Shexiang Baoxin Pill treats acute myocardial infarction by promoting angiogenesis via GDF15-TRPV4 signaling

The potential role of miR-450a-1-3p in chromium-associated heart rate variability reduction

Chromium (Cr) exposure has been reported to be associated with heart rate variability (HRV) decline, whereas the underlying mechanism remains unknown. In present study, a cross-sectional study was conducted in Chinese urban adults to explore the potential role of microRNAs (miRNAs) in the relationship between urinary chromium and HRV decline. In the discovery stage, 20 Cr-related miRNAs were screened out by high-throughput sequencing. Both generalized linear model and differential expression analysis were conducted and miR-450a-1-3p was chosen for further analyses. Then, the quantitative real-time polymerase chain reaction (qRT-PCR) was conducted to measure the concentration of plasma miR-450a-1-3p and generalized linear model was used to estimate the association between urinary chromium, plasma miR-450a-1-3p and HRV indices and further to explore the potential role of miR-450a-1-3p in chromium-induced HRV reduction. Precisely, a positive association of chromium exposure with plasma miR-450a-1-3p was observed and HRV indices were negatively related to urinary chromium or plasma miR-450a-1-3p concentrations elevating (all P < 0.05). Furthermore, plasma miR-450a-1-3p significantly mediated and affected the relationship between chromium exposure and HRV reduction. Finally, we used KEGG analysis to study the potential pathway of miR-450a-1-3p and inferred the arrhythmogenic right ventricular cardiomyopathy and calcium signaling pathway were involved in the chromium-induced HRV reduction.

Shexiang Baoxin Pill alleviates atherosclerosis by inhibiting macrophage-mediated inflammation via suppressing KMT5A mediated Irf7 transcription

ETHNOPHARMACOLOGICAL RELEVANCE

Shexiang Baoxin Pill (SBP) is a traditional compound formulation composed of seven Chinese medicinal ingredients. Although SBP has shown promising clinical outcomes in the treatment of cardiovascular diseases, its role and underlying mechanisms in alleviating atherosclerosis remain insufficiently studied.

AIM OF THE STUDY

This study aims to investigate the effects and mechanisms of SBP in epigenetic modulating macrophage inflammatory responses to mitigate atherosclerosis.

MATERIALS AND METHODS

ApoE-/- mice were treated with high fat diet (HFD) following varying concentrations of SBP. Oil Red O staining, hematoxylin-eosin (HE) staining, and ELISA were used to assess the anti-atherosclerotic and anti-inflammatory efficiency of SBP. Subsequently, RNA sequencing (RNA-seq), RT-PCR, Western blot (WB), immunofluorescence (IF) and chromatin immunoprecipitation (ChIP) were employed in bone marrow derived macrophages (BMDMs) to elucidate the epigenetic mechanisms of SBP in alleviating macrophage inflammatory responses. Lysine methyltransferase 5A (KMT5A) was overexpressed in vivo and in vitro for further validation.

RESULTS

SBP significantly attenuated atherosclerosis in HFD treated ApoE-/- mice by decreasing plaque areas, serum inflammation levels and macrophages infiltration in the aortic root and plaques. SBP treatment reduced BMDMs inflammatory responses following oxidized low-density lipoprotein (oxLDL) treatment. Mechanistically, SBP inhibited interferon regulatory factor 7 (IRF7) expression by reducing KMT5A-mediated mono-methylation of histone H4 lysine 20 (H4K20), thus decreasing the secretion of multiple pro-inflammatory cytokines, including interferon (IFN)-α, IFN-β, TNF-α. Overexpression of KMT5A abolished the anti-atherosclerotic and anti-inflammatory effects of SBP, further confirming that KMT5A/H4K20me/IRF7 axis is a key target for SBP exerting therapeutic effect.

CONCLUSION

SBP exerts anti-atherosclerotic effects by inhibiting macrophage inflammatory responses through downregulation of the H4K20 methylase KMT5A, thereby suppressing the transcription of Irf7. Our findings provide a novel epigenetic mechanism by which SBP alleviates atherosclerosis.

Glycometabolic Regulation of Angiogenesis: Mechanisms and Therapeutic Strategies

Angiogenesis, the process by which new blood vessels emerge from pre-existing vasculature, forms the fundamental biological basis for therapeutic angiogenesis. In recent years, this field has garnered significant attention, particularly in the context of understanding the mechanisms of angiogenesis through the lens of glycometabolism. The potential clinical applications of this research have been widely acknowledged within the medical community. In this article, the role of angiogenesis and the principal molecular mechanisms that govern it are first delineated. The influence of glycometabolism on angiogenesis is then explored, with a focus on glycolysis. Finally, research on therapeutic angiogenesis based on the regulation of glycometabolism is presented, offering novel perspectives for ongoing research and clinical applications.

Growth and differentiation factor 15: An emerging therapeutic target for brain diseases

Growth and differentiation factor 15 (GDF15), a member of the transforming growth factor-βsuperfamily, is considered a stress response factor and has garnered increasing attention in recent years due to its roles in neurological diseases. Although many studies have suggested that GDF15 expression is elevated in patients with neurodegenerative diseases (NDDs), glioma, and ischemic stroke, the effects of increased GDF15 expression and the potential underlying mechanisms remain unclear. Notably, many experimental studies have shown the multidimensional beneficial effects of GDF15 on NDDs, and GDF15 overexpression is able to rescue NDD-associated pathological changes and phenotypes. In glioma, GDF15 exerts opposite effects, it is both protumorigenic and antitumorigenic. The causes of these conflicting findings are not comprehensively clear, but inhibiting GDF15 is helpful for suppressing tumor progression. GDF15 is also regarded as a biomarker of poor clinical outcomes in ischemic stroke patients, and targeting GDF15 may help prevent this disease. Thus, we systematically reviewed the synthesis, transcriptional regulation, and biological functions of GDF15 and its related signaling pathways within the brain. Furthermore, we explored the potential of GDF15 as a therapeutic target and assessed its clinical applicability in interventions for brain diseases. By integrating the latest research findings, this study provides new insights into the future treatment of neurological diseases.

Efficacy and safety of Shexiang Baoxin Pill in patients with angina and non-obstructive coronary arteries: A multicenter, randomized, double-blind, placebo-controlled, phase Ⅳ clinical trial

INTRODUCTION

Solid evidence generated from large studies supporting the recommendation of Shexiang Baoxin Pill (MUSKARDIA) as a promising treatment for angina and nonobstructive coronary arteries (ANOCA) populations is lacking.

OBJECTIVE

To evaluate the efficacy and safety of MUSKARDIA in patients with ANOCA.

METHODS

In this randomized, double-blind, placebo-controlled, phase IV trial, we enrolled 239 patients with ANOCA at 11 centers across China between May 2021 and July 2023. Patients were randomly assigned in a 1:1 ratio to receive MUSKARDIA or placebo (orally 4 pills thrice daily) based on conventional treatment for 12 weeks. The primary endpoint was the change in angina-related outcomes, assessed using the Seattle Angina Questionnaire (SAQ) scores for the treatment groups at week 12.

RESULTS

Among 239 randomized patients with ANOCA, 236 (MUSKARDIA group, n = 117; placebo group, n = 119) completed treatment and endpoint assessments. At week 12, patients in the MUSKARDIA group showed better angina-related outcomes, with a more rapid increase in SAQ scores, than those in the placebo group (all p < 0.0001). Statistically significant differences favoring MUSKARDIA over placebo were observed for change in angina attack frequency compared with baseline at week 12 (p < 0.0001). Meanwhile, according to the Canadian Cardiovascular Society grading of angina, the change in angina pectoris severity, compared with baseline, was significantly reduced in MUSKARDIA group compared with placebo group at week 12 (p < 0.0001). The percentage of patients who did not use sublingual nitroglycerin was noticeably higher in MUSKARDIA group than that in placebo group (84.16 % vs. 58.33 %; p < 0.001). The incidence of adverse events did not differ significantly between the two groups, and no serious adverse events occurred.

CONCLUSION

This randomized, placebo-controlled clinical trial firstly confirmed that MUSKARDIA was an effective, safe, and well-tolerated treatment for patients with ANOCA in clinical settings. This study was registered at ClinicalTrials.gov (NCT04897126).

Integrated metabolomics and network pharmacology to reveal the mechanisms of Shexiang Baoxin pill against atherosclerosis

BACKGROUND

Atherosclerosis is a disease marked by the development of lipid lesions within the endothelium and continues to be a prominent contributor to global mortality. Shexiang Baoxin pill (SBP) has been employed in the management of numerous cardiovascular diseases, but the complex mechanisms by which it operates remain obscure. This research was conducted to determine the potential impact of SBP on atherosclerosis and the underlying regulatory mechanism involved.

METHOD

Network pharmacology was utilized to predict the key drug-disease targets, and a nontargeted metabolomic assay was applied to identify the key metabolites and metabolic pathways. A mouse atherosclerosis model was constructed to clarify the protective effect of SBP on atherosclerosis, and in vivo and in vitro tests were performed to verify the analysis results and clarify the mechanism through which SBP affects atherosclerosis.

RESULTS

The results show that SBP can exert a protective effect in vivo by decreasing lipid levels, plaque formation and endothelial damage. Network pharmacology and metabolomics revealed that MAPK3, AKT1 and STAT3 were the hub targets and that trimethylamine n-oxide (TMAO) was the pivotal metabolite. Due to the atherogenic effect of TMAO, the corresponding protective effect of SBP was investigated in vitro. SBP inhibited TMAO-induced endothelial cell apoptosis and oxidative stress and counteracted the upregulation of MAPK3, AKT1, and STAT3 expression. Molecular docking and enzymatic inhibition suggested that the active components of SBP could bind stably to key target proteins.

CONCLUSION

Taken together, based on the integrated metabolomics and network pharmacology, our findings suggest that SBP may be implicated in TMAO-induced atherosclerosis by affecting endothelial function and bile acid synthesis. We observed that SBP may ameliorate atherosclerosis by regulating TMAO levels through multiple pathways, which may provide a novel direction and insight for SBP involved in cardiovascular protection by mediating the gut-heart axis.

GDF15 attenuates sepsis-induced myocardial dysfunction by inhibiting cardiomyocytes ferroptosis via the SOCS1/GPX4 signaling pathway

Sepsis is a systemic inflammatory response syndrome triggered by infection, presenting with symptoms such as fever, increased heart rate, and low blood pressure. In severe cases, it can lead to multiple organ dysfunction, posing a life-threatening risk. Sepsis-induced cardiomyopathy (SIC) is a critical factor in the poor prognosis of septic patients, leading to myocardial dysfunction characterized by cell death, inflammation, and diminished cardiac function. Ferroptosis, an iron-dependent form of programmed cell death, is a key mechanism causing cardiomyocyte damage in SIC. Growth differentiation factor 15 (GDF15), a member of the TGF-β superfamily, is associated with various cardiovascular diseases and can inhibit oxidative stress, reduce reactive oxygen species (ROS), and suppress ferroptosis. Elevated serum GDF15 levels in sepsis are correlated with organ injuries, suggesting its potential as a therapeutic target. However, its role and mechanisms in SIC remain unclear. Glutathione peroxidase 4 (GPX4), the only enzyme capable of reducing lipid peroxides within cells, protects cells by reducing lipid peroxidation levels and inhibiting ferroptosis. Investigating the regulatory factors of GPX4 may provide a theoretical basis for SIC treatment. In this study, a mouse SIC model revealed that elevated GDF15 exerts a protective effect. Antagonizing GDF15 exacerbates myocardial damage. Through transcriptomic analysis and other methods, we confirmed that GDF15 inhibits the expression of SOCS1 by activating the ALK5-SMAD2/3 pathway, thereby activates the JAK2/STAT3 pathway, promotes the transcription of GPX4, inhibits ferroptosis in cardiomyocytes, and plays a myocardial protective role in SIC.

Mechanisms of Postischemic Stroke Angiogenesis: A Multifaceted Approach

Ischemic stroke constitutes a significant global health care challenge, and a comprehensive understanding of its recovery mechanisms is imperative for the development of innovative therapeutic strategies. Angiogenesis, a pivotal element of ischemic tissue repair, facilitates the restoration of blood flow to damaged regions, thereby promoting neuronal regeneration and functional recovery. Nevertheless, the mechanisms underlying postischemic stroke angiogenesis remain incompletely elucidated. This review meticulously examines the constituents of the neurovascular unit, ion channels, molecular mediators, and signaling pathways implicated in angiogenesis following stroke. Furthermore, it delves into prospective therapeutic strategies informed by these factors. Our objective is to provide detailed and exhaustive information on the intricate mechanisms governing postischemic stroke angiogenesis, thus providing a robust scientific foundation for the advancement of novel neurorepair therapies.

Mitigation of myocardial ischemia/reperfusion-induced chronic heart failure via Shexiang Baoxin Pill-mediated regulation of the S1PR1 signaling pathway

BACKGROUND

Well-defined and effective pharmacological interventions for clinical management of myocardial ischemia/reperfusion (MI/R) injury are currently unavailable. Shexiang Baoxin Pill (SBP), a traditional Chinese medicine Previous research on SBP has been confined to single-target treatments for MI/R injury, lacking a comprehensive examination of various aspects of MI/R injury and a thorough exploration of its underlying mechanisms.

PURPOSE

This study aimed to investigate the therapeutic potential of SBP for MI/R injury and its preventive effects on consequent chronic heart failure (CHF). Furthermore, we elucidated the specific mechanisms involved, contributing valuable insights into the potential pharmacological interventions for the clinical treatment of MI/R injury.

METHODS

We conducted a comprehensive identification of SBP components using high-performance liquid chromatography. Subsequently, we performed a network pharmacology analysis based on the identification results, elucidating the key genes influenced by SBP. Thereafter, through bioinformatics analysis of the key genes and validation through mRNA and protein assays, we ultimately determined the centralized upstream targets. Lastly, we conducted in vitro experiments using myocardial and endothelial cells to elucidate and validate potential underlying mechanisms.

RESULTS

SBP can effectively mitigate cell apoptosis, oxidative stress, and inflammation, as well as promote vascular regeneration following MI/R, resulting in improved cardiac function and reduced CHF risk. Mechanistically, SBP treatment upregulates sphingosine-1-phosphate receptor 1 (S1PR1) expression and activates the S1PR1 signaling pathway, thereby regulating the expression of key molecules, including phosphorylated Protein Kinase B (AKT), phosphorylated signal transducer and activator of transcription 3, epidermal growth factor receptor, vascular endothelial growth factor A, tumor necrosis factor-α, and p53.

CONCLUSION

This study elucidated the protective role of SBP in MI/R injury and its potential to reduce the risk of CHF. Furthermore, by integrating downstream effector proteins affected by SBP, this research identified the upstream effector protein S1PR1, enhancing our understanding of the pharmacological characteristics and mechanisms of action of SBP. The significance of this study lies in providing compelling evidence for the use of SBP as a traditional Chinese medicine for MI/R injury and consequent CHF prevention.