Metabolomics combined with serum pharmacochemistry discovering the potential effective compounds of Fangji Huangqi Tang against nephrotic syndrome

Fangji Huangqi Tang (FHT) was first recorded in "Jin Gui Yao Lue," invented by the archaic Chinese medical doctor Zhongjing Zhang, and is a classic medicine that tonifies qi and expels wind, invigorates spleen for diuresis. A large number of literatures indicated that FHT showed a significant effect on Nephrotic Syndrome (NS). A comprehensive strategy was proposed to discover the potential effective compounds and therapeutic targets of FHT against NS as a case study. Serum metabolomics combined with multivariate statistical analysis was employed to analysis and screen the differential endogenous metabolites in serum samples of the control and model rats induced by Adriamycin. The correlation analysis between the efficacy biomarkers and different compounds absorbed in serum of FHT was conducted to explore the potential effective compounds of FHT against NS. With the help of network pharmacology, the therapeutic targets and the possible molecular mechanisms of FHT against NS were further investigated. Fifteen metabolites, including l-phenylalanine, 3-Hydroxybutyric acid and linolenic acid, were associated with renal damage based on the serum metabolomic results. Metabolic pathway analysis indicated that phenylalanine, tyrosine and tryptophan biosynthesis and linoleic acid metabolism were the key pathways associated with NS. Among them, 6 metabolites were defined as efficacy biomarkers such as uric acid, 2-methylbutyrylcarnitine and 10-HDA. The results of correlation analysis suggested that 14 constituents such as fanGhinoline, cycloastragenol, atractylenolide III, and glycyrrhetinic acid were recognized as potential effective compounds, whose potential protein targets participated in the MAPK signaling pathway, GnRH signaling pathway and aldoaterone-regulated sodium reabsorption. This study has clarified the potential effective compounds and therapeutic targets of FHT against NS. The results provided new evidence for the pharmacological mechanism of FHT on NS.

Effect of Chinese medicine prescription on nephrotic syndrome: A protocol for systematic review and meta-analysis

BACKGROUND

Nephrotic syndrome (NS) is a common chronic recurrent kidney disease. Many trials have shown that Chinese medicine prescription (CMP) can effectively treat NS. The program aims to evaluate the efficacy and safety of CMP for NS.

METHODS

This systematic evaluation will entail an electronic and manual search of all CMP for NS from inception to February, 2020, regardless of the publication status or language. Databases include PubMed, Embase, Springer, Web of Science, the Cochrane Library, the World Health Organization International Clinical Trial Registration Platform, the Chinese Medicine Database, the China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the China Science Journal Database, and the Wanfang Database. Other sources of information, including bibliographies and meeting minutes for identified publications, will also be searched. A manual search for grey literature, including unpublished conference articles will be performed. Additionally, any clinical randomized controlled trials related to CMP for NS, regardless of the publication status and language limitations, will be included in the study. Study selection, data extraction, and research quality assessments will be conducted independently by 2 researchers. The main result was the total clinical efficacy rate or other validated scales after at least 2 weeks of treatment. Secondary outcomes included 24-hour urine protein quantification, blood urea nitrogen, serum creatinine, C-reactive protein, tumor necrosis factor-α, and interleukin 6, recurrence rates and adverse events during follow-up. Implement the Cochrane RevMan V5.3 bias assessment tool to assess bias risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). Mean difference, standard mean deviation and binary data will be used to represent continuous results.

RESULTS

This study will provide a comprehensive review and evaluation of CMP for the treatment of NS.

CONCLUSION

This study will provide new evidence for evaluating the effectiveness and side effects of CMP on NS. Since the data is not personalized, formal ethical approval is not required.

INPLASY REGISTRATION NUMBER

INPLASY202040181.

Screening for Potential Active Components of Fangji Huangqi Tang on the Treatment of Nephrotic Syndrome by Using Integrated Metabolomics Based on "Correlations Between Chemical and Metabolic Profiles"

As for traditional Chinese medicine (TCM) prescription, what puzzled researchers most was how to select proper chemical markers to represent the whole pharmacological action system. In this paper, an integrated metabolomic method was presented for a systematic discovery of potential active components in Fangji Huangqi Tang (FHT), a well-known TCM prescription for nephrotic syndrome treatment, based on “correlations between chemical and metabolic profiles.” Firstly, a metabolomics study was carried out to select representative biomarkers of nephrotic syndrome. Then, after drug administration, the dynamic process of serum composition was investigated by the ultra-high performance liquid chromatography coupled with electrospray ionization–quadrupole–time of flight–mass spectrometry (UHPLC-ESI-Q-TOF-MS) technique to detect the prototypes and related metabolites of relative components from FHT. Pearson correlation analysis was finally used to find out the correlations between the endogenous metabolic spectrums and the chemical serum spectrums. As a result, 17 biomarkers for nephrotic syndrome indication were identified, and the main metabolic pathways of their concern included linoleic acid metabolism; cyanoamino acid metabolism; alpha-linolenic acid metabolism; glycine, serine, and threonine metabolism; arachidonic acid metabolism; and glycerophospholipid metabolism. Meanwhile, active components in FHT for nephrotic syndrome treatment were screened out, including (+)-tetrandrine demethylation, fenfangjine G hydrogenation, tetrandrine, N-methylfangchinoline, tetrandrine demethylation, fangchinoline, glycyrrhetic acid, astragaloside II alcohol dehydration, atractylenolide III demethylation + hydrogenation, atractylenolide III demethylation + hydrogenation, and licoricone-N-acetylcysteine conjugation. This study demonstrated a promising way to elucidate the active chemical material basis of TCM prescription.