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Li X, Liu L, Wan MX, Gong LM, Su J, Xu L. Active Components of Pueraria lobata through the MAPK/ERK Signaling Pathway Alleviate Iron Overload in Alcoholic Liver Disease. Chem Biodivers 2024; 21:e202400005. [PMID: 38504590 DOI: 10.1002/cbdv.202400005] [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: 01/12/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To delve into the primary active ingredients and mechanism of Pueraria lobata for alleviating iron overload in alcoholic liver disease. METHODS Pueraria lobata's potential targets and signaling pathways in treating alcohol-induced iron overloads were predicted using network pharmacology analysis. Then, animal experiments were used to validate the predictions of network pharmacology. The impact of puerarin or genistein on alcohol-induced iron accumulation, liver injury, oxidative stress, and apoptosis was assessed using morphological examination, biochemical index test, and immunofluorescence. Key proteins implicated in linked pathways were identified using RT-qPCR, western blot analysis, and immunohistochemistry. RESULTS Network pharmacological predictions combined with animal experiments suggest that the model group compared to the control group, exhibited activation of the MAPK/ERK signaling pathway, suppression of hepcidin expression, and aggravated iron overload, liver damage, oxidative stress, and hepatocyte death. Puerarin and genistein, the active compounds in Pueraria lobata, effectively mitigated the aforementioned alcohol-induced effects. No statistically significant disparities were seen in the effects above between the two groups receiving drug therapy. CONCLUSION This study preliminarily demonstrated that puerarin and genistein in Pueraria lobata may increase hepcidin production to alleviate alcohol-induced iron overload by inhibiting the MAPK/ERK signaling pathway.
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Affiliation(s)
- Xue Li
- College of Basic Medicine, Dali University, Dali, China
| | - Le Liu
- College of Basic Medicine, Dali University, Dali, China
| | - Mei-Xuan Wan
- College of Basic Medicine, Dali University, Dali, China
| | - Li-Min Gong
- College of Basic Medicine, Dali University, Dali, China
| | - Juan Su
- College of Basic Medicine, Dali University, Dali, China
| | - Li Xu
- College of Basic Medicine, Dali University, Dali, China
- Yunnan Key Laboratory of Screening and Research on Anti-pathogenic Plant Resources from Western Yunnan, Dali University, Dali, China
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Pan J, Li Y, Wu X, Pan X, Liu C, Zhang H, Wang L, Jiang X, Wang J, Zang N, Pang L, Lv X. The mechanism of Shenlong Jianji treatment of idiopathic pulmonary fibrosis inhibits fibroblast-to-myofibroblast transformation via the TGF-β1/smads signaling pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 322:117507. [PMID: 38122910 DOI: 10.1016/j.jep.2023.117507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Shenlong Jianji (SLJJ) is a Chinese herbal compound composed of traditional medicines for supplementing Qi, nourishing Yin, promoting blood circulation, and removing obstruction in channels. It is widely used to treat idiopathic pulmonary fibrosis (IPF) in China. However, the underlying mechanism of SLJJ remains unclear. AIM OF THIS STUDY To elucidate the efficacy and mechanisms of SLJJ in the treatment of IPF through in vivo and in vitro experiments. MATERIAL AND METHODS 84 Wistar rats were randomly and equally divided into 7 groups: the control group (CTRL), the sham operation group (SHAM), the model group (IPF), the low dose of SLJJ group (L-SLJJ), the middle dose of SLJJ group (M-SLJJ), the high dose of SLJJ group (H-SLJJ), and the pirfenidone group (PFD). The rats in the CTRL, SHAM, and IPF groups were given normal saline each time for 28 days; the SLJJ groups were given Shenlong Jianji (9 g kg-1·d-1, 18 g kg-1·d-1, 36 g kg-1·d-1), and pirfenidone was administered as a sequential dose. After 28 days, the general condition of the rats was evaluated, and samples were collected. The lung coefficient was measured. The pathological changes of lung in each group were observed by H&E staining and Masson staining. α-SMA, collagen 1, and E-cadherin proteins were detected by immunohistochemistry. α-SMA, collagen 1, vimentin, E-cadherin, N-cadherin, TGF-β1, smad2, and smad3 proteins were detected by WB in vivo.In vitro, A scratch test was used to assess the ratio of cell migration. α-SMA, vimentin, E-cadherin, and N-cadherin protein levels were evaluated by a cellular immunofluorescence assay. TGF-β1/smads signaling pathway was detected by WB. HPLC-Q-TOF/MS analysis was used to identify the active compounds in the SLJJ. Molecular docking determined the free binding energy of the compound with the TGF-β1 protein. RESULTS SLJJ significantly improved the respiratory symptoms, heart rate, mental state, and food intake of IPF group rats and decreased the lung coefficient. In the IPF group, inflammatory cells were infiltrated, and the thickened alveoli wall and alveoli collapse were shown, while significantly alleviating pathological changes in the SLJJ and PFD groups. Masson staining showed that SLJJ and PFD decreased the collagen expression. Immunohistochemical results showed that the expressions of α-SMA, collagen 1, and N-cadherin decreased in the SLJJ and PFD groups, while E-cadherin increased significantly compared with the IPF group. SLJJ regulates TGF-β1/smads signaling pathway proteins in vivo. SLJJ decreased the ratio of migration in HFL-1 cells; SLJJ reduced the fluorescence intensity of α-SMA, vimentin, and N-cadherin and increased the fluorescence intensity of E-cadherin in primary rat lung (PRL) fibroblast cells and HFL-1 cells. WB results showed that SLJJ significantly down-regulated α-SMA, Vimentin, N-cadherin, TGF-β1, smad2, and p-smad2/3 proteins expression and up-regulated E-cadherin protein expression in vitro, whereas SRI-011381 (a TGF-β1 agonist) antagonized the effects of SLJJ. CONCLUSION SLJJ inhibits idiopathic pulmonary fibrosis. The TGF- β1/Smads signaling pathway can be the target of SLJJ, which inhibits fibroblast-to-myofibroblast transformation and is expected to be a new drug for the treatment of IPF.
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Affiliation(s)
- Jiaxiang Pan
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Shenyang, 110032, Liaoning, China.
| | - Yue Li
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Shenyang, 110032, Liaoning, China.
| | - Xize Wu
- Liaoning University of Traditional Chinese Medicine, 79 East of Chongshan Road, Shenyang, 110847, Liaoning, China; Nantong Hospital of Traditional Chinese Medicine, Nantong Hospital Affiliated to Nanjing University of Chinese Medicine, Nantong, 226000, Jiangsu, China.
| | - Xue Pan
- Liaoning University of Traditional Chinese Medicine, 79 East of Chongshan Road, Shenyang, 110847, Liaoning, China; Dazhou Vocational College of Chinese Medicine, Dazhou, 635000, Sichuan, China.
| | - Chuang Liu
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Shenyang, 110032, Liaoning, China.
| | - Haoyang Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Shenyang, 110032, Liaoning, China.
| | - Linlin Wang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Shenyang, 110032, Liaoning, China.
| | - Xin Jiang
- The Fourth Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 9, Xuesong Road, Jiefang Street, Sujiatun District, Shenyang, 110101, Liaoning, China.
| | - Jiaran Wang
- Liaoning University of Traditional Chinese Medicine, 79 East of Chongshan Road, Shenyang, 110847, Liaoning, China.
| | - Ningzi Zang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Shenyang, 110032, Liaoning, China.
| | - Lijian Pang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Shenyang, 110032, Liaoning, China.
| | - Xiaodong Lv
- Liaoning University of Traditional Chinese Medicine, 79 East of Chongshan Road, Shenyang, 110847, Liaoning, China.
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Zhou P, Wu X, Chen K, Du J, Wang F. Buyang Huanwu decoction ameliorates bleomycin-induced pulmonary fibrosis in rats by attenuating the apoptosis of alveolar type II epithelial cells mediated by endoplasmic reticulum stress. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117300. [PMID: 37813290 DOI: 10.1016/j.jep.2023.117300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE According to the theory of traditional Chinese medicine, the pathogenesis of idiopathic pulmonary fibrosis (IPF) can be attributed to qi deficiency and blood stasis. Buyang Huanwu decoction (BHD), a representative Chinese herbal prescription for qi deficiency and blood stasis syndrome, is widely used to treat IPF in clinical practice. However, its potential mechanisms against IPF remain unclear. AIMS OF THE STUDY This study was carried out to explore the therapeutic effects and underlying mechanisms of BHD on bleomycin (BLM)-induced pulmonary fibrosis in rats. MATERIALS AND METHODS UPLC-MS/MS method was performed to identify the quality of BHD used in this study. Concurrently, a IPF rat model was established by single intratracheal injection of BLM. Pulmonary function test, H&E staining, Masson staining, hydroxyproline assay were conducted to evaluate the therapeutic effects of BHD on BLM-induced pulmonary fibrosis in rats, and the regulatory effect of BHD on endoplasmic reticulum stress (ERS)-mediated alveolar type II epithelial cells (AEC2s) apoptosis in rats was further investigated by TUNEL staining, Western blot, real-time fluorescence quantitative PCR and immunofluorescence co-staining to reveal the potential mechanisms of BHD against IPF. RESULTS The UPLC-MS/MS analysis showed that the BHD we used complied with the relevant quality control standards. The data from animal experiments confirmed that BHD administration ameliorated BLM-induced pulmonary function decline, lung fibrotic pathological changes and collagen deposition in rats. Further mechanism study revealed that BHD increased the Bcl-2 protein expression, decreased the Bax protein expression and inhibited the cleavage of CASP3 via suppressing the activation of PERK-ATF4-CHOP pathway under continuous ERS, thereby alleviating BLM-induced AEC2s apoptosis of rats. CONCLUSION This study demonstrated that BHD ameliorated BLM-induced pulmonary fibrosis in rats by suppressing ERS-mediated AEC2s apoptosis. Our findings can provide some fundamental research basis for the clinical application of BHD in the treatment of IPF.
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Affiliation(s)
- Piao Zhou
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, China; Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinhui Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Keling Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Du
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fei Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Wang X, Chang L, Chen L, He Y, He T, Wang R, Wei S, Jing M, Zhou X, Li H, Zhao Y. Integrated network pharmacology and metabolomics to investigate the effects and possible mechanisms of Dehydroevodiamine against ethanol-induced gastric ulcers. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117340. [PMID: 37879508 DOI: 10.1016/j.jep.2023.117340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Tetradium ruticarpum (A.Juss.) T.G.Hartley, a traditional Chinese medicine with thousands of years of medicinal history, has been employed to address issues such as indigestion, abdominal pain, and vomiting. Dehydroevodiamine (DHE) is a quinazoline alkaloid extracted from traditional Chinese medicine Tetradium ruticarpum (A.Juss.) T.G.Hartley. Previous studies have shown that DHE has anti-inflammatory, analgesic, and antioxidant activities. However, it is still unclear whether DHE has an effect on ethanol-induced gastric ulcers. AIM OF THE STUDY The objective of this study is to investigate the therapeutic efficacy and underlying mechanisms of action of DHE on ethanol-induced gastric ulcers using network pharmacology and metabolomics strategies. METHODS In this study, we used ethanol-induced rats as a model to assess the efficacy of DHE by biochemical indicator assays and pathological tissue detection. The integration of network pharmacology and metabolomics was used to explore possible mechanisms and was validated by western blot experiments. Finally, molecular docking was used to analyze the binding energy between DHE and the targets of PIK3CG and PLA2G2A. RESULTS DHE was able to reverse ethanol-induced abnormalities in biochemical indicators and improve pathological tissue. Network pharmacology results indicated that DHE may be involved in the regulation of gastric ulcers by modulating 79 targets, and metabolomics results showed that a total of 13 metabolites were changed before and after DHE administration. Integrating network pharmacology and metabolomics, PIK3CG and PLA2G2A were identified as possible targets to exert therapeutic effects. In addition, the MAPKs pathway may also be involved in the regulation of ethanol-induced gastric ulcers. Finally, molecular docking results showed that DHE had low binding energies with both PIK3CG and PLA2G2A. CONCLUSIONS These findings suggest that DHE was able to exert a protective effect against ethanol-induced gastric ulcers by modulating multiple metabolites with multiple targets. This study provides a valuable reference for the development of antiulcer drugs.
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Affiliation(s)
- Xin Wang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lei Chang
- College of Pharmacy, Southern Medical University, Guangzhou, China
| | - Lisheng Chen
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yong He
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tingting He
- Department of Pharmacy Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Ruilin Wang
- Department of Pharmacy Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Shizhang Wei
- Department of Pharmacy Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Manyi Jing
- Department of Pharmacy Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Xuelin Zhou
- Department of Pharmacology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Haotian Li
- Department of Pharmacy Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
| | - Yanling Zhao
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China; Department of Pharmacy Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
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Li X, Bai Z, Li Z, Wang J, Yan X. Toosendanin Restrains Idiopathic Pulmonary Fibrosis by Inhibiting ZEB1/CTBP1 Interaction. Curr Mol Med 2024; 24:123-133. [PMID: 37138491 PMCID: PMC10804237 DOI: 10.2174/1566524023666230501205149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Extensive deposition of extracellular matrix (ECM) in idiopathic pulmonary fibrosis (IPF) is due to hyperactivation and proliferation of pulmonary fibroblasts. However, the exact mechanism is not clear. OBJECTIVE This study focused on the role of CTBP1 in lung fibroblast function, elaborated its regulation mechanism, and analyzed the relationship between CTBP1 and ZEB1. Meanwhile, the antipulmonary fibrosis effect and its molecular mechanism of Toosendanin were studied. METHODS Human IPF fibroblast cell lines (LL-97A and LL-29) and normal fibroblast cell lines (LL-24) were cultured in vitro. The cells were stimulated with FCS, PDGF-BB, IGF-1, and TGF-β1, respectively. BrdU detected cell proliferation. The mRNA expression of CTBP1 and ZEB1 was detected by QRT-PCR. Western blotting was used to detect the expression of COL1A1, COL3A1, LN, FN, and α-SMA proteins. An animal model of pulmonary fibrosis was established to analyze the effects of CTBP1 silencing on pulmonary fibrosis and lung function in mice. RESULTS CTBP1 was up-regulated in IPF lung fibroblasts. Silencing CTBP1 inhibits growth factor-driven proliferation and activation of lung fibroblasts. Overexpression of CTBP1 promotes growth factor-driven proliferation and activation of lung fibroblasts. Silencing CTBP1 reduced the degree of pulmonary fibrosis in mice with pulmonary fibrosis. Western blot, CO-IP, and BrdU assays confirmed that CTBP1 interacts with ZEB1 and promotes the activation of lung fibroblasts. Toosendanin can inhibit the ZEB1/CTBP1protein interaction and further inhibit the progression of pulmonary fibrosis. CONCLUSION CTBP1 can promote the activation and proliferation of lung fibroblasts through ZEB1. CTBP1 promotes lung fibroblast activation through ZEB1, thereby increasing excessive deposition of ECM and aggravating IPF. Toosendanin may be a potential treatment for pulmonary fibrosis. The results of this study provide a new basis for clarifying the molecular mechanism of pulmonary fibrosis and developing new therapeutic targets.
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Affiliation(s)
- Xingbin Li
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050005, China
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, Hebei, 050041,China
| | - Zina Bai
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, Hebei, 050041,China
| | - Zhensheng Li
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, Hebei, 050041,China
| | - Jun Wang
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, Hebei, 050041,China
| | - Xixin Yan
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050005, China
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Wang Y, Liu Y, Chen S, Li F, Wu Y, Xie X, Zhang N, Zeng C, Bai L, Dai M, Zhang L, Wang X. The protective mechanism of Dehydromiltirone in diabetic kidney disease is revealed through network pharmacology and experimental validation. Front Pharmacol 2023; 14:1201296. [PMID: 37680723 PMCID: PMC10482231 DOI: 10.3389/fphar.2023.1201296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
Background: Salvia miltiorrhiza (SM) is an effective traditional Chinese medicine for treating DKD, but the exact mechanism is elusive. In this study, we aimed to investigate and confirm the method underlying the action of the active components of SM in the treatment of DKD. Methods: Renal tissue transcriptomics and network pharmacology of DKD patients was performed to identify the active components of SM and the disease targets of DKD. Next, the point of convergence among these three groups was studied. Potential candidate genes were identified and analyzed using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG). The component-target networks were modelled and visualized with Cytoscape. In addition, docking studies were performed to validate our potential target predictions. Lastly, in vitro and in vivo experiments were performed to understand the role of Dehydromiltirone (DHT), the active component of SM, in the phenotypic switching of mesangial cells. Results: Transcriptomics of DKD patients' renal tissues screened 4,864 differentially expressed genes. Eighty-nine active components of SM and 161 common targets were found. Functional enrichment analysis indicated that 161 genes were enriched in apoptosis, the PI3K-AKT signaling pathway, and the AGE-RAGE signaling pathway in diabetes complications. Molecular docking and molecular dynamic simulations show that DHT can bind to functional PIK3CA pockets, thereby becoming a possible inhibitor of PIK3CA. In vitro study demonstrated that DHT reduced the expression of phenotypic switching markers α-SMA, Col-I, and FN in HMCs by downregulating the over-activation of the PI3K-AKT signaling pathway through the inhibition of PIK3CA. Furthermore, the DKD mouse model confirmed that DHT could reduce proteinuria and improve glomerular hypertrophy in vivo. Conclusion: DHT was identified as the key active component of SM, and its therapeutic effect on DKD was achieved by inhibiting the phenotypic switching of mesangial cells via the PIK3CA signaling pathway.
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Affiliation(s)
- Yanzhe Wang
- Department of Nephrology, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuyuan Liu
- Department of Nephrology, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Nephrology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Sijia Chen
- Department of Nephrology, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fengqin Li
- Department of Nephrology, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Wu
- Department of Nephrology, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinmiao Xie
- Department of Nephrology, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Zhang
- Department of Nephrology, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chuchu Zeng
- Department of Nephrology, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Linnan Bai
- Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengshi Dai
- Department of Geriatrics, Huashan Hospital, Fudan University, Shanghai, China
| | - Ling Zhang
- Department of Obstetrics and Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaoxia Wang
- Department of Nephrology, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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