Analysis of the Molecular Mechanism of Xueshuantong in the Treatment of Wet Age-Related Macular Degeneration (AMD) Using GEO Datasets, Network Pharmacology, and Molecular Docking

At present, the main treatment method for wet AMD is single anti-VEGF therapy, which can require multiple injections, is costly and may have poor efficacy. Studies and clinical experiments have shown that the oral Chinese medicine Xueshuantong combined with anti-VEGF therapy is more effective, and this study aims to explore the molecular mechanism. The TCMSP database was used to identify the main Xueshuantong components. The PubChem database and SWISS Target Prediction data were used to find the SMILES molecular formulas of compounds and corresponding target genes and disease-related genes were searched using the GEO, DisGeNET, and GeneCards databases. Venny was used to identify the intersecting wet AMD-related genes and Xueshuantong targets and Cytoscape software was used to construct direct links between the drug components and disease targets. Then, PPI networks were constructed using the STRING website. R software was used for GO and KEGG enrichment analyses. Cytoscape software was used for topological analyses, and AutoDock Vina v.1.1.2 software was used for molecular docking. 64 compounds corresponding to four drugs were found by the TCMSP database, 1001 total drug targets were found by the PubChem database, 607 wet AMD target genes were found by the GEO, DisGeNET, and GeneCards databases, and 87 Xueshuantong target genes for wet AMD were obtained. Then, by constructing the drug component and disease target network and PPI network, we found that the components closely interacted with VEGF, TNF, caspase 3, CXCL8, and AKT1, which suggested that the therapeutic effects might be related to the inhibition of neovascularization, inflammation, and AKT pathway. Then, GO enrichment analysis showed that the biological processes response to hypoxia, positive regulation of angiogenesis, and inflammatory response were enriched. KEGG enrichment results showed that the HIF-1 and pi3k-akt pathways may mediate the inhibition of wet AMD by Xueshuantong. Topological analysis results identified 10 key proteins, including VEGF, TNF, AKT1, and TLR4. The results of molecular docking also confirmed their strong binding to their respective compounds. In this study, it was confirmed that Xueshuantong could inhibit wet AMD by targeting VEGF, TNF, TLR4, and AKT1, multichannel HIF-1, and the PI3K-AKT pathway, which further proved the therapeutic effects of Xueshuantong combined with single anti-VEGF therapy on wet AMD and provided new insights into the study of novel molecular drug targets for the treatment of wet AMD.

Targeted trace ingredients coupled with chemometric analysis for consistency evaluation of Panax notoginseng saponins injectable formulations

Evaluating the consistency of herb injectable formulations could improve their product quality and clinical safety, particularly concerning the composition and content levels of trace ingredients. Panax notoginseng Saponins Injection (PNSI), widely used in China for treating acute cardiovascular diseases, contains low-abundance (10%-25%) and trace saponins in addition to its five main constituents (notoginsenoside R1, ginsenoside Rg1, ginsenoside Re, ginsenoside Rb1, and ginsenoside Rd). This study aimed to establish a robust analytical method and assess the variability in trace saponin levels within PNSI from different vendors and formulation types. To achieve this, a liquid chromatography-triple quadrupole mass spectrometry (LC-MS/MS) method employing multiple ions monitoring (MIM) was developed. A "post-column valve switching" strategy was implemented to eliminate highly abundant peaks (NR1, Rg1, and Re) at 26 min. A total of 51 saponins in PNSI were quantified or relatively quantified using 18 saponin standards, with digoxin as the internal standard. This study evaluated 119 batches of PNSI from seven vendors, revealing significant variability in trace saponin levels among different vendors and formulation types. These findings highlight the importance of consistent content in low-abundance and trace saponins to ensure product control and clinical safety. Standardization of these ingredients is crucial for maintaining the quality and effectiveness of PNSI in treating acute cardiovascular diseases.

Effects of the triple therapy of carnosine glycoside, edaravone, and Xueshuantong in hemorrhagic cerebral infarction

OBJECTIVE

This study was designed to evaluate the effects of the triple therapy of Muscular Amino Acid and Peptides and Nucleosides (MAAPN), edaravone, and Xueshuantong on neurological function, tumor volume, and adverse reactions in patients with hemorrhagic cerebral infarction.

METHODS

In this retrospective study, a total of 115 patients with hemorrhagic cerebral infarction admitted to the hospital from January 2020 to January 2021 were enrolled and assigned to the observation group (n=57) or the control group (n=58) according to different treatment methods. The two groups were both treated with a conventional treatment regimen, and the observation group was additionally given carnosine, edaravone, and Xueshuantong, with a course of treatment spanning 14 days. The neurological and motor functions and changes in cerebral edema and cerebral infarct lesion size in patients were evaluated. The levels of inflammatory factors, blood lipids, neuron-specific enolase (NSE), S-100β, and matrix metalloproteinase-9 (MMP-9) of the two groups were determined and compared. The adverse effects and rebleeding of patients were recorded. The Barthel index (BI) was used to evaluate the quality of life of patients.

RESULTS

The treatment efficiency in the observation group was significantly higher than that in the control group (P<0.05). After treatment, the observation group obtained more favorable outcomes in terms of the neurological and motor functions, lesions of brain edema and cerebral infarction, and BI scores, than those of the control group (all P<0.05). In addition, after treatment, the levels of inflammatory factors, blood lipids, NSE, S-100β, MMP-9, plasma viscosity, and whole blood viscosity of the two groups of patients all decreased remarkably, with better outcomes in the observation group when compared with the control group (all P<0.05). The observation group showed a markedly lower rebleeding rate than the control group (P<0.05).

CONCLUSION

For patients with hemorrhagic cerebral infarction, the triple therapy of carnosine glycoside, edaravone, and Xueshuantong effectively enhances the neurological and motor function, reduces cerebral edema and cerebral infarction, and improves the quality of life, with high safety.

Xueshuantong for Injection Ameliorates Diabetic Nephropathy in a Rat Model of Streptozotocin-Induced Diabetes

Diabetic nephropathy (DN) is a major complication of diabetes and becomes the chief cause of end-stage renal disease. Our study was undertaken to investigate the ameliorative effect and underlying mechanism of Xueshuantong for Injection (XST) on DN in streptozotocin (STZ)-induced rats. Effect of XST treatment (XST, 50 mg/kg/day, i.p.) lasting 60 days after STZ-induced (60 mg/kg, i.p.) diabetes was investigated. Blood sugar levels and body weight were recorded every week of the experiment. At the 28th and 56th days after injection urine glucose and 24 h urine protein excretion were determined. Apoptosis related factors such as cleaved caspase-3, Bcl-2, Bax and inflammation related factors, including tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), IL-1β, inducible nitric oxide synthase (iNOS) and intercellular adhesion molecule-1 (ICAM-1) were detected by PCR or western blot. The expression levels of fibronectin, Collagen Ⅰ, α-smooth muscle actin (α-SMA) and proliferating cell nuclear antigen (PCNA), TGF-β-Smad2/3 signaling pathway, and receptor for advanced glycation end products (RAGE) was investigated. Our results showed that XST treatment did not affect levels of body weight, blood glucose and urine glucose levels. Our analysis revealed that XST inhibited cell apoptosis and suppressed the properties of RAGE in the kidney. XST treatment could also significantly suppress the overexpression of pro-inflammatory mediators in kidney and prevent renal fibrosis by blocking the TGF-β/Smad2/3 signaling pathway. In conclusion, our findings suggested that XST could provide protection against DN through reduction of RAGE accumulation, decreasing inflammation, inhibition of renal fibrosis, and blocking the TGF-β/Smad2/3 signaling pathway.

Xueshuantong improves cerebral blood perfusion in elderly patients with lacunar infarction

A total of 64 patients with acute lacunar infarction were enrolled within 24 hours of onset. The patients received conventional therapy (antiplatelet drugs and hypolipidemic drugs) alone or conventional therapy plus 450 mg Xueshuantong once a day. The main ingredient of the Xueshuantong lyophilized powder used for injection was Panax notoginseng saponins. Assessments were made at admission and at discharge using the National Institutes of Health Stroke Scale, the Activity of Daily Living and the Mini-Mental State Examination. Additionally, the relative cerebral blood flow, relative cerebral blood volume and relative mean transit time in the region of interest were calculated within 24 hours after the onset of lacunar infarction, using dynamic susceptibility contrast magnetic resonance perfusion imaging technology. Patients underwent a follow-up MRI scan after 4 weeks of treatment. There was an improvement in the Activity of Daily Living scores and a greater reduction in the scores on the National Institutes of Health Stroke Scale in the treatment group than in the control group. However, the Mini-Mental State Examination scores showed no significant differences after 4 weeks of treatment. Compared with the control group, the relative cerebral blood flow at discharge had increased and showed a greater improvement in the treatment group. Furthermore, there was a reduction in the relative mean transit time at discharge and the value was lower in the treatment group than in the control group. The experimental findings indicate that Xueshuantong treatment improves neurological deficits in elderly patients with lacunar infarction, and the mechanism may be related to increased cerebral perfusion.