Therapeutic effects of Qishen Yiqi Dropping Pill on myocardial injury induced by chronic hypoxia in rats

Integrated network pharmacology and metabolomics to reveal the mechanism of QiShenYiQi Dripping Pills (T101) against cardiac structural and functional abnormalities

Background: Heart failure (HF), the final stage of cardiovascular diseases, is a clinical syndrome of cardiac structural or functional abnormalities. QiShenYiQi Dripping Pills (T101), short for QSYQ (T101), showed effectiveness and safety in the treatment of HF according to modern pharmacological research and clinical studies, but the mechanism remains unclear. This study aims to clarify the mechanism of QSYQ (T101) in treating heart failure through the analysis to critical biomarkers, targets and pathways.

Materials and Methods: In this study, the efficacies of QSYQ (T101) in non-human primates and rodents were evaluated, and the mechanism was demonstrated by integrating network pharmacology and metabolomics analysis. Furthermore, the targets from network pharmacology and the metabolites from targeted metabolomics were jointly analyzed to screen the critical pathways.

Results: In rhesus monkeys with spontaneous chronic heart failure, nasogastric administration of QSYQ (T101) for 12 weeks caused profound improvement of systolic and diastolic function as evidenced by echocardiography detection. Consistently, QSYQ (T101) administration especially with higher dose lowered the blood pressure and improved the ventricular remodeling, collagen deposition and fibrosis markedly in Spontaneous Hypertension Rats (SHR) model. Computational prediction showed that QSYQ (T101) exhibited anti-HF effects possibly through HIF-1 signaling pathway, FoxO signaling pathway, TNF signaling pathway, PI3K-Akt signaling pathway and other enriched paths. Metabolomics analysis obtained 23 significantly altered metabolites, revealing that QSYQ (T101) significantly regulated the abnormal levels of fatty acids, carnitines, organic acids pyridines, nucleosides, which were mostly involved in myocardial energy metabolism related pathways.

Conclusion: Based on serum and myocardium metabolomics and network pharmacology, the present study revealed that the actions of QSYQ (T101) in treating HF depend on multi-components, multi-targets and multi-pathways.

Efficacy of Qishen Yiqi Drop Pill for Chronic Heart Failure: An Updated Meta-Analysis of 85 Studies

Background

Despite evidence for beneficial effects of Qishen Yiqi Drop Pill (QSYQ) on congestive heart failure, the majority of studies are based on insufficient sample sizes. The aim of this study was to evaluate the therapeutic effects of QSYQ using a meta-analysis approach. Methodology/Principal Findings. All relevant studies published before December 31, 2019, were identified by searches of various databases with key search terms. In total, 85 studies involving 8,579 participants were included. The addition of QSYQ to routine Western medicine increased 6-minute walking distance (SMD = 2.08, 95% CI: 1.72–2.44, p < 0.001), left ventricular ejection fraction (SMD = 1.05, 95% CI: 0.87–1.23, p < 0.001), and cardiac index (SMD = 1.44, 95% CI: 0.92–1.95, p < 0.001) and reduced brain natriuretic peptide (SMD = −2.28, 95% CI: -2.81 to -1.76, p < 0.001), N-terminal prohormone of brain natriuretic peptide (SMD = −2.49, 95% CI: -3.24 to -1.73, p < 0.001), left ventricular end-diastolic dimensions (SMD = −0.92, 95% CI: -1.25 to -0.59, p < 0.001), and left ventricular end-systolic dimensions (SMD = −0.55, 95% CI: -0.89 to -0.21, p < 0.001). The results were stable in subgroup analyses and sensitivity analyses.

Conclusions

Our current meta-analysis indicated that QSYQ combined with Western therapy might be effective in CHF patients. Further researches are needed to identify which subgroups of CHF patients will benefit most and what kind of combination medicines work best.

Protective effect of Qishen Yiqi dropping pills on the myocardium of rats with chronic heart failure

Protective effect of Qishen Yiqi dropping pills on the myocardium of rats with chronic heart failure (CHF) was investigated. Sixty rats were divided into the sham operation (n=20), the model (n=20) and the Qishen Yiqi dropping pill treatment group (n=20) using the random table method. The treatment group received administration of Qishen Yiqi dropping pills. The model and the sham operation group were given the same amount of normal saline. Within 24 h after the last administration, the rats were sacrificed. The myocardia were used for reverse transcription-polymerase chain reaction, western blot analysis and histological examination. In the sham operation group, cardiomyocytes were stained evenly and arranged neatly and densely with clear structures. In the model group, the cell morphology was fuzzy, the myocytes were hypertrophied, the nuclear pyknosis was fragmented, the arrangement was disordered, the intercellular space was narrowed, and the cytoplasm was missing. The apoptosis rates of cardiomyocytes in the model and Qishen Yiqi dropping pill treatment group were significantly higher than that in the sham operation group (P<0.05). The myocardial infarction areas in the model group and the Qishen Yiqi dropping pill treatment group were larger than that in the sham operation group (P<0.05). The expression levels of transforming growth factor-β1, mothers against decapentaplegic homolog 2 (Smad2), Smad3, and caspase-3 messenger ribonucleic acids and proteins in the model group and the Qishen Yiqi dropping pill treatment group were higher than those in the sham operation group (P<0.05). Qishen Yiqi dropping pills have an obvious myocardial protective effect on CHF rats, which may enhance the degree of myocardial fibrosis by inhibiting the TGF-β1/Smads pathway and improve cardiomyocyte apoptosis by suppressing the caspase-3 signaling pathway, thus protecting the myocardium.