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Zeng NX, Li H, Su MY, Chen X, Yang XY, Shen M. Therapeutic potential of Erxian decoction and its special chemical markers in depression: a review of clinical and preclinical studies. Front Pharmacol 2024; 15:1377079. [PMID: 38915473 PMCID: PMC11194323 DOI: 10.3389/fphar.2024.1377079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/15/2024] [Indexed: 06/26/2024] Open
Abstract
The increasing prevalence of depression is a major societal burden. The etiology of depression involves multiple mechanisms. Thus, the outcomes of the currently used treatment for depression are suboptimal. The anti-depression effects of traditional Chinese medicine (TCM) formulations have piqued the interest of the scientific community owing to their multi-ingredient, multi-target, and multi-link characteristics. According to the TCM theory, the functioning of the kidney is intricately linked to that of the brain. Clinical observations have indicated the therapeutic potential of the kidney-tonifying formula Erxian Decoction (EXD) in depression. This review aimed to comprehensively search various databases to summarize the anti-depression effects of EXD, explore the underlying material basis and mechanisms, and offer new suggestions and methods for the clinical treatment of depression. The clinical and preclinical studies published before 31 August 2023, were searched in PubMed, Google Scholar, China National Knowledge Infrastructure, and Wanfang Database. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies have demonstrated that EXD exhibits therapeutic properties in patients with menopausal depression, postpartum depression, and maintenance hemodialysis-associated depression. Meanwhile, preclinical studies have reported that EXD and its special chemical markers exert anti-depression effects by modulating monoamine neurotransmitter levels, inhibiting neuroinflammation, augmenting synaptic plasticity, exerting neuroprotective effects, regulating the hypothalamic-pituitary-adrenal axis, promoting neurogenesis, and altering cerebrospinal fluid composition. Thus, the anti-depression effects of EXD are mediated through multiple ingredients, targets, and links. However, further clinical and animal studies are needed to investigate the anti-depression effects of EXD and the underlying mechanisms and offer additional evidence and recommendations for its clinical application. Moreover, strategies must be developed to improve the quality control of EXD. This review provides an overview of EXD and guidance for future research direction.
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Affiliation(s)
- Ning-Xi Zeng
- Department of Rehabilitation Medicine, People’s Hospital of Longhua, Shenzhen, China
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Han Li
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Department of Pharmacy, Shenzhen Bao’an Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Meng-Yuan Su
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Urology Surgery, Guangzhou Baiyun District Maternal and Child Health Hospital, Guangzhou, China
| | - Xin Chen
- Department of Rehabilitation Medicine, People’s Hospital of Longhua, Shenzhen, China
| | - Xiao-Yan Yang
- Department of Rehabilitation Medicine, People’s Hospital of Longhua, Shenzhen, China
| | - Mei Shen
- Department of Rehabilitation Medicine, People’s Hospital of Longhua, Shenzhen, China
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Zhang L, Li J, Xie R, Zeng L, Chen W, Li H. Osteoporosis guidelines on TCM drug therapies: a systematic quality evaluation and content analysis. Front Endocrinol (Lausanne) 2024; 14:1276631. [PMID: 38317713 PMCID: PMC10839061 DOI: 10.3389/fendo.2023.1276631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024] Open
Abstract
Objective The aims of this study were to evaluate the quality of osteoporosis guidelines on traditional Chinese medicine (TCM) drug therapies and to analyze the specific recommendations of these guidelines. Methods We systematically collected guidelines, evaluated the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool, and summarized the recommendations of TCM drug therapies using the Patient-Intervention-Comparator-Outcome (PICO) model as the analysis framework. Results and conclusions A total of 20 guidelines were included. Overall quality evaluation results revealed that four guidelines were at level A, four at level B, and 12 at level C, whose quality needed to be improved in the domains of "stakeholder involvement", "rigor of development", "applicability" and "editorial independence". Stratified analysis suggested that the post-2020 guidelines were significantly better than those published before 2020 in the domains of "scope and purpose", "stakeholder involvement" and "editorial independence". Guidelines with evidence systems were significantly better than those without evidence systems in terms of "stakeholder involvement", "rigor of development", "clarity of presentation" and "applicability". The guidelines recommended TCM drug therapies for patients with osteopenia, osteoporosis and osteoporotic fracture. Recommended TCM drugs were mainly Chinese patent medicine alone or combined with Western medicine, with the outcome mainly focused on improving bone mineral density (BMD).
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Affiliation(s)
- Luan Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahui Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Runsheng Xie
- Research Team of Chinese Medicine Standardization, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Research Team of Chinese Medicine Standardization, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Lingfeng Zeng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenjia Chen
- Research Team of Chinese Medicine Standardization, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Research Team of Chinese Medicine Standardization, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Hui Li
- Research Team of Chinese Medicine Standardization, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Research Team of Chinese Medicine Standardization, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Huang H, Qian Y, Feng Y, Wang Y, Qian P, Xu F, Wang Q. Erxian Decoction-induced serum exosomes slowed bone marrow mesenchymal stem cell senescence through mitophagy. J Gene Med 2024; 26:e3617. [PMID: 37935422 DOI: 10.1002/jgm.3617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/17/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE Erxian Decoction (EXD) is traditionally employed in the treatment of menopausal syndromes, although its underlying mechanisms remain largely undefined. Given that the senescence of bone marrow mesenchymal stem cells (BMSCs) is intertwined with organismal aging and associated diseases, this study endeavored to elucidate the influence of EXD on aging BMSCs and uncover the mechanisms through which EXD impedes BMSC senescence. METHODS Initially, we probed the anti-senescent mechanisms of EXD on BMSCs via network pharmacology. We subsequently isolated and identified exosomes from the serum of EXD-fed rats (EXD-Exos) and administered these to H2 O2 -induced aging BMSC. Assays were conducted to assess BMSC senescence indicators and markers pertinent to mitochondrial autophagy. Treatments with mitophagy inhibitors and activators were then employed to substantiate our findings. RESULTS Protein-protein interaction (PPI) network analyses spotlighted AKT1, TP53, TNF, JUN, VEGFA, IL6, CASP3 and EGFR as focal targets. Gene Ontology and Kyoto Encylcopedia of Genes and Genomes pathway analyses underscored oxidative stress, mitophagy and cell proliferation as pivotal processes. Our cellular assays ascertained that EXD-Exos mitigated H2 O2 -induced senescence phenotypes in BMSCs. Moreover, EXD-Exos ameliorated disrupted mitophagy in BMSCs, as evidenced by enhanced cellular membrane potential and diminished reactive oxygen species levels. Intriguingly, EXD-Exos also preserved the osteogenic differentiation potential of BMSCs while curtailing their adipogenic propensity. CONCLUSION Our findings compellingly suggest that EXD counteracts BMSC senescence by fostering mitophagy.
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Affiliation(s)
- Haoqiang Huang
- Department of Orthopaedics, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, Jiangsu, China
| | - Yinhua Qian
- Department of Orthopaedics, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, Jiangsu, China
| | - Ye Feng
- School of Stomatology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yitao Wang
- Department of Orthopaedics, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, Jiangsu, China
| | - Pingkang Qian
- Department of Orthopaedics, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, Jiangsu, China
| | - Feng Xu
- Department of Orthopaedics, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, Jiangsu, China
| | - Qing Wang
- Department of Orthopaedics, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, Jiangsu, China
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Hao J, Bei J, Li Z, Han M, Ma B, Ma P, Zhou X. Qing`e Pill Inhibits Osteoblast Ferroptosis via ATM Serine/Threonine Kinase (ATM) and the PI3K/AKT Pathway in Primary Osteoporosis. Front Pharmacol 2022; 13:902102. [PMID: 35865965 PMCID: PMC9294279 DOI: 10.3389/fphar.2022.902102] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/23/2022] [Indexed: 12/24/2022] Open
Abstract
Osteoporosis (OP) is an aging-related disease that is the main etiology of fragility fracture. Qing’e Pill (QEP) is a mixture of traditional Chinese medicine (TCM) consisting of Eucommia ulmoides Oliv., Psoralea corylifolia L., Juglans regia L., and Allium sativum L. QEP has an anti-osteoporosis function, but the underlying mechanism remains unclear. In this study, online databases were employed to determine the chemical compounds of QEP and potential target genes in osteoporosis. Potential pathways associated with genes were defined by Gene Ontology (GO) and Kyoto Encyclopaedia of Genes and Genomes (KEGG) databases. A compound–target–disease network was constructed. Hub genes screened through Cytoscape were intersected with the FerrDB database. The potential key genes were validated in HFOB 1.19 cells, and rat models were ovariectomized through Western blot, RT-qPCR, ELISA, HE staining, immunohistochemistry, and immunofluorescence analyses. The intersection targets of QEP and osteoporosis contained 121 proteins, whereas the target–pathway network included 156 pathways. We filtered five genes that stood out in the network analysis for experimental verification. The experiments validated that QEP exerted therapeutic effects on osteoporosis by inhibiting ferroptosis and promoting cell survival via the PI3K/AKT pathway and ATM. In conclusion, combining the application of network analysis and experimental verification may provide an efficient method to validate the molecular mechanism of QEP on osteoporosis.
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Affiliation(s)
- Jian Hao
- Orthopedics Department, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
- *Correspondence: Jian Hao, ; Xianhu Zhou,
| | - Jiaxin Bei
- Laboratory of Interventional Radiology, Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenhan Li
- School of Clinical, Wannan Medical College, Wuhu, China
| | - Mingyuan Han
- Orthopedics Department, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Boyuan Ma
- Orthopedics Department, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Pengyi Ma
- Department of Orthopaedic, Graduate School, Tianjin Medical University, Tianjin, China
| | - Xianhu Zhou
- Orthopedics Department, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
- *Correspondence: Jian Hao, ; Xianhu Zhou,
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Zhou L, Wong KY, Poon CCW, Yu W, Xiao H, Chan CO, Mok DKW, Wong MS. Water Extract of Rhizoma Drynaria Selectively Exerts Estrogenic Activities in Ovariectomized Rats and Estrogen Receptor-Positive Cells. Front Endocrinol (Lausanne) 2022; 13:817146. [PMID: 35282447 PMCID: PMC8908013 DOI: 10.3389/fendo.2022.817146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/27/2022] [Indexed: 12/18/2022] Open
Abstract
Our previous study demonstrated that the bone protective actions of herbal medicine Rhizoma Drynariae (Gusuibu, RD) were mainly mediated by flavonoid phytoestrogens via estrogen receptors, raising concerns about the safety of using RD as it may induce estrogen-like risk-benefit profile and interact with other ER ligands, such as selective estrogen receptor modulators (SERMs), when coadministered. The present study evaluated the estrogenic activities of RD and its potential interaction with tamoxifen, a SERM, in estrogen-sensitive tissues by using mature ovariectomized (OVX) rats and ER-positive cells. Similar to but weaker than tamoxifen, RD at its clinical dose dramatically ameliorated OVX-induced changes in bone and dopamine metabolism-related markers in OVX rats. However, tamoxifen, but not RD, induced uterotrophic effects. No significant alteration in mammary gland was observed in OVX rats treated with RD, which was different from the inhibitory actions of tamoxifen. The two-way ANOVA results indicated the interactions between RD and tamoxifen in the bone, brain, and uterus of OVX rats while RD did not alter their responses to tamoxifen. Our results demonstrate that RD selectively exerts estrogenic actions in a different manner from tamoxifen. Moreover, RD interacts with tamoxifen without altering its effects in OVX rats.
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Affiliation(s)
- Liping Zhou
- Cell Therapy Center, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Ka-Ying Wong
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Christina Chui-Wa Poon
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Center for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wenxuan Yu
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Huihui Xiao
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Center for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Chi-On Chan
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Daniel Kam-Wah Mok
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Man-Sau Wong
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Center for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
- *Correspondence: Man-Sau Wong,
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