1.Inhibitory effect of hydroxy safflower yellow A on neuronal pyroptosis after glucose-oxygen deprivation/reglucose-reoxygenation treatment
Zeqian WANG ; Yanzhe DUAN ; Yige WU ; Dong MA ; Jianjun HUANG ; Yuqing YAN ; Lijuan SONG
Chinese Journal of Tissue Engineering Research 2025;29(19):4044-4051
BACKGROUND:Hydroxy safflower yellow A has anti-ischemia,anti-oxidation,anti-thrombotic and anti-inflammatory effects.Whether it affects neuronal pyroptosis after glucose-oxygen deprivation/reglucose-reoxygenation is still unclear. OBJECTIVE:To investigate the protective effect of hydroxy safflower yellow A on neuronal pyroptosis and its mechanism. METHODS:HT22 cells in logarithmic growth phase were randomly divided into five groups:normal group,model group,hydroxy safflower yellow A group,colivelin group,and colivelin+hydroxy safflower yellow A group.HT22 cells were treated with glucose-oxygen deprivation/reglucose-reoxygenation to establish neuronal pyroptosis model,and then treated with STAT3 agonist Colivelin and hydroxy safflower yellow A.JC-1 probe was employed to assess changes in mitochondrial membrane potential.Reactive oxygen species kit was used to determine the content of reactive oxygen species in cells.GSDMD/TUNEL staining was conducted to observe cell pyroptosis.Immunofluorescence analysis was performed to detect STAT3 and GSDMD protein expression.RT-PCR was utilized for assessing mRNA expression levels of STAT3,NLRP3,and Caspase-1.Western blot assay was utilized to measure the protein expression levels of p-STAT3,NLRP3,GSDMD,Cleaved-caspase-1,and interleukin-1β. RESULTS AND CONCLUSION:(1)Compared with the normal group,the number of pyroptotic cells increased in HT22 cells in the model group along with a significant increase in protein expression levels of p-STAT3,NLRP3,Cleaved-caspase-1,GSDMD,and interleukin-1β.Compared with the model group,the number of pyroptotic cells reduced,and the expression of pyroptosis-related proteins significantly decreased in the hydroxy safflower yellow A group.(2)In comparison with the model group,pyroptosis worsened in the colivelin group where mitochondrial membrane potential decreased along with elevated reactive oxygen species content and increased mRNA expression levels of STAT3,NLRP3,and Caspase-1,as well as increased protein expression levels of p-STAT3,NLRP3,GSDMD,Cleaved-caspase-1,and interleukin-1β.Compared with the Colivelin group,above indexes were improved in the colivelin+hydroxy safflower yellow A group.These results suggest that hydroxy safflower yellow A plays a neuroprotective role through STAT3 signaling pathway to inhibit HT22 pyroptosis after glucose-oxygen deprivation/reglucose-reoxygenation treatment.
2.Exploring Mechanism of Heart and Brain Protection of Bukan Yilidan on a Rat Model of Perimenopausal Psycho-cardiac Disease Based on Mitochondrial Autophagy
Ningyang XU ; Xiande MA ; Lu REN ; Yuqing HU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(15):48-59
ObjectiveTo investigate the effect and mechanism of Bukan Yilidan on perimenopausal psycho-cardiac disease by mitochondrial autophagy mediated by dynamin-related protein 1(Drp1)/phosphatase and tensin homolog(PTEN) induced putative kinase 1(PINK1)/Parkin pathway. MethodsSixty rats were randomly divided into the blank group, model group, western medicine group(isosorbide mononitrate 7.2 mg·kg-1+sertraline hydrochloride tablets 18 mg·kg-1), Bukan Yilidan low, medium and high dose groups(2.59, 5.18, 10.35 g·kg-1), with 10 rats in each group. Except for the blank group, the rat model of perimenopausal psycho-cardiac disease was prepared by ovariectomy(OVX) combined with high-fat feeding, chronic unpredictable mild stress(CUMS) and subcutaneous multi-point injection of isoproterenol hydrochloride. After successful modeling, the general state and tongue image of rats were observed. The depression status of rats in vivo was evaluated by open field test, sucrose preference test, forced swimming immobility time and grip strength value, and the cardiac function of rats was evaluated by electrocardiogram and echocardiography. The levels of serum norepinephrine(NE), dopamine(DA) and 5-hydroxytryptamine(5-HT) were detected by enzyme-linked immunosorbent assay(ELISA), and biochemical detection was used to assess myocardial injury by measuring serum levels of high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), triglyceride(TG), total cholesterol(TC), aspartate aminotransferase(AST), alanine aminotransferase(ALT), lactate dehydrogenase(LDH) and creatine kinase isoenzyme(CK-MB). Hematoxylin-eosin(HE) and Nissl staining were used to observe the pathological status of hippocampus and myocardial tissue in rats, the status of mitophagosomes in hippocampus and myocardium was observed by transmission electron microscope(TEM), and Western blot was used to detect the contents of Drp1, mitochondrial fusion protein 2(Mfn2), optic atrophy protein 1(OPA1), PINK1, Parkin, p62 and microtubule-associated protein light chain 3B(LC3B) in hippocampus and myocardium. ResultsCompared with the blank group, the food intake and water intake of rats in the model group decreased, the hair was dark yellow, the gloss and smoothness decreased, the spirit was depressed, the tongue was light purple or dark purple, accompanied by petechiae or ecchymosis, the sublingual collaterals were purple and black, and the tongue coating was white and smooth. The indexes of open field test, grip strength and sucrose preference of rats decreased significantly, and the immobility time of forced swimming increased significantly(P<0.01). Electrocardiogram and echocardiography showed that ST segment was significantly depressed, and left ventricular fractional shortening(LVFS) and left ventricular ejection fraction(LVEF) were significantly decreased(P<0.05, P<0.01). Pathological observation showed that the number of hippocampal neurons and myocardial cells decreased, and the structural damage was obvious. The levels of serum TC, TG, LDL-C, CK-MB, LDH, AST and ALT increased, while the levels of HDL-C, 5-HT, DA and NE decreased(P<0.05, P<0.01). TEM showed obvious mitochondrial damage in hippocampus and myocardial tissue. The protein expressions of Drp1, PINK1, Parkin and p62 in hippocampus and myocardium were increased, while the protein expressions of OPA1, Mfn2 and LC3BⅡ/Ⅰ were decreased(P<0.05, P<0.01). Compared with the model group, the mental state, body curling up, fear of cold and other symptoms of rats in each administration group were improved, and the degree of pale purple or dark purple tongue was reduced. The scores of open field test, grip strength, sucrose preference, LVFS and LVEF were increased, and the immobility time of forced swimming was shortened(P<0.05, P<0.01). The ST segment of electrocardiogram had a significant recovery(P<0.01), pathological observation showed that the damage of nerve cells and myocardial tissue was improved. The levels of serum TC, TG, LDL-C, CK-MB, LDH, AST and ALT decreased, while the levels of HDL-C, 5-HT, DA and NE increased(P<0.05, P<0.01). TEM showed that mitochondrial damage was reduced in hippocampal neurons and cardiomyocytes with visible mitochondrial autophagosomes. The protein expressions of Drp1, PINK1, Parkin and p62 in hippocampus and myocardium were decreased, while the protein expressions of OPA1, Mfn2 and LC3BⅡ/Ⅰ were increased(P<0.05, P<0.01). ConclusionBukan Yilidan can alleviate depression, lipid metabolism disorder and myocardial ischemia injury in rats with perimenopausal psycho-cardiac disease, and its mechanism may be related to inhibiting Drp1/PINK1/Parkin signaling pathway and enhancing mitochondrial autophagy.
3.Analysis of components migrating to blood and metabolites of Polygonum cuspidatum in rats with acute gouty arthritis
Caiyi KE ; Meng SHEN ; Li JI ; Xuechun WANG ; Yuqing ZHU ; Xi CHEN ; Chengweiqi WANG ; Qun MA
China Pharmacy 2025;36(13):1581-1586
OBJECTIVE To analyze the components migrating to blood and metabolites of Polygonum cuspidatum in rats with acute gouty arthritis (AGA). METHODS SD rats were randomly divided into blank group, model group and P. cuspidatum group (10 g/kg, by raw material), with 6 rats in each group. Except for blank group, AGA model was induced in the remaining groups by injecting potassium oxonate and sodium urate; meanwhile, they were administered corresponding drug solutions or water intragastrically, once a day, for 10 consecutive days. The histopathological morphology of the knee joint tissues in rats was observed;rat serum samples were collected, and the components migrating to blood and metabolites of P. cuspidatum were analyzed by using UPLC-Q-Exactive-Orbitrap-MS. RESULTS Following the intervention with P. cuspidatum, the histopathological morphology of the knee joint synovial tissue in AGA rats showed significant improvement, with reduced inflammatory cell infiltration and hyperplasia, and the preservation of the honeycomb-like structure integrity. In both positive and negative ion modes, a total of 67 chemical components were detected in the serum of rats from P. cuspidatum group, including 25 prototype components and 42 metabolites. The involved compound types encompassed stilbenes, anthraquinones, naphthols, and flavonoids, among others. The metabolic reactions identified included methylation, acetylation, sulfation, and glucuronidation. Notably, compounds such as polydatin, resveratrol and emodin were capable of entering the bloodstream in their prototype forms and undergoing in vivo metabolism. CONCLUSIONS Compounds such as polydatin, resveratrol and emodin are likely to be the active components responsible for the anti-AGA effects of P. cuspidatum.
4.Analysis of Current Status and Prospects of Traditional Chinese Medicine in Responding to Public Health Emergencies Under Healthy China Strategy: Taking Major Emerging Epidemics as an Example
Yuqing CAO ; Xinyu JI ; Xiyu SHANG ; Qiujie CAI ; Yipin FAN ; Yanping WANG ; Yan MA
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(20):222-232
Under the background of the Healthy China strategy, the integration of traditional Chinese medicine (TCM) into the public health emergency response system has become an important measure to enhance the capacity for coping with public health emergencies. In recent years, the role of TCM in responding to such emergencies has become increasingly prominent. Taking major emerging epidemics as an example, TCM has developed a rich theoretical system and practical experience in epidemic prevention and treatment over thousands of years, and has played a significant role in successive outbreaks with its unique advantages. Based on the concept of ''preventing disease before its onset'' and the theoretical framework of treatment based on syndrome differentiation, TCM has achieved remarkable results through early intervention and full participation in the integrated model of TCM and Western medicine, from severe acute respiratory syndrome (SARS) to corona virus disease-2019 (COVID-19), in improving clinical symptoms and outcomes, reducing adverse reactions, and promoting recovery. From the perspective of the Healthy China strategy, this paper systematically reviews the historical development of TCM in epidemic prevention and treatment, with particular attention to recent epidemics such as SARS, influenza A (H1N1), and COVID-19. It further examines the similarities and differences between TCM and Western medicine in responding to major emerging epidemics, as well as relevant policies related to TCM in epidemic prevention and control. In addition, it summarizes the existing problems in TCM's role in the prevention and treatment of major emerging epidemics, and explores measures to improve its rapid response capacity under the Healthy China strategy. This study not only provides a ''Chinese solution'' for the prevention and control of newly emerging infectious diseases worldwide, but also offers theoretical and practical references for strengthening the public health emergency response system, carrying strategic significance for promoting the modernization and internationalization of TCM.
5.Cinnamomi Ramulus-Alismatis Rhizoma in Treatment of External-contraction Diseases from Traditional Chinese Medicine and Modern Pharmacy: A Review
Yuqing CAO ; Yang GUO ; Xiyu SHANG ; Zihan JIA ; Yibai XIONG ; Renbo CHEN ; Lei ZHANG ; Lin TONG ; Huamin ZHANG ; Yan MA
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(24):279-288
Cinnamomi Ramulus and Alismatis Rhizoma are commonly used in the treatment of external-contraction diseases. Cinnamomi Ramulus is pungent, sweet, and warm, with the effects of ventilating lung and dispersing cold, warming Yang and transforming Qi, and promoting water and liquid flow from Taiyang meridian to remove dampness. Alismatis Rhizoma is sweet and cold, with the effects of draining dampness and promoting urination, regulating the waterway, removing water retention in lung, and promoting urination to remove dampness and heat. Herbal pairs are extracted from the accumulated experience of medical practitioners over the ages in the use of medicines and have been proved by clinical application to be composed of simple and effective combinations for specific diseases. The herb pair Cinnamomi Ramulus-Alismatis Rhizoma is an important part in ancient classic formulas such as Wulingsan. Both herbs play a role in draining dampness and promoting urination, warming Yang and transforming Qi, being a representative herb pair used for treating external-contraction exterior syndrome and water retention inside. The review of ancient medical publications revealed that there were a large number of compound formulas containing Cinnamomi Ramulus-Alismatis Rhizoma for dispersing cold and removing dampness, which were widely used for thousands of years in clinical practice. Modern pharmacological studies have shown that the active pharmacological components of Cinnamomi Ramulus (cinnamaldehyde and cinnamic acid) and Alismatis Rhizoma (alisol A and 23-acetate alisol B) have anti-inflammatory, antiviral, and immunoregulatory effects and high safety. Qingfei Paidu decoction containing this herbal pair played an important role in fighting against COVID-19. Despite the extensive pharmacological studies on Cinnamomi Ramulus and Alismatis Rhizoma, few studies have been carried out regarding this herb pair. This paper summarizes the traditional Chinese medicine knowledge about Cinnamomi Ramulus and Alismatis Rhizoma in the treatment of external-contraction diseases and summarizes the chemical composition, pharmacological effects, toxicology and other aspects of the two herbs before and after compatibility, aiming to provide a reference for further research and clinical application.
6.Traditional Chinese Medicine Treats Cardiovascular Diseases by Regulating Mitochondrial Membrane Potential: A Review
Jingzhuo MA ; Yuqing TAN ; Hengwen CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(12):242-250
Mitochondrial membrane potential (MMP) is one of the most sensitive indicators of cell damage and one of the potential targets of traditional Chinese medicine (TCM) intervention in the cardiac function. Cardiovascular diseases, with complex mechanisms of the occurrence and development, often involve the myocardium and other organs and present slow development and high mortality, seriously affecting the quality of life of patients. The TCM treatment of cardiovascular diseases is praised for small side effects, low drug resistance, and holistic treatment and can effectively relieve symptoms and improve prognosis. In recent years, the research on the occurrence mechanism of cardiovascular diseases from mitochondrial function has gained increasing attention. MMP is closely related to the functioning mechanism of mitochondria. Studies have shown that TCM regulates MMP to treat cardiovascular diseases by modulating energy metabolism, improving mitochondrial structure and function, and inhibiting oxidative stress and apoptosis, thus protecting the heart function, improving the cure rate, and reducing the mortality of patients. This paper systematically reviews the studies about the mechanisms of TCM regulation of MMP in cardiovascular diseases including atherosclerosis, heart failure, myocardial ischemia-reperfusion injury, diabetic cardiomyopathy disease, and pulmonary artery hypertension. Most of Chinese medicine compound prescriptions, Chinese medicinal herbs, effective fraction, and active components can protect mitochondrial function by regulating MMP. However, relevant clinical trials and TCM theoretical studies of MMP remain to be carried out to provide more ideas for TCM treatment of cardiovascular diseases.
7.Visual analysis of the effect of apoptosis on ischemic stroke
Yanzhe DUAN ; Jianlin HUA ; Zhibin DING ; Nan JIANG ; Lijuan SONG ; Yuqing YAN ; Cungen MA
Chinese Journal of Tissue Engineering Research 2024;28(26):4145-4150
BACKGROUND:Ischemic stroke is a highly prevalent disease associated with apoptosis.Neuronal death occurs after cerebral ischemia,including necrosis and apoptosis.The ischemic core region is dominated by necrosis,while delayed neuronal death in the penumbra is dominated by apoptosis.The penumbra has become a target for the treatment of ischemic stroke.This bibliometric analysis was used to identify the characteristics,hotspots,and frontiers of global scientific output related to apoptosis in ischemic stroke over the past 5 years. OBJECTIVE:To analyze the role of apoptosis and its mechanisms in the pathological process of ischemic stroke through a bibliometric approach. METHODS:A total of 927 relevant literature records from 2018 to 2022 were retrieved from Science Citation Index Expanded(SCI-Expanded)and Social Science Citation Index Expanded(SSCI-Expanded)of the Web of Science Core Collection.Research trends and hotspots of apoptosis in ischemic stroke were visualized using Citespace,VOSviewer and Bibliometrix. RESULTS AND CONCLUSION:From 2018 to 2020,the number of papers on the role of apoptosis in ischemic stroke showed an upward trend,but in 2020,the number of papers began to reduce.China had the largest number of publications,and the United States ranked the second.Capital Medical University and BRAIN RESEARCH BULLETIN were the institutions and journals with the most articles,respectively.In recent years,the two keywords"expression"and"oxidative stress"have appeared more frequently.The bibliometric study showed that in the past 5 years,most of the studies focused on basic research,in which research on the role of apoptosis in ischemic stroke has gradually decreased in the last 3 years,showing a downward trend.On the contrary,nerve regeneration has gradually become a research hotspot,especially the regulation of neurotrophic factors under the influence of different mechanisms,and the research on angiogenesis and glial cell repair is on the rise.At the same time,apoptosis in nerve regeneration is a potential point of discovery.
8.WIN55212-2 inhibits glycolysis and attenuates acute lung injury in septic mice by regulating mTOR/HIF-1α/PFKFB3 signaling pathway
Qianwen DUAN ; Xupeng DONG ; Yuan MA ; Che LIU ; Ming ZHANG ; Yuqing MA
Chinese Journal of Pathophysiology 2024;40(3):521-526
AIM:To investigate the effects of cannabinoid receptor agonist WIN55212-2(WIN)on acute lung injury(ALI)in septic mice,and to explore its potential mechanisms through glycolysis.METHODS:A mouse model of septic ALI was established by intraperitoneal injections of lipopolysaccharide(LPS).Male C57BL/6J mice were randomly divided into 4 groups(n=6):(1)control group;(2)LPS group,receiving intraperitoneal injections of LPS at 10 mg/kg;(3)LPS+WIN group,receiving 1 mg/kg WIN intraperitoneally 30 min prior to LPS injection;(4)LPS+WIN+MHY1485[mammalian target of rapamycin(mTOR)activator]group,receiving 10 mg/kg MHY1485 intraperitoneally 1 d before LPS injection and 1 mg/kg WIN plus 10 mg/kg MHY1485 30 min before LPS injection.Tissues were collected 24 h after modeling for analysis.Lung indexes were calculated,and histopathological changes of lung tissues were observed via he-matoxylin-eosin(HE)staining.Inflammatory cytokines interleukin-1β(IL-1β)and IL-10 in lung tissues,and lactic acid and lactate dehydrogenase A(LDHA)in serum were quantified using ELISA.The levels of mTOR/hypoxia-inducible fac-tor-1α(HIF-1α)/6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3(PFKFB3)signaling pathway-related proteins were assessed by Western blot.RESULTS:Compared with control group,the LPS group exhibited an increased lung in-dex,significant lung tissue damage,an increase in IL-1β levels(P<0.05),a decrease in IL-10 levels(P<0.05),and el-evated expressions of lactate and LDHA(P<0.05),along with increased levels of phosphorylated mTOR(p-mTOR),HIF-1α and PFKFB3 proteins(P<0.05).The LPS+WIN group showed improvements with a reduced lung index(P<0.05),lessened lung injury,decreased IL-1β levels(P<0.05),increased IL-10 levels(P<0.05),and lower levels of lactic acid,LDHA,p-mTOR,HIF-1α,and PFKFB3(P<0.05).Conversely,the LPS+WIN+MHY1485 group displayed increased lung indexes and lung tissue damage,elevated IL-1β levels(P<0.05),reduced IL-10 levels(P<0.05),and higher expressions of lactic acid,LDHA,p-mTOR,HIF-1α and PFKFB3(P<0.05)compared to the LPS+WIN group.CONCLUSION:WIN55212-2 mitigates sepsis-induced ALI,potentially by modulating the mTOR/HIF-1α/PFKFB3 sig-naling pathway,thereby inhibiting glycolysis and alleviating inflammatory responses.
9.Augmented reality navigation system for assisting CT-guided puncture of pulmonary nodules in dog models
Tao ZHOU ; Nannan SUN ; Xiaobo FAN ; Xiu WANG ; Zhengyi XIE ; Yuqing SUN ; Chenxiao YANG ; Chunming XU ; Shouyu ZHANG ; Zhuangfei MA ; Min ZHANG ; Shouqiang JIA
Chinese Journal of Interventional Imaging and Therapy 2024;21(1):38-41
Objective To observe the value of augmented reality(AR)navigation system for assisting CT-guided puncture of pulmonary nodules in dog models.Methods Five healthy dogs were selected,and 4 target lung rings were implanted in each dog to build pulmonary nodule models.Deferring to crossover design,CT-guided punctures were performed with or without AR navigation 2 and 4 weeks after successful modeling,respectively,while punctures with AR navigation were regarded as AR group and the others as conventional group,respectively.The time duration of puncturing,the times of CT scanning,of needle adjustment,and the deviation distance between needle pinpoint to the center of pulmonary nodule shown on three-dimensional reconstruction were compared between groups.Results The duration time of puncture in AR group and conventional group was(13.62±5.11)min and(20.16±4.76)min,respectively.In AR group,the times of CT scanning,of needle adjustment,and the deviation distance was 2.40±0.50,2.75±0.44 and(2.94±1.92)mm,respectively,while in conventional group was 3.10±0.64,3.70±0.57 and(4.90±3.38)mm,respectively.The introduction of AR navigation was helpful to shortening the duration of puncture,reducing times of CT scanning and needle adjustment,also decreasing positioning error of needle pinpoint(all P<0.05).In contrast,the variance of puncture sequences and dogs had no obvious effect on the results(both P>0.05).Conclusion AR navigation system could improve accuracy and efficiency in CT-guided puncture of pulmonary nodules in dog models.
10.WIN55212-2 alleviates acute kidney injury in septic mice by regulating the AKT/mTOR/PFKFB3 signaling pathway
Xupeng DONG ; Qianwen DUAN ; Yuan MA ; Che LIU ; Yu GONG ; Yuqing MA
Journal of Army Medical University 2024;46(10):1100-1106
Objective To investigate the effects of cannabinoid receptor agonist,WIN55212-2(WIN),on acute kidney injury(AKI)in mice with sepsis and its underlying mechanism.Methods Twenty-four healthy male mice were divided into(n=6):Control group,sepsis group(LPS group),sepsis+WIN55212-2 group(LPS+WIN group)and sepsis+WIN55212-2+mTOR activator MHY1485 group(LPS+WIN+MHY group).The sepsis model was constructed by intraperitoneal injection of LPS.After the tissue and blood samples were harvested in 24 h after modeling,ELISA was used to determine the contents of IL-1β,IL-18 and lactate dehydrogenase A(LDHA)in the renal tissues,as well as Scr,kidney injury molecule-1(KIM-1)and lactic acid(LA)in the serum.HE staining was employed to observe the pathological changes of kidney tissue and Paller score was calculated.The expression of p-AKT,p-Mtor and 6-phosphofructokinase-2/fructose-2,6-biphosphatase 3(PFKFB3)in the renal tissues was detected by Western blotting.Results Compared with the Control group,the LPS group had obvious kidney tissue damage,increased Paller score(P<0.05),increased serum contents of lactic acid,Scr and KIM-1(P<0.05),up-regulated contents of LDHA,IL-1β and IL-18 in the renal tissues(P<0.05),and elevated expression levels of p-AKT,p-Mtor and PFKFB3 in the renal tissues(P<0.05).Milder pathological injury in kidney tissue,decreased Paller score(P<0.05),reduced contents of lactic acid,Scr and KIM-1(P<0.05),decreased contents of LDHA,IL-1β and IL-18(P<0.05),and lower expression of p-AKT,p-Mtor and PFKFB3 were observed in the LPS+WIN group than the LPS group(P<0.05).The LPS+WIN+MHY group had notably higher Paller score(P<0.05),raised contents of lactic acid,Scr and KIM-1(P<0.05),increased contents of LDHA,IL-1β and IL-18(P<0.05),and up-regulated expression of p-AKT,p-Mtor and PFKFB3(P<0.05)when compared with the LPS+WIN group.Conclusion WIN can alleviate AKI in sepsis,and it may reduce the level of glycolysis in renal tissue,and alleviate inflammation through inhibiting AKT/Mtor/PFKFB3 signaling pathway.

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