ObjectiveTo investigate the effects of retention enema with Huangling Jiedu Xiezhuo granules（HJXG） on Nod-like receptor protein 3（NLRP3）， intestinal flora， and short-term prognosis in patients with gout. MethodsA total of 60 patients with gout admitted to the hospital from January 2021 to December 2023 were selected and divided into a control group and an observation group according to the random number table method， with 30 cases in each group. The control group was treated with febuxostat， and the observation group was treated with retention enema with HJXG on the basis of the control group. After 14 days of continuous treatment， the clinical efficacy， traditional Chinese medicine （TCM） syndrome score， and visual analogue scale （VAS） pain index of the two groups were compared， and serum creatinine（SCr）， blood urea nitrogen（BUN）， uric acid（UA）， cystatin C（CysC）， β₂- microglobulin（β₂-MG）， glomerular filtration rate test（GFR）， creatinine clearance rate （Ccr）， erythrocyte sedimentation rate（ESR）， hypersensitive C-reactive protein，（hs-CRP）， interleukin 6（IL-6）， interleukin-1β（IL-1β）， interleukin-18 （IL-18）， NLRP3 inflammasome levels， and the number of intestinal flora were detected in the two groups. The prognosis of patients was followed up within 12 weeks. COX regression analysis was used to analyze the effect of short-term prognosis. ResultsAfter treatment， TCM syndrome scores and VAS pain index in both groups were reduced （P<0.05）， and TCM syndrome scores in the observation group were significantly lower than those in the control group. After treatment， ESR， hs-CRP， IL-6， NLRP3， IL-18， and IL-1β were significantly decreased in both groups （P<0.01）， and the levels of IL-6， ESR， NLRP3， and IL-18 were significantly improved in the observation group compared with the control group （P<0.05）. BUN， SCr， UA， β₂-MG， GFR indexes in both groups were significantly lower after treatment， Ccr indexes in both groups were significantly higher after treatment， and the levels of SCr， UA， CysC， and Ccr in the observation group were significantly better than those in the control group （P<0.05）. After treatment， the intestinal flora in both groups was improved， and the observation group was significantly improved compared with the control group in terms of Lactobacillus， Proteus， Bacteroides， and Escherichia coli （P<0.05）. COX regression analysis showed that retention enema with HJXG could reduce the risk of poor short-term prognosis in patients with gout compared with Western medicine alone. ConclusionThe retention enema with HJXG can improve the curative effect of patients with gout， improve the TCM syndromes， reduce inflammation， and enhance renal function， intestinal flora， and short-term prognosis.

ObjectiveTo investigate the effects of Xinfeng capsules combined with chronic disease management of traditional Chinese medicine （TCM） on rapid disease control and short-term prognosis of patients with rheumatoid arthritis （RA）. MethodsA total of 80 RA patients hospitalized in the Department of Rheumatology of The First Affiliated Hospital of Anhui University of Chinese Medicine from January 2022 to March 2024 were enrolled and randomly divided into an observation group （40 cases） and a control group （40 cases）. The control group was treated with conventional methotrexate combined with standard chronic disease management， while the observation group was additionally treated with Xinfeng Capsules combined with TCM chronic disease management. The treatment course lasted 24 weeks. The outcomes were compared between two groups， including disease activity ［28-joint disease activity score （DAS28）， clinical disease activity index （CDAI）， simplified disease activity index （SDAI）］， visual analogue scale （VAS） for pain， TCM syndrome score， tender joint count （TJC）， swollen joint count （SJC）， morning stiffness duration， Health Assessment Questionnaire （HAQ）， Self-Rating Anxiety Scale （SAS）， Self-Rating Depression Scale （SDS）， American College of Rheumatology （ACR） 20%， 50% and 70% response rates （ACR20/50/70）， erythrocyte sedimentation rate （ESR）， high-sensitivity C-reactive protein （hs-CRP）， rheumatoid factor （RF）， anti-cyclic citrullinated peptide antibody （CCP-Ab）， interleukin （IL）-6， IL-1β， tumor necrosis factor-α （TNF-α）， and serum immunoglobulin G （IgG）. The Chronic Disease Self-Management Scale （CDSMS） was used to evaluate patients’ self-management ability， self-care ability， and nursing satisfaction. Patients were followed up for 12 weeks to assess prognosis， and COX regression analysis was performed to determine the impact on short-term prognosis. ResultsAfter treatment， TJC， SJC， morning stiffness duration， DAS28， CDAI， SDAI， VAS， TCM syndrome score， ESR， hs-CRP， RF， CCP-Ab， IL-6， IL-1β， TNF-α， IgG， HAQ， SAS， SDS， chronic disease self-management behavior， self-efficacy， and self-care ability all improved significantly in both groups compared with baseline （P<0.05，P<0.01）. Compared with the control group， the observation group showed more significant improvements in TJC， SJC， morning stiffness duration， DAS28， CDAI， SDAI， VAS， TCM syndrome score， ESR， IL-1β， IgG， HAQ， SAS， SDS， self-care ability， chronic disease self-management behavior， and self-efficacy （P<0.05 or P<0.01）. The ACR70 response rate and nursing satisfaction were significantly higher in the observation group than in the control group （P<0.01）. COX regression analysis showed that Xinfeng capsules combined with TCM chronic disease management reduced the risk of poor short-term prognosis in RA patients. ConclusionXinfeng capsules combined with TCM chronic disease management facilitates rapid disease control in RA patients， effectively improves short-term prognosis， and plays an important role in the treatment of the disease.

OBJECTIVES: To investigate the mechanism of Qihuang Jianpi Zishen Granules (QJZ) for ameliorating renal damage in MRL/lpr mice. METHODS: With 6 female C57BL/6 mice as the normal control group, 30 female MRL/lpr mice were randomized into model group, QJZ treatment groups at low, moderate and high doses, and prednisone treatment group (n=6). After 8 weeks of treatment, the mice were examined for 24-h urine protein, creatinine and albumin levels, serum levels of IgG, complement 3 (C3), C4, anti-dsDNA, interferon γ (IFN‑γ) and interleukin 17 (IL-17). Kidney tissues were sampled for histopathological examination with HE staining and observation of glomerular ultrastructure changes using transmission electron microscopy (TEM). The expressions of MyD88/NF-κB pathway-related molecules in the kidney tissue were detected using RT-qPCR, Western blotting and immunohistochemistry. RESULTS: Compared with those in the model group, the mice treated with QJZ at the 3 doses and prednisone showed significant reductions in the renal injury biomarkers and serum IgG, anti-dsDNA, IFN‑γ and IL-17 levels and elevation of serum C3 and C4 levels. HE staining revealed lessened glomerular endothelial cell proliferation and mesangial thickening in all the treatment groups. TEM observation further demonstrated reduced electron-dense deposits and diminished inflammatory cell infiltration in the glomeruli in the intervention groups. QJZ at the 3 doses and prednisone treatment all significantly lowered renal expression levels of MyD88, NF-κB, p65 and p52 in the mouse models. CONCLUSIONS QJZ can improve renal damage in MRL/lpr mice possibly by inhibiting overactivation of the MyD88/NF-κB pathway.
Animals ; Drugs, Chinese Herbal/therapeutic use* ; Female ; Mice, Inbred C57BL ; Mice, Inbred MRL lpr ; Myeloid Differentiation Factor 88/metabolism* ; Mice ; NF-kappa B/metabolism* ; Signal Transduction/drug effects* ; Kidney/metabolism* ; Interleukin-17

OBJECTIVES: To investigate the efficacy of Qihuang Jianpi Zishen Granules (QJZ) for inhibiting renal B cell differentiation in MRL/lpr mice and explore its underlying mechanism. METHODS: Thirty 8-week-old female MRL/lpr mice were randomly divided into model group, QJZ group, prednisone (Pred) group, QJZ+Pred group, and AIM2 inhibitor group (n=6), with 6 8-week-old female C57BL/6 mice as the normal control group. After treatments with normal saline, QJZ, Pred, or AIM2 inhibitor for 8 weeks, the mice were examined for urinary total protein-to-creatinine ratio (TPCR) and albumin-to-creatinine ratio (ACR), serum creatinine (Cr) and blood urea nitrogen (BUN) levels, and renal histopathology (with HE, Masson, and PAS staining) and ultrastructural changes (with electron microscopy). ELISA, immunohistochemistry, immunofluorescence staining and flow cytometry were used to detect blood levels of anti-dsDNA antibodies, cytokines and chemokines, renal deposition of complement components C3 and C4, renal expressions of AIM2, CD19, CD27 and CD138, and changes in splenic B lymphocyte subsets. The effect of QJZ on the AIM2/Blimp-1/Bcl-6 signaling axis was examined using Western blotting. RESULTS: QJZ treatment significantly improved Cr, BUN, TPCR and ACR in MRL/lpr mice, ameliorated renal pathologies, reduced the expressions of ds-DNA, BAFF, IL-21, CXCL12, CXCL13, C3 and C4, and increased IL-10 levels. QJZ significantly downregulated renal expressions of the key B-cell transcription factors Blimp-1 and XBP-1, upregulated Bcl-6 and PAX5 expressions, inhibited B-cell differentiation, and lowered the expressions of AIM2, CD27, CD138 and CD69. Inhibition of AIM2 similarly reduced renal Blimp-1 and XBP-1 expressions, increased Bcl-6 and PAX5 levels, suppressed B-cell differentiation, decreased IgG production, reduced C3 and C4 deposition, and alleviated renal pathology in MRL/lpr mice. CONCLUSIONS QJZ inhibits B cell differentiation and alleviates renal damage in systemic lupus erythematosus possibly by suppressing the AIM2/Blimp-1/Bcl-6 signaling pathway.
Animals ; Drugs, Chinese Herbal/therapeutic use* ; Mice, Inbred MRL lpr ; Female ; Mice ; Mice, Inbred C57BL ; Cell Differentiation/drug effects* ; B-Lymphocytes/drug effects* ; Proto-Oncogene Proteins c-bcl-6/metabolism* ; Kidney/drug effects* ; DNA-Binding Proteins/metabolism* ; Signal Transduction ; Lupus Nephritis

ObjectiveTo investigate the clinical efficacy of Qihuang Jianpi Zishen Granules in the treatment of systemic lupus erythematosus （SLE） and its effect on the signal transducer and activator of tranSCription 3/mammalian target of rapamycin （STAT3/mTOR） signaling pathway， and to decipher the possible mechanism. MethodSixty female SLE patients who met the criteria in the First Affiliated Hospital of Anhui University of Chinese Medicine from May 2022 to May 2023 were selected and randomized into a control group and an observation group （30 cases in each group）. The control group was treated with prednisone acetate + hydroxychloroquine sulfate orally， and the observation group was additionally treated with Qihuang Jianpi Zishen granules. The treatment lasted for 8 weeks. The SLE disease activity （SLEDAI）， TCM syndrome score， erythrocyte sedimentation rate （ESR）， hypersensitive C-reactive protein （hs-CRP）， immune indexes ［immunoglobulin G （IgG）， C3， C4， CD4⁺， and CD8⁺］， interleukin （IL）-17， IL-23， interferon （IFN）-γ， 24 h urinary protein （24 h PRO）， serum creatinine （SCr）， and expression of proteins ［STAT3， phosphorylated （p）-STAT3， mTOR protein and STAT3，mTOR mRNA］ in the STAT3/mTOR signaling pathway were determined before and after treatment. In addition， the adverse reactions were recorded. ResultAfter 8 weeks of treatment， the total response rate in the observation group was 93.33% （28/30）， which was higher than that （70.00%， 21/30） in the control group （χ²=4.007， P<0.05）. After treatment， both groups showed declined SLEDAI， TCM syndrome score， ESR， hs-CRP， IgG， CD8⁺， IL-17， IL-23， IFN-γ， 24 h PRO， SCr， and expression of proteins in the STAT3/mTOR pathway （P<0.01） and elevated levels of C3， C4， and CD4⁺ （P<0.01）. Moreover， the observation group had lower SLEDAI， TCM syndrome score， ESR， hs-CRP， IgG， CD8⁺， IL-17， IL-23， IFN-γ， 24 h PRO， SCr， and expression of proteins in the STAT3/mTOR pathway （P<0.05， P<0.01） and higher levels of C3， C4， and CD4⁺ （P<0.05， P<0.01） than the control group after treatment. Neither group showed serious adverse reactions during the treatment period. ConclusionQihuang Jianpi Zishen Granules can ameliorate the inflammatory response， reduce the disease activity， and mitigate the kidney injury in SLE by inhibiting the STAT3/mTOR signaling pathway to regulate the immune function.

Objective To explore the therapeutic mechanism of Jianpi Zishen(JPZS)granules for systemic lupus erythematosus(SLE)in light of podocyte autophagy regulation.Methods TCMSP,GeneCards,OMIM,and TTD databases were used to obtain the targets of JPZS granules,SLE,and podocyte autophagy.The protein-protein interaction network was constructed using Cytoscape,and the key active ingredients and targets were screened for molecular docking.In the clinical study,46 patients with SLE were randomized into two groups to receive baseline treatment with prednisone acetate and mycophenolate mofetil(control group)and additional treatment with JPZS granules(observation group)for 12 weeks,with 10 healthy volunteers as the healthy control group.Urinary levels of nephrin and synaptopodin of the patients were detected with ELISA.Western blotting was performed to determine peripheral blood levels of p-JAK1/JAK1,p-STAT1/STAT1,LC3Ⅱ/LC3I,and p62 proteins of the participants.Results Four key active ingredients and 5 core target genes(STAT1,PIK3CG,MAPK1,PRKCA,and CJA1)were obtained,and enrichment analysis identified the potentially involved signaling pathways including AGE-RAGE,JAK/STAT,EGFR,and PI3K/Akt.Molecular docking analysis showed that STAT1 was the most promising target protein with the highest binding activity,suggesting its role as an important mediator for signal transduction after JPZS granule treatment.In the 43 SLE patients available for analysis,treatment with JPZS granule significantly reduced serum levels of p-JAK1/JAK1,p-STAT1/STAT1,and LC3Ⅱ/LC3I(P<0.05 or 0.01),increased the protein level of P62(P<0.05),and reduced urinary levels of nephrin and synaptopodin(P<0.05).Conclusion The therapeutic effect of JPZS granules on SLE is mediated probably by coordinated actions of quercetin,kaempferol,β-sitosterol,and isorhamnetin on their target gene STAT1 to inhibit the JAK/STAT pathway,thus suppressing autophagy and alleviating podocyte injuries in SLE.

Rheumatoid arthritis(RA)is a common chronic autoimmune disease with synovitis as its pathological basis and erosive arthritis as its main symptom.Pathogenesis of RA is complex,combination of genetic factors,environmental factors,immune cells,cytokines and autoantibodies causes joint injury,bone destruction and multi-system disease of RA.However,the above mecha-nisms can not fully explain the poor prognosis,high disability rate and poor clinical treatment effect of RA.Therefore,exploring new pathogenesis and therapeutic targets of RA is the focus of RA research.In recent years,with the deepening of RA research,it has been found that there is a new form of cell death in pathological process of RA,namely ferroptosis.Ferroptosis is a type of cell death caused by inhibition of glutathione peroxidase activity and accumulation of lipid reactive oxygen species.Previous studies have con-firmed the close correlation between RA and ferroptosis,this paper mainly explores ferroptosis-related signal pathways that affect the change and development of RA disease from the perspective of regulating the main signal pathways of ferroptosis,so as to find new therapeutic targets for RA and new therapeutic ideas for research.

Objective To explore the therapeutic mechanism of Jianpi Zishen(JPZS)granules for systemic lupus erythematosus(SLE)in light of podocyte autophagy regulation.Methods TCMSP,GeneCards,OMIM,and TTD databases were used to obtain the targets of JPZS granules,SLE,and podocyte autophagy.The protein-protein interaction network was constructed using Cytoscape,and the key active ingredients and targets were screened for molecular docking.In the clinical study,46 patients with SLE were randomized into two groups to receive baseline treatment with prednisone acetate and mycophenolate mofetil(control group)and additional treatment with JPZS granules(observation group)for 12 weeks,with 10 healthy volunteers as the healthy control group.Urinary levels of nephrin and synaptopodin of the patients were detected with ELISA.Western blotting was performed to determine peripheral blood levels of p-JAK1/JAK1,p-STAT1/STAT1,LC3Ⅱ/LC3I,and p62 proteins of the participants.Results Four key active ingredients and 5 core target genes(STAT1,PIK3CG,MAPK1,PRKCA,and CJA1)were obtained,and enrichment analysis identified the potentially involved signaling pathways including AGE-RAGE,JAK/STAT,EGFR,and PI3K/Akt.Molecular docking analysis showed that STAT1 was the most promising target protein with the highest binding activity,suggesting its role as an important mediator for signal transduction after JPZS granule treatment.In the 43 SLE patients available for analysis,treatment with JPZS granule significantly reduced serum levels of p-JAK1/JAK1,p-STAT1/STAT1,and LC3Ⅱ/LC3I(P<0.05 or 0.01),increased the protein level of P62(P<0.05),and reduced urinary levels of nephrin and synaptopodin(P<0.05).Conclusion The therapeutic effect of JPZS granules on SLE is mediated probably by coordinated actions of quercetin,kaempferol,β-sitosterol,and isorhamnetin on their target gene STAT1 to inhibit the JAK/STAT pathway,thus suppressing autophagy and alleviating podocyte injuries in SLE.

Objective To investigate the effect of serum containing Xinfeng capsule (XFC) on the angiogenesis of human umbilical vein endothelial cells (HUVEC) induced by rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) and its mechanism of action. Methods An in vitro co-culture model of RA-FLS and HUVEC was established. Serum containing XFC was prepared by oral gavage of SD rats. CCK-8 was used to screen the optimal co-culture ratio and XFC serum concentration. The lncRNA HOTAIR overexpression plasmid (pcDNA3.1-lncRNA HOTAIR), along with the negative control group, were constructed and transfected into RA-FLS. The experiments were done in HUVEC control group, model group (co-culture of HUVEC and RA-FLS), XFC group (co-culture of RA-FLS treated with 200 mL/L XFC), HOTAIR negative control group (co-culture of RA-FLS transfected with pcDNA3.1-NC), HOTAIR overexpression group (co-culture of RA-FLS transfected with pcDNA3.1-lncRNA HOTAIR), and XFC-treated HOTAIR overexpression group (co-culture of RA-FLS transfected with pcDNA3.1-lncRNA HOTAIR and treated with 200 mL/L XFC). The proliferation ability of HUVEC was detected by CCK-8 method. The migration ability of HUVEC was detected by Transwell^TM method. The tube formation ability of HUVEC was detected by tubule formation assay. The expression of CD34 and CD105 in HUVEC was detected by flow cytometry. The expressions of lncRNA HOTAIR, miR-126-3p, phosphatidylinositol 3-kinase (PI3K), PI3K receptor 2 (PIK3R2), AKT, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF) mRNA in HUVEC were detected by real-time quantitative PCR. The protein expressions of PI3K, AKT, p-AKT, VEGF, and bFGF in HUVEC were detected by Western blot and immunofluorescence technique. Results The results of CCK-8 method showed that the optimal treatment ratio and time of RA-FLS and HUVEC co-culture were 5:1 and 48 h respectively. The optimal intervention concentration and time of XFC were 200 mL/L and 48 h. Compared with the control group, the proliferation, migration, tube-forming ability and CD34 and CD105 levels of HUVEC in the model group were significantly improved, the expressions of lncRNA HOTAIR, PIK3R2, VEGF, bFGF, PI3K, AKT and p-AKT were significantly upregulated, and miR-126-3p was significantly downregulated. Compared with the model group, the proliferation, migration, tube-forming ability and CD34 and CD105 levels of HUVEC in the XFC group were significantly decreased, the expressions of lncRNA HOTAIR, PIK3R2, VEGF, bFGF, PI3K, AKT and p-AKT were significantly downregulated, while the expression of miR-126-3p was significantly upregulated. Compared with the HOTAIR negative control group, in the HOTAIR overexpression group, the proliferation, migration, tube-forming ability and CD34 and CD105 levels of HUVECs were significantly increased, the expressions of lncRNA HOTAIR, PIK3R2, VEGF, bFGF, PI3K, AKT and p-AKT were significantly upregulated, and the expression of miR-126-3p was significantly downregulated. Compared with the HOTAIR overexpression group, the proliferation, migration, tube-forming ability and CD34 and CD105 levels of HUVECs in the HOTAIR overexpression group treated with XFC were significantly downregulated, the expressions of lncRNA HOTAIR, PIK3R2, VEGF, bFGF, PI3K, AKT and p-AKT were significantly downregulated, and the expression of miR-126-3p was significantly upregulated. Conclusion XFC-containing serum may play a therapeutic role by inhibiting the expression of lncRNA HOTAIR/PI3K/AKT pathway, reducing the expression levels of VEGF and bFGF, and alleviating synovial angiogenesis induced by RA-FLS to exert therapeutic effect.
RNA, Long Noncoding/metabolism* ; Humans ; Human Umbilical Vein Endothelial Cells/metabolism* ; Phosphatidylinositol 3-Kinases/genetics* ; Proto-Oncogene Proteins c-akt/genetics* ; Animals ; Signal Transduction ; Rats ; Drugs, Chinese Herbal/pharmacology* ; Rats, Sprague-Dawley ; Neovascularization, Pathologic/metabolism* ; Coculture Techniques ; Cell Proliferation/genetics* ; Fibroblasts/metabolism* ; Vascular Endothelial Growth Factor A/genetics* ; Male ; Cells, Cultured ; Capsules ; Angiogenesis

OBJECTIVES: To explore the mechanism of Qihuang Jianpi Zishen Granules (QJZG) for improving thrombocytopenia in a mouse model of systemic lupus erythematosus (SLE). METHODS: Twenty-four MRL/lpr lupus mice were randomized equally into 4 groups for treatment with daily gavage of saline, QJZG or prednisone (Pred) or intraperitoneal injection (twice a week) of CaMKK2 activator, with 6 C57BL/6 mice with saline gavage as the control group. After 8 weeks of treatment, the mice were examined for PLT, PCT, PDW, MPV, serum levels of TPO, IL-6, IL-10, TNF-α and IFN-γ, and calcium ion fluorescence intensity using ELISA or flow-through assay. RT-qPCR was used to detect platelet CaMKK2, AMPK2α, mTOR, Beclin1 and p62 mRNA expression levels, and the protein expressions of CaMKK2, p-CaMKK2, AMPK, p-AMPK, mTOR, p-mTOR, LC3, Beclin1 and p62 were detected using Western blotting. RESULTS: The saline-treated MRL/lpr lupus mice showed significantly lowered levels of PLT, PCT, IL-10, mTOR, p62 mRNA, p-mTOR and P62 with increased PDW, MPV, serum TPO, IL-6, TNF-α and IFN-γ levels, and platelet expressions of CaMKK2, AMPK, Bcl-1 mRNA, p-CaMKK2, p-AMPK, LC3II and Beclin1. These abnormalities were significantly improved in QJZG group and Pred group but worsened after treatment with the CaMKK2 activator. CONCLUSIONS QJZG can ameliorate thrombocytopenia in mouse models of SLE by reducing inflammation and inhibiting platelet autophagy via regulating the Ca²⁺/CaMKK2/AMPK/mTOR signaling pathways.
Animals ; Lupus Erythematosus, Systemic/metabolism* ; Mice ; Calcium-Calmodulin-Dependent Protein Kinase Kinase/metabolism* ; Drugs, Chinese Herbal/pharmacology* ; TOR Serine-Threonine Kinases/metabolism* ; Thrombocytopenia/metabolism* ; Signal Transduction/drug effects* ; Autophagy/drug effects* ; AMP-Activated Protein Kinases/metabolism* ; Disease Models, Animal ; Mice, Inbred C57BL ; Mice, Inbred MRL lpr ; Calcium/blood* ; Blood Platelets/metabolism*