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Li J, Wei JJ, Wu CH, Zou T, Zhao H, Huo TQ, Wei CJ, Yang T. Epimedin A inhibits the PI3K/AKT/NF-κB signalling axis and osteoclast differentiation by negatively regulating TRAF6 expression. Mol Med 2024; 30:125. [PMID: 39152382 PMCID: PMC11330075 DOI: 10.1186/s10020-024-00893-w] [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: 03/11/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Epimedin A (EA) has been shown to suppress extensive osteoclastogenesis and bone resorption, but the effects of EA remain incompletely understood. The aim of our study was to investigate the effects of EA on osteoclastogenesis and bone resorption to explore the corresponding signalling pathways. METHODS Rats were randomly assigned to the sham operation or ovariectomy group, and alendronate was used for the positive control group. The therapeutic effect of EA on osteoporosis was systematically analysed by measuring bone mineral density and bone biomechanical properties. In vitro, RAW264.7 cells were treated with receptor activator of nuclear factor kappa-B ligand (RANKL) and macrophage colony-stimulating factor (M-CSF) to induce osteoclast differentiation. Cell viability assays, tartrate-resistant acid phosphatase (TRAP) staining, and immunofluorescence were used to elucidate the effects of EA on osteoclastogenesis. In addition, the expression of bone differentiation-related proteins or genes was evaluated using Western blot analysis or quantitative polymerase chain reaction (PCR), respectively. RESULTS After 3 months of oral EA intervention, ovariectomized rats exhibited increased bone density, relative bone volume, trabecular thickness, and trabecular number, as well as reduced trabecular separation. EA dose-dependently normalized bone density and trabecular microarchitecture in the ovariectomized rats. Additionally, EA inhibited the expression of TRAP and NFATc1 in the ovariectomized rats. Moreover, the in vitro results indicated that EA inhibits osteoclast differentiation by suppressing the TRAF6/PI3K/AKT/NF-κB pathway. Further studies revealed that the effect on osteoclast differentiation, which was originally inhibited by EA, was reversed when the TRAF6 gene was overexpressed. CONCLUSIONS The findings indicated that EA can negatively regulate osteoclastogenesis by inhibiting the TRAF6/PI3K/AKT/NF-κB axis and that ameliorating ovariectomy-induced osteoporosis in rats with EA may be a promising potential therapeutic strategy for the treatment of osteoporosis.
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Affiliation(s)
- Jun Li
- Department of Spine Surgery, Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, 213000, People's Republic of China.
| | - Jia J Wei
- Department of Orthopedics, Yunnan Province Hospital of Traditional Chinese Medicine, Kunming, 650000, People's Republic of China
| | - Cen H Wu
- Department of Spine Surgery, Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, 213000, People's Republic of China
| | - Tao Zou
- Department of Spine Surgery, Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, 213000, People's Republic of China
| | - Hong Zhao
- Department of Spine Surgery, Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, 213000, People's Republic of China
| | - Tian Q Huo
- Department of Spine Surgery, Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, 213000, People's Republic of China
| | - Cheng J Wei
- Department of Orthopedics, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, 210000, People's Republic of China.
| | - Ting Yang
- Department of Rheumatology, Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, 213000, People's Republic of China
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Wen Z, Chen C, Shang Y, Fan K, Li P, Li C, Zheng J, Deng Q, Yu Z. Baohuoside I inhibits virulence of multidrug-resistant Staphylococcus aureus by targeting the transcription Staphylococcus accessory regulator factor SarZ. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 130:155590. [PMID: 38810547 DOI: 10.1016/j.phymed.2024.155590] [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: 11/07/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Staphylococcus aureus is a versatile pathogen that can cause a wide range of infections in humans. Biofilms play a crucial role in the pathogenicity of S. aureus and contribute to its ability to cause persistent and chronic infections. Baohuoside I has garnered increasing recognition as a natural flavonol glycoside with a wide spectrum of health-related activities. PURPOSE The antibacterial and anti-biofilm properties of Baohuoside I have not been extensively investigated. Our study aimed to assess its inhibitory effects and the underlying mechanisms on biofilm formation and hemolytic capacity in S. aureus. STUDY DESIGN/METHODS The impact of Baohuoside I on the biofilm and virulence of S. aureus was evaluated through in vitro experiments and Galleria mellonella as an in vivo infection model. The mechanisms were explored by Drug affinity responsive target stability (DARTS) and validated in genetic knockout strain and through molecular biological experiments using DARTS, molecular docking, electrophoretic mobility shift assay (EMSA), and bio-layer interferometry (BLI). RESULTS Baohuoside I significantly inhibits the formation of S. aureus biofilms and hemolytic activity at 6.25 µM. Proteomics analysis revealed that treatment with Baohuoside I led to a reduction in the expression of quorum-sensing system agr-regulated genes. DARTS analysis identified Staphylococcus accessory regulator factor (SarZ), a key regulator involved in the expression of virulence factors in S. aureus by acting as activator of the agr quorum-sensing system, was the direct target of Baohuoside I. Molecular docking, DARTS, BLI and EMSA assays collectively confirmed the direct binding of Baohuoside I to SarZ, inhibiting its binding to downstream promoters. Furthermore, it is found through site-directed protein mutagenesis that the Tyr27 and Phe117 residues are key for Baohuoside I binding to SarZ. Additionally, the knockout of SarZ significantly diminished the hemolytic ability of S. aureus, underscoring its crucial role as a pivotal regulator of virulence. Lastly, in vivo tests utilizing the G. mellonella infection model demonstrated the efficacy of Baohuoside I. CONCLUSION This study provides valuable insights into the mechanism by which Baohuoside I inhibits the virulence of S. aureus through its interaction with SarZ. These findings highlight the significance of SarZ as an effective target against the virulence of S. aureus.
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Affiliation(s)
- Zewen Wen
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Chengchun Chen
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Yongpeng Shang
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Kewei Fan
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Peiyu Li
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Congcong Li
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Jinxin Zheng
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Qiwen Deng
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China.
| | - Zhijian Yu
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China.
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Song L, Wang D, Zhai Y, Zhang X, Zhang Y, Yu Y, Sun L, Zhou K. Aqueous extract of Epimedium sagittatum (Sieb. et Zucc.) Maxim. induces liver injury in mice via pyroptosis. JOURNAL OF ETHNOPHARMACOLOGY 2024; 329:118164. [PMID: 38593963 DOI: 10.1016/j.jep.2024.118164] [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: 12/25/2023] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/11/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Epimedium sagittatum (Sieb. et Zucc.) Maxim. has been used traditionally in Asia. It can dispel wind and cold, tonify the kidney, and strengthen bones and tendons. However, adverse effects of E. sagittatum have been reported, and the underlying mechanisms remain unclear. AIM OF THE STUDY This study aimed to investigate liver injury caused by an aqueous extract of E. sagittatum in Institute of Cancer Research (ICR) mice and explore its potential mechanisms. MATERIALS AND METHODS Dried E. sagittatum leaves were decocted in water to prepare aqueous extracts for ultra-high performance liquid chromatography analysis. Mice were administered an aqueous extract of E. sagittatum equivalent to either 3 g raw E. sagittatum/kg or 10 g raw E. sagittatum/kg once daily via intragastric injection for three months. The liver weights and levels of the serum biochemical parameters including alanine transaminase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), total bilirubin (TBIL), and alkaline phosphatase were measured. Hematoxylin-eosin staining was performed for histopathology. Apoptosis was detected using the TUNEL apoptosis assay kit. IL-1β was detected using ELISA kits. Proteomics was used to identify the differentially expressed proteins. Western blot analysis was performed to determine the levels of proteins significantly affected by the aqueous extract of E. sagittatum. RESULTS E. sagittatum treatment increased the liver weights and liver coefficients, and ALT and AST levels significantly increased (p < 0.05). A high dose of E. sagittatum significantly increased LDH and TBIL levels (p < 0.05). Ruptured cell membranes and multiple sites of inflammatory cell infiltration were also observed. No evidence of apoptosis was observed. IL-1β levels were significantly increased (p < 0.05). The expressions of PIK3R1, p-MAP2K4, p-Jun N-terminal kinase (JNK)/JNK, p-c-Jun, VDAC2, Bax, and CYC were upregulated, whereas that of Bcl-2 was inhibited by E. sagittatum. The expression of cleaved caspase-1 was significantly increased; however, its effects on GSDMD and GSDMD-N were significantly decreased. The expression levels of cleaved caspase-3 and its effector proteins GSDME and GSDME-N significantly increased. CONCLUSIONS Our results suggest that the aqueous extract of E. sagittatum induces liver injury in ICR mice after three months of intragastric injection via inflammatory pyroptosis.
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Affiliation(s)
- Lei Song
- Center of Drug Safety Evaluation, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; State Key Laboratory of Component-based Chinese Medicine, Tianjin, 301617, China
| | - Dongyu Wang
- Center of Drug Safety Evaluation, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yuxia Zhai
- Center of Drug Safety Evaluation, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Xiaoying Zhang
- Center of Drug Safety Evaluation, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yue Zhang
- Center of Drug Safety Evaluation, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; State Key Laboratory of Component-based Chinese Medicine, Tianjin, 301617, China
| | - Yingli Yu
- Center of Drug Safety Evaluation, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; State Key Laboratory of Component-based Chinese Medicine, Tianjin, 301617, China
| | - Likang Sun
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Kun Zhou
- Center of Drug Safety Evaluation, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; State Key Laboratory of Component-based Chinese Medicine, Tianjin, 301617, China.
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Shi Y, Lu Z, Song W, Wang Y, Zhou Q, Geng P, Zhou Y, Wang S, Han A. The Impact of Baohuoside I on the Metabolism of Tofacitinib in Rats. Drug Des Devel Ther 2024; 18:931-939. [PMID: 38560524 PMCID: PMC10980839 DOI: 10.2147/dddt.s436549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To study the potential drug-drug interactions between tofacitinib and baohuoside I and to provide the scientific basis for rational use of them in clinical practice. Methods A total of eighteen Sprague-Dawley rats were randomly divided into three groups: control group, single-dose group (receiving a single dose of 20 mg/kg of baohuoside I), and multi-dose group (receiving multiple doses of baohuoside I for 7 days). On the seventh day, each rat was orally administered with 10 mg/kg of tofacitinib 30 minutes after giving baohuoside I or vehicle. Blood samples were collected and determined using UPLC-MS/MS. In vitro effects of baohuoside I on tofacitinib was investigated in rat liver microsomes (RLMs), as well as the underlying mechanism of inhibition. The semi-inhibitory concentration value (IC50) of baohuoside I was subsequently determined and its inhibitory mechanism against tofacitinib was analyzed. Furthermore, the interactions between baohuoside I, tofacitinib and CYP3A4 were explored using Pymol molecular docking simulation. Results The administration of baohuoside I orally has been observed to enhance the area under the concentration-time curve (AUC) of tofacitinib and decrease the clearance (CL). The observed disparity between the single-dose and multi-dose groups was statistically significant. Furthermore, our findings suggest that the impact of baohuoside I on tofacitinib metabolism may be a mixture of non-competitive and competitive inhibition. Baohuoside I exhibit an interaction with arginine (ARG) at position 106 of the CYP3A4 enzyme through hydrogen bonding, positioning itself closer to the site of action compared to tofacitinib. Conclusion Our study has demonstrated the presence of drug-drug interactions between baohuoside I and tofacitinib, which may arise upon pre-administration of tofacitinib. Altogether, our data indicated that an interaction existed between tofacitinib and baohuoside I and additional cares might be taken when they were co-administrated in clinic.
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Affiliation(s)
- Yaru Shi
- Key Laboratory of Joint Diagnosis and Treatment of Chronic Liver Disease and Liver Cancer of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Zebei Lu
- Key Laboratory of Joint Diagnosis and Treatment of Chronic Liver Disease and Liver Cancer of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Wei Song
- Key Laboratory of Joint Diagnosis and Treatment of Chronic Liver Disease and Liver Cancer of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Yu Wang
- Key Laboratory of Joint Diagnosis and Treatment of Chronic Liver Disease and Liver Cancer of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Quan Zhou
- Key Laboratory of Joint Diagnosis and Treatment of Chronic Liver Disease and Liver Cancer of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Peiwu Geng
- Key Laboratory of Joint Diagnosis and Treatment of Chronic Liver Disease and Liver Cancer of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Yunfang Zhou
- Key Laboratory of Joint Diagnosis and Treatment of Chronic Liver Disease and Liver Cancer of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Shuanghu Wang
- Key Laboratory of Joint Diagnosis and Treatment of Chronic Liver Disease and Liver Cancer of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Aixia Han
- Key Laboratory of Joint Diagnosis and Treatment of Chronic Liver Disease and Liver Cancer of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
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Liu Y, Yang Q, Guo Y, Jiang Y, Zhu H, Yang B. New insights of flavonoid glycosidases and their application in food industry. Crit Rev Food Sci Nutr 2023:1-13. [PMID: 38117083 DOI: 10.1080/10408398.2023.2294167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Flavonoids are significant natural nutraceuticals and a key component of dietary supplements. Given that flavonoid glycosides are more plentiful in nature and less beneficial to human health than their aglycone counterparts, they serve as potential precursors for flavonoid production. Glycosidases have shown substantial potential within the food industry, particularly in enhancing the organoleptic properties of juice, wine, and tea. When applied to food resources, glycosidases can amplify their biological activities, thereby improving the performance of functional foods. This review provides up-to-date information on flavonoid glycosidases, including their catalytic mechanisms, biochemical properties, and natural sources, as well as their applications within the food industry. The use of flavonoid glycosidases in improving food quality is also reviewed.
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Affiliation(s)
- Yingjun Liu
- State Key Laboratory of Plant Diversity and Specialty Crops, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- Functional Food Group, South China National Botanical Garden, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Qiuxia Yang
- State Key Laboratory of Plant Diversity and Specialty Crops, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- Functional Food Group, South China National Botanical Garden, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Yushan Guo
- State Key Laboratory of Plant Diversity and Specialty Crops, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- Functional Food Group, South China National Botanical Garden, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Yueming Jiang
- State Key Laboratory of Plant Diversity and Specialty Crops, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- Functional Food Group, South China National Botanical Garden, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Hong Zhu
- State Key Laboratory of Plant Diversity and Specialty Crops, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- Functional Food Group, South China National Botanical Garden, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Bao Yang
- State Key Laboratory of Plant Diversity and Specialty Crops, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- Functional Food Group, South China National Botanical Garden, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
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Zhang X, Tang B, Wen S, Wang Y, Pan C, Qu L, Yin Y, Wei Y. Advancements in the Biotransformation and Biosynthesis of the Primary Active Flavonoids Derived from Epimedium. Molecules 2023; 28:7173. [PMID: 37894651 PMCID: PMC10609448 DOI: 10.3390/molecules28207173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Epimedium is a classical Chinese herbal medicine, which has been used extensively to treat various diseases, such as sexual dysfunction, osteoporosis, cancer, rheumatoid arthritis, and brain diseases. Flavonoids, such as icariin, baohuoside I, icaritin, and epimedin C, are the main active ingredients with diverse pharmacological activities. Currently, most Epimedium flavonoids are extracted from Epimedium plants, but this method cannot meet the increasing market demand. Biotransformation strategies promised huge potential for increasing the contents of high-value Epimedium flavonoids, which would promote the full use of the Epimedium herb. Complete biosynthesis of major Epimedium flavonoids by microbial cell factories would enable industrial-scale production of Epimedium flavonoids. This review summarizes the structures, pharmacological activities, and biosynthesis pathways in the Epimedium plant, as well as the extraction methods of major Epimedium flavonoids, and advancements in the biotransformation and complete microbial synthesis of Epimedium flavonoids, which would provide valuable insights for future studies on Epimedium herb usage and the production of Epimedium flavonoids.
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Affiliation(s)
- Xiaoling Zhang
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
- Laboratory of Synthetic Biology, School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
- Key Laboratory of Food Safety Quick Testing and Smart Supervision Technology for State Market Regulation, Zhengzhou 450003, China
| | - Bingling Tang
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
- Laboratory of Synthetic Biology, School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Sijie Wen
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
- Laboratory of Synthetic Biology, School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Yitong Wang
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
- Laboratory of Synthetic Biology, School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Chengxue Pan
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Lingbo Qu
- College of Chemistry, Zhengzhou University, Zhengzhou 450001, China
| | - Yulong Yin
- Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410081, China
| | - Yongjun Wei
- Laboratory of Synthetic Biology, School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
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Kwon DY, Gu JH, Oh M, Lee EJ. Combination effects of herbal and western medicines on osteoporosis in rheumatoid arthritis: systematic review and meta-analysis. Front Pharmacol 2023; 14:1164898. [PMID: 37637429 PMCID: PMC10448903 DOI: 10.3389/fphar.2023.1164898] [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: 02/13/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose: This study aimed to comprehensively review the effect of combining herbal medicine (HM) with Western Medicine (WM) compared to WM alone on bone mineral density (BMD) improvement for osteoporosis in patients with rheumatoid arthritis (RA). Methods: Randomized controlled trials (RCTs) were searched using 10 databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Nation Information by NII. We selected studies that used BMD as an evaluation index and administered HM treatment for osteoporosis in patients with RA. Subsequently, a meta-analysis was conducted using BMD as a continuous variable using RevMan version 5.4. Results: Eighteen RCTs that met the eligibility criteria of this study were selected. The total number of study participants was 1,491 (481 men and 1,010 women). The mean age of participants was 52.4 ± 7.4 years, and the mean morbidity period of RA was 6.8 ± 1.3 years. In all studies, disease-modifying anti-rheumatic drugs (DMARDs; 16 RCTs) or bisphosphonates (two RCTs) were used as WM co-intervention with HMs (17 types of HM, 18 RCTs). Overall, the combination of HM and WM improved the BMD score, producing better results than WM alone. In particular, when HM was used in combination with DMARDs, which were used in most studies, BMD improved by 0.04 g/cm2 (95% confidence interval [CI]: 0.03-0.05, p < 0.001, I2 = 19%) in the lumbar spine and 0.03 g/cm2 (95% CI: 0.02-0.03, p < 0.001, I2 = 0%) in the femoral neck compared to the DMARDs alone group after treatment. In addition to BMD, bone markers and inflammatory indicators evaluated by each RCT showed significant improvement after HM plus WM treatment. In the analysis of frequently prescribed HMs, the BMD after treatment was higher by 0.04 g/cm2 (95% CI: 0.03-0.04, p < 0.001, I2 = 45%) in the Xianlinggubao-capsule plus methotrexate (MTX) group and by 0.02 g/cm2 (95% CI: 0.00-0.03, p = 0.04, I2 = 0) in the Hanbikang-tang plus MTX group compared to the MTX alone group. Conclusion: This systematic review cautiously provides evidence for the combined therapeutic effect of HM and WM for osteoporosis in patients with RA. However, well-designed, large-scale clinical trials are necessary before recommending this combination therapy for osteoporosis in patients with RA. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331854], identifier [CRD42022331854].
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Affiliation(s)
| | | | | | - Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
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