1.XU Fengqin's Experience in Treating Hypertension in the Elderly based on the Theory of “Combination of Disease and Symptoms”
Luyao HUAN ; Jiajun WENG ; Song SHENG ; Haiyun WANG ; Yanhong ZHANG ;
Journal of Traditional Chinese Medicine 2023;64(19):1964-1968
This paper summarized the clinical experience of XU Fengqin in the treatment of hypertension in the elderly. It is believed that the basic pathogenesis of hypertension in the elderly is liver and kidney depletion, and the key is ascendant hyperactivity of liver yang and spleen failing to transport. Therefore, the theory of “combination of disease and symptoms” is put forward that the four common clinical symptoms of hypertension in the elderly, including morning hypertension, non-dipper hypertension with abnormal circadian rhythm, postprandial hypotension and orthostatic hypotension, should be differentiated and treated with prescription in accordance with the characteristics of the corresponding pathogenesis. Specifically, the pathogenesis of morning hypertension is mainly liver-kidney yin deficiency and ascendant hyperactivity of liver yang, for which the treatment method of enriching liver and boosting kidney, calming the liver and subduing yang is suggested, and Qingxuan Jiangya Decoction (清眩降压汤) in modifications can be used. For non-dipper hypertension with abnormal circadian rhythm, the pathogenesis is mainly phlegm-dampness obstruction and clear yang failing to ascend, and treatment method should be dissolving phlegm and dispelling dampness, calming the liver and extinguishing wind, with Banxia Baizhu Tianma Decoction and Modified Honglong Xiahai Decoction (半夏白术天麻汤合加味红龙夏海汤) in its modifications. Regarding postprandial hypotension and orthostatic hypotension, the pathogenesis is mainly spleen-stomach depletion and clear yang failing to ascend, and thus the method of supplementing the center and boosting qi, raising yang and lifting the sunken is advised with Buzhong Yiqi Decoction (补中益气汤) or Yiqi Congming Decoction (益气聪明汤) in the modifications.
2.Drug discovery of sclerostin inhibitors.
Sifan YU ; Dijie LI ; Ning ZHANG ; Shuaijian NI ; Meiheng SUN ; Luyao WANG ; Huan XIAO ; Dingdong LIU ; Jin LIU ; Yuanyuan YU ; Zongkang ZHANG ; Samuel Tin Yui YEUNG ; Shu ZHANG ; Aiping LU ; Zhenlin ZHANG ; Baoting ZHANG ; Ge ZHANG
Acta Pharmaceutica Sinica B 2022;12(5):2150-2170
Sclerostin, a protein secreted from osteocytes, negatively regulates the WNT signaling pathway by binding to the LRP5/6 co-receptors and further inhibits bone formation and promotes bone resorption. Sclerostin contributes to musculoskeletal system-related diseases, making it a promising therapeutic target for the treatment of WNT-related bone diseases. Additionally, emerging evidence indicates that sclerostin contributes to the development of cancers, obesity, and diabetes, suggesting that it may be a promising therapeutic target for these diseases. Notably, cardiovascular diseases are related to the protective role of sclerostin. In this review, we summarize three distinct types of inhibitors targeting sclerostin, monoclonal antibodies, aptamers, and small-molecule inhibitors, from which monoclonal antibodies have been developed. As the first-in-class sclerostin inhibitor approved by the U.S. FDA, the monoclonal antibody romosozumab has demonstrated excellent effectiveness in the treatment of postmenopausal osteoporosis; however, it conferred high cardiovascular risk in clinical trials. Furthermore, romosozumab could only be administered by injection, which may cause compliance issues for patients who prefer oral therapy. Considering these above safety and compliance concerns, we therefore present relevant discussion and offer perspectives on the development of next-generation sclerostin inhibitors by following several ways, such as concomitant medication, artificial intelligence-based strategy, druggable modification, and bispecific inhibitors strategy.