human diseases; however, few studies have addressed the pleiotropic role of DNA methylation in Chinese herbal medicine (CHM). CHM has been used worldwide for the prevention and treatment of multiple diseases. Newly developed epigenetic techniques have brought great opportunities for the development of CHM. In this review, we summarize the DNA methylation studies and portray the pleiotropic role of DNA methylation in CHM. DNA methylation serves as a mediator participating in plant responses to environmental factors, and thus affecting CHM medicinal plants growth and bioactive compound biosynthesis which are vital for therapeutic effects. Furthermore, DNA methylation helps to uncover the pharmaceutical mechanisms of CHM formulae, herbs, and herbal-derived compounds. It also provides scientific validation for constitution theory and other essential issues of CHM. This newly developed field of DNA methylation is up-and-coming to address many complicated scientific questions of CHM; it thus not only promotes disease treatment but also facilitates health maintenance.

Analyses of Long Noncoding RNA and mRNA Profiles in Subjects with the Phlegm-Dampness Constitution

Background

Constitution in traditional Chinese medicine (TCM) plays a key role in the genesis, development, and prognosis of diseases. Phlegm-dampness constitution (PDC) is one of the nine constitutions in TCM, susceptible to metabolic disorders, which is mainly manifested by profuse phlegm, loose abdomen, and greasy face. Epidemiologic, genomic, and epigenetic studies have been carried out in previous works, confirming that PDC represents a distinctive population with microcosmic changes related to metabolic disorders. However, whether long noncoding RNAs (lncRNAs) play a regulatory role in metabolic disease in subjects with PDC remains largely unknown. We aimed to investigate distinct lncRNA and mRNA expression signatures and lncRNA-mRNA regulatory networks in the phlegm-dampness constitution (PDC).

Methods

The peripheral blood mononuclear cells (PBMCs) were isolated from the subjects with PDC (n = 13) and balanced constitution (BC) (n = 9). The profiles of lncRNAs and mRNAs in PBMCs were analyzed using microarray and further validated with RT-qPCR. Subsequently, pathway analysis was performed to investigate the function of differentially expressed mRNAs by using Ingenuity Pathway Analysis (IPA).

Results

Results suggested that some mRNAs, which were regulated by the differentially expressed lncRNAs, were mainly enriched in lipid metabolism and immune inflammation-related pathways. This was consistent with the molecular characteristics of previous studies, indicating that the clinical characteristics of metabolic disorders in PDC might be regulated by lncRNAs. Furthermore, by making coexpression network construction as well as cis-regulated target gene analysis, several lncRNA-mRNA pairs with potential regulatory relationships were identified by bioinformatic analyses, including RP11-317J10.2-CA3, RP11-809C18.3-PIP4K2A, LINC0069-RFTN1, TTTY15-ARHGEF9, and AC135048.13-ORAI3.

Conclusions

This study first revealed that the expression characteristics of lncRNAs/mRNAs may be potential biomarkers, indicating that the distinctive physical and clinical characteristics of PDC might be partially attributed to the specific expression signatures of lncRNAs/mRNAs.

A Meta-Analysis of the Association between Diabetes Mellitus and Traditional Chinese Medicine Constitution

Objective

To explore the distribution of constitution types of diabetes mellitus (DM) in traditional Chinese medicine (TCM) and to provide evidence-based medicine basis for the prevention and treatment of diabetes.

Methods

PubMed, Embase, Web of Science, and three Chinese databases were searched to include research literature on the relationship between diabetes and TCM constitution. The single rate study of cross-sectional literature was conducted with RStudio software, and the control meta-analysis of the diabetic and nondiabetic population was performed with Review Manager 5.3 software. Two independent reviewers assessed the methodological quality of the studies' data. The main outcomes included the distribution of constitutional types in the diabetic population and the odds ratio (OR) between the two. Effect sizes are expressed as proportions or ORs with 95% confidence intervals (CI).

Results

A total of 28,781 diabetic cases were included in 87 articles. Yin-deficiency, phlegm-dampness, and qi-deficiency accounted for 18% (95% CI (15%, 20%), P < 0.01), 17% (95% CI (15%, 19%), P < 0.01), and 13% (95% CI (11%, 15%), P < 0.01) of the total diabetic cases. The risk of diabetes in people with yin-deficiency and phlegm-dampness was 3.06 (95% CI (1.38-6.78), P=0.006) and 1.89 (95%CI (1.05-3.42), P=0.03) times higher than that in those with other constitutions, respectively. The distribution of TCM constitution of DM patients varied significantly in different regions and ages.

Conclusion

Yin-deficiency and phlegm-dampness are the common constitution types of diabetic people, and they may also be the risk factors of diabetes. Balanced constitution may be a protective factor of diabetes. More high-quality cohort and case-control studies need to be designed to provide more valuable evidence-based basis for assessing the correlation between DM and TCM constitution.

Etiology Exploration of Non-alcoholic Fatty Liver Disease From Traditional Chinese Medicine Constitution Perspective: A Cross-Sectional Study

Background: From the traditional Chinese medicine (TCM) constitution theory perspective, the phlegm-dampness constitution is thought to be closely related to the occurrence of non-alcoholic fatty liver disease (NAFLD). However, this viewpoint still lacks rigorous statistical evidence. This study aimed to test the association between the phlegm-dampness constitution and NAFLD. Methods: We conducted a cross-sectional study. Participants were residents living in Chengdu, China, undergoing health checkups at the health management center of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine between December 2018 and September 2020. TCM constitution type was diagnosed by DAOSH four examinations instrument, NAFLD was diagnosed according to the liver ultrasonography and medical history. Multivariate logistic regression and propensity score matching (PSM) were used to analyze a total of 1,677 qualified data. Results: 1,037 participants had biased constitution(s), 67.8% of which had mixed constitutions (with at least two constitutions). Among 1,677 participants, the phlegm-dampness constitution was associated with the yang-deficiency, yin-deficiency, dampness-heat, qi-depression, and blood-stasis constitutions. The correlation coefficients were 0.11, 0.32, 0.42, 0.20, 0.14, respectively. Between the phlegm-dampness constitution and NAFLD, the odds ratio (OR) and the 95% confidence interval (CI) was 2.05 (1.57-2.69) in the crude model. After adjusting for age, gender, Body mass index (BMI), other biased constitutions, smoking, high blood pressure, diabetes, and dyslipidemia, the OR reduced to 1.51 (1.04-2.18). The associations of seven other biased TCM constitutions and NAFLD were not statistically significant in the fully adjusted model. The PSM analysis showed consistent results with the logistic regression. Conclusions: Among eight biased TCM constitutions, the phlegm-dampness constitution is independently associated with NAFLD. We speculate the phlegm-dampness constitution is a risk factor of NAFLD. Longitudinal studies are needed to confirm this causal relationship in the future. In addition, inconsistent with some TCM practitioners' experience, we disagree that the blood-stasis constitution is associated with NAFLD.

Differences in serum proteins in traditional Chinese medicine constitutional population: Analysis and verification

Traditional Chinese medicine assigns individuals into different categories called "constitutions" to help guide the clinical treatment according to subjective physiologic, psychologic analyses, large-scale clinical observations, and epidemiologic studies. To further explore more objective expressions of constitutions, antibody microarrays were used to analyze the serologic protein profiles of two different constitutions, a balanced (or healthy) constitution (BC) and the dampness constitution (DC) comprising phlegm-dampness and damp-heat constitutions. The profiles of changing constitutions across time were also analyzed. Nineteen differentially expressed proteins between the two groups were identified, with known biologic functions involved in immunity and inflammation. This proteomic study may provide a biologic explanation why the BC is different than the dampness constitution.

How to continue lipid-lowering therapy in patients with coronary heart disease and severe liver dysfunction?: A case report of plaque regression by a combination of Chinese and Western Medicine

RATIONALE

Atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD), atherosclerotic stroke and peripheral vascular disease, has become the most deadly chronic noncommunicable disease throughout the world in recent decades, while plaque regression could reduce the occurrence of ASCVD. Traditional Chinese Medicine (TCM) has been widely used for prevention and treatment of these diseases. In the perspective of TCM, phlegm and blood stasis are considered to be leading pathogenesis for CHD. Hence, activating blood circulation and dissipating phlegm, which is of great benefit to regress plaque, have been regarded as general principles in treatment.

PATIENT CONCERNS

A 36-year-old man presented with a 3-month history of intermittent exertional chest pain. Coronary angiography revealed 60% stenosis of the proximal left anterior descending coronary artery. Liver function showed: alanine transaminase (ALT):627U/L, aspartate transaminase (AST):243U/L.

DIAGNOSES

CHD and hepatitis B with severe liver dysfunction.

INTERVENTIONS

The patient should have been treated with high-intensity statin therapy. Actually, due to severe liver dysfunction, Huazhirougan granule instead of statins was administered. In addition, he was treated with TCM according to syndrome differentiation for two and a half years.

OUTCOMES

The chest pain disappeared and other symptoms alleviated as well after treatment. Coronary computed tomographic angiography revealed no stenosis in the proximal left anterior descending coronary artery. ALT and AST level returned to normal (ALT:45U/L,AST:24U/L).

LESSONS

For patients with CHD and severe hepatic dysfunction, antilipidemic drugs such as statins are not recommended. This case suggested that TCM might fill a gap in lipid-lowering therapy. Thus, we could see that statins were not the only drug for plaque regression and the effect of TCM in treating coronary artery disease cannot be ignored.

The Role of Chinese Medicine in Health Maintenance and Disease Prevention: Application of Constitution Theory

Traditional Chinese medicine (TCM) has guided health maintenance and disease treatment for thousands of years and has been widely used in many countries around the world. TCM regards each individual as unique so all corresponding therapeutic and preventive approaches in TCM are personalized. Personalized medicine, also referred to as precision medicine, is an emerging medical paradigm that points toward a new direction for future medical development. TCM constitution studies the holistic body condition, which is affected by both inborn and acquired factors. Body constitution lays the foundation for disease diagnosis, prevention and treatment. Different constitution types predispose individuals to different disease susceptibilities. Examining an individual's unique body constitution can promote effective health management and benefit the application of personalized medicine significantly. This review will introduce and discuss the application of the TCM constitution for health maintenance and disease prevention. In last decade, a number of modern techniques have been employed in the constitution research to evaluate the health status of individuals. The TCM constitution reflects the current status and future trends of human health in four aspects, i.e., individual differences, life processes, psychological condition and adaptability to natural and social environments. This TCM constitution theory has already been applied in the Chinese public health management at different levels with promising outcome. The constitution theory and practice provide a new approach for health maintenance and disease prevention.