Chemical composition and absorption characteristics of Angong Niuhuang Pill based on two-dimensional ultra-high-performance liquid chromatography-quadrupole Orbitrap high-resolution mass spectrometry

Angong Niuhuang Pill (ANP) is a traditional Chinese medicine (TCM) formula with significant clinical efficacy in the treatment of stroke. Due to its complex composition, little attention has been directed toward the analysis of chemical composition and absorption characteristics of ANP. In this study, a reliable two-dimensional ultra-high-performance liquid chromatography (2D-UHPLC) coupled with quadrupole-Orbitrap high-resolution mass spectrometry (Q-Orbitrap HRMS) method was established to characterize the chemical constituents in ANP as well as the prototype components and metabolites absorbed in plasma, urine, feces, and brain tissues after oral administration. The prototype components were identified by a high mass accuracy (within 5 ppm) and MS/MS data based on online, local, and ANP self-built databases. The metabolites were predicted and identified using Compound Discoverer metabolic platform. A total of 154 compounds mainly including 37 flavonoids, 35 alkaioids, 19 organic acid, 19 bile acid, 32 terpenoids and 12 others were identified in this way. In addition, 60 prototype components mainly including flavonoids, alkaioids, organic acid, terpenoids and 164 metabolites were confirmed or preliminarily identified in rats. The metabolic pathways phase I reaction (hydration, reduction, oxidation, demethylation, and hydroxylation) and phase II reaction (acetylation, stearyl conjugation, and methylation) for the absorbed constituents were explored and summarized. This is the first systematic and comprehensive chemical characterization in ANP and its metabolism in vivo by 2D-UHPLC-Q-Orbitrap HRMS. This approach provides an effective strategy for the characterization of compounds and metabolites in traditional Chinese medicine formulas.

Characterization and quantification of chemical constituents in Angong Niuhuang Pill using ultra-high performance liquid chromatography tandem mass spectrometry

Material basis researches and quality evaluation of traditional Chinese medicine preparations (TCMPs) face great challenges due to the complex composition and abundant unexpected interference. Angong Niuhuang Pill (ANP), one of the most famous TCMPs in China, containing 11 crude drugs has been commonly used for the treatment of febrile diseases. However, previous literatures of comprehensive chemical constituents in ANP were still limited. Herein, Ultra-high performance liquid chromatography-ion mobility-quadrupole time-of-flight mass spectrometry (UHPLC-IM-QTOF MS) method was established to effectively recognize the chemicals in Angong Niuhuang Pill (ANP). A total of 205 compounds, containing 72 confirmed with reference standards, were characterized from ANP with the application of a systematic strategy integrated polygonal mass defect filtering (MDF) and diagnostic fragment ion filtering (DFIF)/neutral loss filtering (NLF). Additionally, 68 major constituents in 8 batches of ANP samples were simultaneously determined by ultra-performance liquid chromatography-triple quadrupole tandem mass spectrometry (UPLC-QQQ MS/MS) within 40 min. The quantitative method was validated regarding linearity, precision, repeatability, stability, and accuracy. These findings proved the established liquid chromatography-mass spectrometry (LC-MS) method was efficient and dependable for qualitative and quantitative chemical profiling of ANP. Besides, this research could provide the material basis for further pharmacological researches and quality control of ANP.

Anti-Atherosclerosis Effect of Angong Niuhuang Pill via Regulating Th17/Treg Immune Balance and Inhibiting Chronic Inflammatory on ApoE-/- Mice Model of Early and Mid-Term Atherosclerosis

Angong Niuhuang Pill (ANP) is a well-known patented Chinese medicine which is used for hundreds of years for treating the central nervous system diseases. Atherosclerosis is a poly-aetiological chronic inflammatory vascular disease. Preventing inflammation is fundamental for treating atherosclerosis in early stages. In this study, we investigated the protective effects and possible mechanisms of ANP action on a high-fat diet induced early and mid-term atherosclerosis ApoE^-/- mice. The effects of ANP were compared with accepted drug simvastatin. Twelve male C57BL/6J mice were used as the control group, and 60 male ApoE^-/- mice were randomly divided into five groups: Model group, Simvastatin group, Low-, Medium-, and High-dose ANP group these groups received, respectively, saline, simvastatin (3.0mg/kg), low-dose ANP (0.25 g/kg), medium-dose ANP (0.50 g/kg), and high-dose ANP (1.0 g/kg), once every other day for 10 weeks. After administration, serum biochemical indices were detected by the automatic biochemical analyzer, the concentrations of IL-6 and IL-10 in the serum were assayed by ELISA, expression levels of IL-1β, TNF-α, MMP-2, MMP-9, CCL2, and its receptor CCR2 in the full-length aorta, and expression levels of transcription factors Foxp3, RORγt in the spleen were assayed via western blotting and RT-qPCR. Flow cytometry was used to analyze Th17 cells and Treg cells. Pathological and histological analysis was completed on aortic root. ANP decreased LDL/HDL ratio, concentrations of IL-6 while increased IL-10 in serum. Moreover, ANP down-regulated the expression levels of IL-1β, TNF-α, MMP-2, MMP-9, CCL2, and CCR2 receptor in the full-length aorta. In addition, ANP decreased Th17 cells and expression levels of transcription factor RORγt, increased Treg cells and expression levels of transcription factor Foxp3. ANP decreased content of collagen fibers and infiltration of inflammatory cells in the aortic root. In conclusion, we demonstrated that ANP has anti-atherosclerosis effects on a high-fat diet induced ApoE^-/- mice early and mid-term AS model via regulating Th17/Treg balance, inhibiting chronic inflammation, reducing plaque collagen fibers, and reducing inflammatory cells infiltration, to exert its multi-channel multi-target anti-early and mid-term AS effects.

Angong Niuhuang Pill as adjuvant therapy for treating acute cerebral infarction and intracerebral hemorrhage: A meta-analysis of randomized controlled trials

ETHNOPHARMACOLOGICAL RELEVANCE

Angong Niuhuang Pill (ANP) is a well-known traditional Chinese patent medicine. This meta-analysis aimed to evaluate the efficacy and safety of ANP as an adjuvant therapy in patients with acute cerebral infarction (ACI) and acute intracerebral hemorrhage (AIH).

MATERIALS AND METHODS

We performed a literature search in Embase, Pubmed, Cochrane Library, CNKI, Wanfang, and VIP database from their inceptions to April 2018. Randomized controlled trials evaluating ANP as an adjuvant therapy for acute stroke were selected. Risk ratio (RR) or weighted mean difference (WMD) with their 95% confidence interval (CI) was calculated between with and without ANP therapy.

RESULTS

Eighteen trials involving 1,601 patients were identified and analyzed. Meta-analysis showed that ANP plus usual treatment significantly improved the total response rate in patients with ACI (RR 1.27; 95% CI 1.14-1.41) and AIH (RR 1.26; 95% CI 1.14-1.38) compared with the usual treatment alone. Adjuvant treatment with ANP also significantly reduced the neurologic deficit score in patients with ACI (WMD -3.64; 95% CI -4.97 to - 2.31) and AIH (WMD -3.52; 95% CI -5.51 to -1.54). Moreover, ANP significantly improved the Glasgow Coma Scale in patients with ACI (WMD 1.18; 95% CI 0.79-1.56) and AIH (WMD 2.28; 95% CI 1.37-3.19).

CONCLUSIONS

Adjuvant treatment with ANP appears to improve the total response rate and neurologic deficit score in patients with ACI and AIH. More well-designed trials are required due to the suboptimal methodological quality of the included trials.