Possible protective effect of TNF-α inhibition and triad NO/cGMP/VEGF activation on gastric ulcer in rats

Duloxetine protected indomethacin-induced gastric mucosal injury by increasing serotonin-dependent RANTES expression and activating PI3K-AKT-VEGF pathway

Antidepressant duloxetine has been shown protective effect on indomethacin-induced gastric ulcer, which was escorted by inflammation in the gastric mucosa. Cytokines are the principal mediators of inflammation. Thus, by screening the differential expression of cytokines in the gastric mucosa using cytokine array at 3 h after indomethacin exposure, when the gastric ulcer began to format, we found that indomethacin increased cytokines which promoted inflammation responses, whereas duloxetine decreased pro-inflammatory cytokines increased by indomethacin and increased RANTES expression. RANTES was consistently increased by pretreated with both 5 mg/kg and 20 mg/kg duloxetine at 3 h and 6 h after indomethacin exposure in male rats. Selective blockade of RANTES-CCR5 axis by a functional antagonist Met-RANTES or a CCR5 antagonist maraviroc suppressed the protection of duloxetine. Considering the pharmacologic action of duloxetine on reuptake of monoamine neurotransmitters, we examined the serotonin (5-HT), norepinephrine and dopamine contents in the blood and discovered 20 mg/kg duloxetine increased 5-HT levels in platelet-poor plasma, while treatment with 5-HT promoted expression of RANTES in the gastric mucosa and alleviated the indomethacin-induced gastric injury. Furthermore, duloxetine activated PI3K-AKT-VEGF signaling pathway, which was regulated by RANTES-CCR5, and selective inhibitor of VEGF receptor axitinib blocked the prophylactic effect of duloxetine. Furthermore, duloxetine also protected gastric mucosa from indomethacin in female rats, and RANTES was increased by duloxetine after 6 h after indomethacin exposure too. Together, our results identified the role of cytokines, particularly RANTES, and the underlying mechanisms in gastroprotective effect of duloxetine against indomethacin, which advanced our understanding in inflammatory modulation by monoamine-based antidepressants.

In vivo and In silico evidence of the protective properties of carvacrol against experimentally-induced gastric ulcer: Implication of antioxidant, anti-inflammatory, and antiapoptotic mechanisms

Gastric ulcer is a serious disease that affects millions of individuals worldwide. Alcohol consumption is a major contributor to the disease pathogenesis and ethanol-induced ulcer in rats closely recapitulates the clinical pathology of ulcer. In this study, rats were pretreated with carvacrol (CAR,50 and 100 mg/kg, orally) 1 h before absolute ethanol administration to induce gastric ulcer. CAR prevented ethanol-induced increases in gastric volume and acidity while restored mucin content. The gastro-protective activity of CAR, particularly the higher dose (100 mg/kg), was further supported by histopathological examination, as manifested by reduced gastric lesions. Interestingly, oxidative stress is linked to early stages of ulcer development and progression. In this study, ethanol administration upregulated the levels of ROS-producing enzymes, NADPH oxidase homologs 1 and 4 (Nox1 and Nox4) and lipid peroxides while depleting the antioxidant defense mechanisms, including GSH, Glutathione Peroxidase (GPX) and catalase. Interestingly, these alterations were significantly ameliorated by CAR pretreatment. Additionally, CAR possesses anti-inflammatory and anti-apoptotic activities. Pretreatment with CAR blunted ethanol-induced increases in inflammatory cytokines (NF-κB and TNF-α) and rectified the apoptosis regulator (Bax/Bcl2 ratio) in gastric tissue. Moreover, the docking simulation of CAR illustrated good fitting and interactions with GPX, Nox1 and TNF-α through the formation of hydrogen and hydrophobic (pi-H) bonds with conservative amino acids, thus, further supporting the anti-inflammatory and antioxidant effects underlying the gastroprotective effects of CAR. In conclusion, this study elucidates, using in silico and in vivo models, that the gastroprotective activity of CAR is attributed, at least in part, to its mucin-secretagogue, antioxidative, anti-inflammatory, and anti-apoptotic mechanisms.

Kangfuxin solution for treatment of gastric ulcer: Efficacy and impact on serum VEGF and ERK12 levels

BACKGROUND

Kangfuxin solution can improve microcirculation and promote mucous membrane repair, and has a significant effect in ulcer disease. This study applied Kangfuxin solution to the treatment of gastric ulcer and analyzed its effect on the repair of gastric ulcer.

AIM

To investigate the efficacy of Kangfuxin solution combined with conventional Western medicine in the treatment of gastric ulcer complicated by chronic obstructive pulmonary disease and its effect on serum levels of vascular endothelial growth factor (VEGF) and extracellular regulated protein kinases 1/2 (ERK1/2).

METHODS

Prospectively, 48 patients with gastric ulcer treated at our hospital from January 2021 to August 2021 were selected as study subjects and randomly divided into either a control group or an observation group, with 24 cases in each group. Both groups received conventional treatments for gastric ulcer such as acid suppression, gastric mucosa protection, and antibiotics, and the observation group was additionally treated with Kangfuxin solution for 8 wk. The clinical effects, mucosal microvascular morphology, serum levels of ERK1/2 and VEGF, immune-responsive T lymphocyte subsets (CD3+, CD4+, CD4+/CD8+), histological maturation of the regenerated mucosa, gastric fluid pH, and the incidence of adverse effects and recurrence rate were recorded.

RESULTS

The overall clinical efficiency of the observation group was 95.83%, which was higher than that of the control group (66.67%; P < 0.05). The proportion of regular microvascular network was higher in the observation group than in the control group (P < 0.05). Serum levels of VEGF and ERK1/2 were higher in the observation group than in the control group after treatment (P < 0.05). The percentages of CD3⁺ T lymphocyte and CD4⁺ T lymphocyte, and CD4⁺/CD8⁺ ratio were higher in the observation group than in the control group (P < 0.05). The area of collagen fiber deposition, types Ⅰ/Ⅱ collagen ratio, hydroxyproline content, and gastric fluid pH were higher in the observation group than in the control group (P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P > 0.05), and the 3-mo recurrence rate in the observation group was lower than that of the control group (4.17% vs 33.33%, P < 0.05).

CONCLUSION

Kangfuxin solution combined with conventional drugs for the treatment of gastric ulcer complicated by chronic obstructive pulmonary disease can significantly improve clinical efficacy, promote ulcer healing, and reduce the risk of recurrence, without significantly increasing adverse drug reactions.

Revealing the Active Compounds and Mechanism of Banxia Xiexin Decoction Against Gastric Ulcer by Network Pharmacology and Molecular Docking

Gastric ulcer (GU) is a clinically common gastrointestinal disease with a long disease course that frequently reoccurs. Banxia Xiexin decoction (BXD), a traditional Chinese medicine prescription, has a prominent protective effect against GU. Nonetheless, the therapeutic mechanisms of BXD against GU remain elusive. In this study, a rat model of GU was established by gavage with 95% ethanol, and BXD significantly attenuated the inflammatory effect of GU in rats. An “active ingredient–target” interaction and GU protein–protein interaction networks were constructed based on system biology, which could screen out the crucial active ingredients. The target protein–protein interaction network for the BXD treatment of GU was constructed to identify the key target proteins with network topology parameters. The DAVID database was then used to perform Gene Ontology and Kyoto encyclopedia of genes and genomes enrichment analysis on the proteins targeted by BXD in the treatment of GU. Finally, molecular docking technology was used to study the interactions between key active ingredients and core target proteins. A total of 89 active ingredients of BXD were screened and 63 target proteins of BXD in the treatment of GU were identified. Through the analysis of protein–protein interaction and the active ingredient–target protein network diagram, it was found that tumor necrosis factor-α(TNF-α), AKT1, and PTGS2 may play a key role in the treatment of GU by BXD. Molecular docking showed that these 3 core target proteins had a good affinity with the main components of BXD, including baicalein, norwogonin, and skullcapflavone II. The mechanism of BXD against GU may involve the inhibition of inflammatory response and oxidative stress, involving signaling pathways such as TNF, hypoxia-inducible factor-1, and mitogen-activated protein kinase. Network pharmacology and molecular docking technology indicated the key active ingredients, target proteins, and signal pathways that may be the biological basis of BXD in the treatment of GU.

A Retrospective Trial Exploring Erzhu Yiren Decoction in Gastric Ulcer with Spleen Deficiency and Dampness-Heat

Objective

To assess the efficacy of Erzhu Yiren Decoction in treating gastric ulcer of spleen deficiency and dampness-heat and its effect on serum NO, EGF, and PGE2 levels.

Methods

A retrospective study was conducted among 64 patients with gastric ulcers of spleen deficiency and dampness heat admitted to our hospital from September 2019 to May 2020, and they were divided at a ratio of 1 : 1 into an observation group (rabeprazole sodium enteric-coated capsules plus Erzhu Yiren Decoction) and a control group (rabeprazole sodium enteric-coated capsules) based on different treatment methods. The clinical symptom scores, the effective rate of ulcer healing under gastroscopy, the quality of ulcer healing (QOUH), serum nitric oxide (NO), endothelial growth factor (EGF), and prostaglandin E2 (PGE2) levels were compared between the two groups.

Results

The clinical symptom scores of the observation group after treatment were significantly lower than those of the control group (P < 0.001). The observation group obtained a remarkably higher efficacy of ulcer healing under gastroscopy than the control group (P = 0.039). The observation group outperformed the control group in terms of the number of patients with excellent and good QOUH (P = 0.003, 0.014), but no statistical difference in the number of patients with poor QOUH between the two groups was found (P > 0.05). Serum NO, EGF, and PGE2 levels of the observation group after treatment were significantly better than those of the control group (P < 0.001).

Conclusion

Erzhu Yiren Decoction can relieve the clinical symptoms of patients with gastric ulcers of spleen deficiency and dampness heat; improve the serum NO, EGF, and PGE2 levels; optimize the mucosal maturity; and enhance the overall efficacy, which merits clinical promotion.