Baihui (DU20), Shenmen (HT7) and Sanyinjiao (SP6) target the cAMP/CREB/BDNF and PI3K/Akt pathways to reduce central nervous system apoptosis in rats with insomnia

Parishin A alleviates insomnia by regulating hypothalamic-pituitary-adrenal axis homeostasis and directly targeting orexin receptor OX2

Parishin A (PA), a bioactive compound derived from Gastrodia elata Blume, has been used as a herbal remedy for insomnia. Nevertheless, the mechanism underlying the effect of PA on promotion of sleep and its potential targets remain to be elucidated. This study aimed to investigate the potential of PA in ameliorating insomnia, probing into its interactions with the orexin receptor 2 (OX2), antagonists of which are used clinically for the treatment of sleep disorders. We employed an array of methodologies, including in vivo experiments involving the assessment of the impacts of PA on sleep behavior in a p-chlorophenylalanine (PCPA)-induced insomnia mouse model, and the detection of neurotransmitters, inflammatory factors, and hypothalamic-pituitary-adrenal (HPA) axis-related hormones. In vitro experiments, such as extracellular signal-regulated kinase (ERK) 1/2 phosphorylation assay, drug-receptor binding stability assay (DARTS), cellular thermal shift assay (CETSA), solvent-induced protein precipitation (SIP), and molecular docking, were performed to validate the interaction between PA and OX2. The results showed that PA relieved insomnia in mice by effectively increasing the content of 5-hydroxytryptamine (5-HT) while reducing those of dopamine (DA), norepinephrine (NE) and glutamine/γ-aminobutyric acid (Glu/GABA), as well as the inflammatory factor tumor necrosis factor-alpha (TNF-α) in the hypothalamus. PA also improved the morphological changes in the hippocampus of insomnia mice and decreased the levels of HPA axis-related hormones. Furthermore, OX2 was found to be a potential direct target of PA. In conclusion, PA might be an antagonist of OX2 because of its ability to inhibit OX2-induced ERK 1/2 activation. These findings provide valuable insights into the therapeutic potential of PA in insomnia.

Electroacupuncture Promotes the Proliferation and Differentiation of Enteric Neural Precursor Cells via the PTEN/PI3K/Akt/mTOR Signaling Pathway in Diabetic Mice

BACKGROUND

Enteric neuronal loss significantly contributes to gastrointestinal (GI) motility disorders. Electroacupuncture (EA) can promote the regeneration of lost enteric neurons in diabetic mice, but its mechanisms are not fully understood. Nestin+/Ngfr+ cells can function as enteric neural precursor cells (ENPCs) to proliferate and differentiate into enteric neurons in adult mice. However, EA's effects on ENPCs remain unknown. The study aimed to investigate whether EA reversed enteric neuronal loss via regulation of ENPCs and its molecular basis.

MATERIALS AND METHODS

The study utilized conventional C57BL/6J mice and ENPC-tracing transgenic mice. Streptozotocin-induced type 1 diabetic mouse, PI3K inhibitor, and PTEN inhibitor models were used. GI motility was evaluated by defecation frequency, fecal water content, and whole gut transit test. The alterations of enteric neurons, ENPCs, and PTEN/PI3K/Akt/mTOR signaling were detected by Western blot and immunofluorescence.

RESULTS

EA increased defecation frequency and fecal water content, reduced whole gut transit time, and increased the number of enteric neurons. Notably, EA inhibited ENPC apoptosis and facilitated ENPC proliferation and differentiation with a preferential into ChAT enteric neurons. Additionally, PTEN was decreased and PI3K/Akt/mTOR signaling was activated with EA. However, LY294002 (PI3K inhibitor) inhibited EA's effects on ENPCs, while BpV(HOpic) (PTEN inhibitor) partially rescued these inhibitory effects.

CONCLUSIONS

EA alleviates diabetic enteric neuropathy by regulating ENPC dynamics through the PTEN/PI3K/Akt/mTOR signaling pathway. Notably, EA-mediated anti-apoptotic and pro-proliferative effects on ENPCs, and their preferential cholinergic differentiation establish EA as a multimodal therapy that bridges neuromodulation with precursor cell biology, offering an alternative strategy for GI motility disorders.

Acupuncture for chronic insomnia disorder: a systematic review with meta-analysis and trial sequential analysis

Objective

To investigate the effect of placebo response to acupuncture on subjective and objective sleep indices in patients with chronic insomnia disorder and to understand the effectiveness of acupuncture in the treatment of chronic insomnia disorder (CID).

Methods

A comprehensive search was conducted from the inception of the databases to March 17, 2025, encompassing eight databases. A randomized controlled pilot study of collecting acupuncture versus sham acupuncture for the treatment of CID. Systematic collection of acupuncture therapies for CID was performed based on randomized controlled trials (RCTs). Independent researchers critically reviewed the literature, recorded relevant data, and assessed the quality of research. Data were analyzed using RevMan 5.3, Stata 17.0, and TSA 0.9.5.10.

Results

The study included a total of 757 patients across 10 trials. Acupuncture demonstrated significant improvement in PSQI scores [MD = -2.60, 95% CI = (-3.24, -1.97), p < 0.00001] and ISI scores (MD = -2.04, 95% CI = [-3.18, -0.90], p = 0.0005) compared to sham acupuncture. Sequential analyses of the trials showed stable results. Subgroup analyses showed that manual acupuncture and electroacupuncture were superior to sham acupuncture in improving PSQI scores [MD = -3.85, 95% CI = (-4.94, -2.76), p < 0.00001; MD = -1.67, 95% CI = (-2.25, -1.08), p < 0.00001]. Manual acupuncture and electroacupuncture were superior to sham acupuncture in improving ISI scores [MD = -2.60, 95% CI = (-4.72, -0.48), p = 0.02; MD = -1.93, 95% CI = (-3.16, -0.71), p = 0.002]. In terms of objective sleep indices, there was no statistically significant difference in total sleep time between acupuncture and sham acupuncture [MD = 11.92, 95% CI = (-20.25, 44.09), p = 0.47]. Acupuncture was superior to sham acupuncture in terms of sleep efficiency and wake after sleep onset [MD = 3.62, 95% CI = (0.92, 6.32), p = 0.009; MD = -18.53, 95% CI = (-29.22, -7.85), p = 0.0007]. However, the sequential analysis indicated limitations due to small sample size which hindered drawing definitive conclusions.

Conclusion

Compared with sham acupuncture, acupuncture is effective in improving subjective sleep quality in patients with CID. However, whether acupuncture improves patients' objective sleep indices compared to sham acupuncture is uncertain and more high-quality clinical trial evidence is needed to validate this.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, Identifier CRD42024541760.

The Chronobiological and Neuroprotective Mechanisms of Resveratrol in Improving Sleep

According to statistics, more than one-third of the global population currently experiences sleep problems, and about 10% of adults have been diagnosed with insomnia, a proportion that is increasing annually. Most currently used insomnia medications are not specifically developed but are discovered by chance, often resulting in unavoidable side effects like addiction. Thus, there is an urgent need to find safer and more effective therapeutic options. Resveratrol, a natural polyphenolic compound, shows significant potential in improving insomnia. Research shows that its effects may be achieved through multiple biological processes, including antiapoptosis, antioxidant activity, anti-inflammation, circadian rhythm regulation, modulation of neurotransmitters (gamma-aminobutyric acid (GABA), DA, 5-HT, cortisol), and increased levels of neurotrophic factor BDNF. Additionally, resveratrol's treatment of insomnia is closely linked to the SIRT1, AMPK, NF-κB, mTOR, PI3K/Akt, and MAPK pathways. This review summarizes the mechanisms of resveratrol in treating insomnia to provide researchers with a deeper understanding of its action, which can aid in the development of novel targeted drugs and offer innovative ideas and methods for clinical insomnia treatment.

Comparative efficacy of interventions for insomnia in cancer patients: a systematic review and network meta-analysis

BACKGROUND

Cancer-related insomnia demonstrates twice the prevalence observed in the general population, with significant implications for disease progression. This network meta-analysis systematically compares the therapeutic efficacy of diverse interventions for managing insomnia in oncological populations.

METHODS

We systematically queried four biomedical databases (PubMed, Embase, Medbase, and Web of Science) for eligible studies assessing insomnia interventions in cancer patients. Primary outcomes encompassed standardized metrics: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE). A frequentist approach with random-effects model was employed for comparative effectiveness analysis.

RESULTS

The analysis incorporated 21 studies with sample sizes ranging from 16 to 255 participants. Comparative evaluation against standard care revealed that both cognitive behavioral therapy for insomnia (CBT-I) (MD = - 3.04, 95%CI[- 4.49,-1.59]) and electroacupuncture (MD = - 3.80, 95%CI[- 6.50,-1.09]) produced clinically meaningful reductions in ISI scores, while CBT-I (MD = 2.71%, 95%CI[0.89,4.53]) and Tai Chi (MD = 5.26%, 95%CI[0.41,10.11]) exhibited statistically significant improvements in sleep efficiency metrics.

CONCLUSIONS

CBT-I emerges as an evidence-based intervention for ameliorating insomnia severity and optimizing sleep efficiency in cancer patients. Complementary modalities including electroacupuncture and Tai Chi present viable alternatives. Methodological limitations necessitate future rigorously designed trials to strengthen clinical recommendations.

Efficacy and Safety of Acupuncture for Post-COVID-19 Insomnia: Protocol for a Systematic Review and Meta-Analysis

BACKGROUND

The COVID-19 pandemic has had a profound global impact, leading to a range of persistent sequelae referred to as post-COVID-19 condition or "long COVID" that continue to affect patients worldwide. Among these sequelae, post-COVID-19 insomnia (PCI) has emerged as a significant issue. Conventional treatments, including cognitive behavioral therapy and pharmacological interventions, face limitations such as variable efficacy, potential side effects, and substantial costs. Recently, acupuncture has gained traction due to its efficacy, cost-effectiveness, and safety profile.

OBJECTIVE

This study aims to conduct a meta-analysis and systematic review evaluating the efficacy and safety of acupuncture for the treatment of PCI to delineate the optimal modality, intervention frequency, and duration for achieving the most beneficial outcomes, thereby providing a comprehensive understanding of acupuncture's role in managing PCI, contributing to evidence-based clinical practice, and informing clinical decision-making.

METHODS

Electronic searches will be performed in 12 databases from inception to October 2024 without language restrictions. This includes both English databases (PubMed, Cochrane Library, Web of Science, Embase, OVID and Scopus), as well as Chinese databases (China National Knowledge Infrastructure, Wan-Fang Data, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, Duxiu Database and the Chinese Clinical Trial Registry Center). Randomized controlled trials on acupuncture for PCI will be included. Primary outcomes will include the response rate and insomnia severity; secondary outcomes will include the Traditional Chinese Medicine Symptom Scale (TCMSS) and adverse event rates. Data synthesis will use risk ratios for dichotomous data and mean differences for continuous data. Study selection, data extraction, and quality assessment will be conducted independently by 2 reviewers. Methodological quality of eligible studies will be evaluated following the Cochrane Handbook for Systematic Reviews of Interventions (version 6.3). Meta-analysis will be performed with RevMan 5.3.

RESULTS

Based on the data on response rate, insomnia severity, TCMSS score, and adverse event rates, this study will provide an evidence-based review of the efficacy and safety of acupuncture for PCI treatment.

CONCLUSIONS

This systematic review will present the current evidence for acupuncture for PCI, aiming to inform clinical practices and decision-making and to enhance the understanding of acupuncture's role in managing PCI. Furthermore, it will identify research gaps and suggest potential areas for future investigation.

TRIAL REGISTRATION

PROSPERO CRD42024499284; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=499284.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/69417.

Analyzing gene-based apoptotic biomarkers in insomnia using bioinformatics

Insomnia is increasingly common and poses significant health risks. The aims of this study are to identify apoptosis-related genes and potential biomarkers for insomnia and to find new therapeutic targets. Insomnia gene expression profiles were downloaded from the Gene Expression Omnibus database, and differentially expressed genes in normal and insomnia samples were identified by limma rapid differential analysis, and then the major modular genes with clinical relevance to insomnia were analyzed using the Weighted Gene Co-Expression Network Analysis, and intersections were obtained with the differentially expressed genes as well as with apoptotic gene databases. We validated apoptosis-related differentially expressed genes, enriched and analyzed the specific biological process of insomnia and related signaling pathways. In addition, we constructed a protein-protein interaction network and obtained Top10 hub genes using Cytoscape. We selected 3 of them as hub genes and compared their expression in normal hippocampal neuronal cells and hippocampal neuronal cells of the model group exposed to corticosterone induction by Western Blot and qRT-PCR experiments. A total of 190 differentially expressed apoptosis-related genes were identified in insomnia, and BCL2, SOCS3, and IL7R were identified as important hub genes. Enrichment analysis showed that the occurrence of apoptosis in insomnia was mainly related to "PI3K-Akt signaling pathway," "JAK-STAT signaling pathway," "P53 signaling pathway" and so on. GO analysis showed that apoptosis in insomnia was mainly related to "immune response," "T cell differentiation in thymus," and "positive regulation of MAPK cascade." Western Blot and qRT-PCR experiments showed that BCL2, SOCS3, IL7R antiapoptotic indexes were under-expressed in modeled hippocampal neuronal cells compared to normal hippocampal neuronal cells. This study emphasizes the role of apoptosis-related genes in insomnia and preliminarily predicts that the occurrence of insomnia is closely related to apoptosis. Compared to the normal group, the antiapoptotic ability of hippocampal neurons in the model group is reduced. Although BCL2 has been studied in the context of sleep deprivation, SOCS3 and IL7R have not yet been explored in insomnia. Insomnia and sleep deprivation involve similar pathways, but due to different mechanisms and types of insomnia, gene expression may vary.

Isobicyclogermacrenal ameliorates hippocampal ferroptosis involvement in neurochemical disruptions and neuroinflammation induced by sleep deprivation in rats

BACKGROUND

Sleep deprivation (SLD) is a widespread condition that disrupts physiological functions and may increase mortality risk. Valeriana officinalis, a traditional medicinal herb known for its sedative and hypnotic properties, contains isobicyclogermacrenal (IG), a newly isolated active compound. However, research on the therapeutic potential of IG for treating SLD remains limited.

METHODS

In this study, IG was extracted and characterized from Valeriana officinalis, and an SLD model was established in rats using p-chlorophenylalanine (PCPA). Behavioral tests and pathological studies were conducted to assess the effects of IG on SLD, and transcriptomic and metabolomic analyses were utilized to investigate its underlying mechanisms.

RESULTS

IG administration significantly improved the cognitive performance of SLD rats in behavioral tests and ameliorated histological injuries in the hippocampus and cerebral cortex. IG treatment increased the levels of brain-derived neurotrophic factor (BDNF) and neurotransmitters such as serotonin (5-HT) in SLD rats. Additionally, IG directly targets TFRC, thereby improving iron metabolism in the hippocampus. Comprehensive transcriptomic and metabolomic analyses revealed that the improvements from IG stemmed from the mitigation of abnormalities in iron metabolism, cholesterol metabolism, and glutathione metabolism, leading to reduced oxidative stress, ferroptosis, and neuroinflammation in the hippocampus caused by SLD.

CONCLUSIONS

Collectively, these findings suggest that IG has the potential to ameliorate neurological damage and cognitive impairment caused by SLD, offering a novel strategy for protection against the adverse effects of SLD.

The central regulatory effects of acupuncture in treating primary insomnia: a review

Chronic insomnia has the potential to significantly impact physical well-being, occupational performance, and overall quality of life. This review summarizes the clinical and basic research on the central regulatory mechanism of acupuncture in treating primary insomnia (PI), aiming to explore the clinical effectiveness and possible mechanism of acupuncture in treating PI. The currently available drugs for insomnia exhibit notable adverse effects and tend to induce dependence. Empirical evidence from clinical investigations has demonstrated that acupuncture has a favorable safety profile while substantially enhancing the sleep quality of individuals diagnosed with PI. The combination of acupuncture and medication has been shown to augment the therapeutic efficacy of medication while reducing the dosage and mitigating the occurrence of unwanted effects. A review of the current clinical and basic research on the effects of acupuncture on central alterations in PI patients revealed that acupuncture exerts a regulatory influence on the functional activity of brain regions implicated in cognitive and emotional processes. Additionally, acupuncture has been found to impact metabolite levels and circadian clock gene expression and enhance inflammatory responses and energy metabolism. Notably, a single acupuncture intervention had a modulatory effect on functional brain regions similar to that of cumulative acupuncture. The current clinical trials on acupuncture have been limited in scale, and basic research has focused on a single objective. With the continuous progress of brain research, extensive clinical randomized controlled trials of high quality can be combined with various neuroimaging technology modalities. Moreover, different targets and pathways can be explored through basic research. This may serve to enhance the understanding of the fundamental central nervous system mechanisms involved in the efficacy of acupuncture in treating PI.

Electroacupuncture alleviates paradoxical sleep deprivation-induced postoperative hyperalgesia via a7nAChR mediated BDNF/TrkB-KCC2 signaling pathway in the spinal cord

Perioperative Paradoxical sleep deprivation (PSD) is associated with postoperative hyperalgesia. However, the clinical therapeutic strategies for PSD-induced postoperative hyperalgesia are limited. Electroacupuncture (EA) has been used for attenuating many types of pain, including neuropathic pain and inflammatory pain, but its effect on PSD-induced postoperative hyperalgesia is still unclear, and its analgesia mechanism should be further explored. In this study, we designed to investigate the possible mechanism of PSD-induced postoperative hyperalgesia and the effect of EA on PSD-induced postoperative hyperalgesia, and whether the mechanism is related to the BDNF/TrkB signaling pathway mediated by α7nAChR in the spinal cord. The paw withdrawal thermal latency (PWTL) and paw withdrawal mechanical threshold (PWMT) of rats were used to detect PSD-induced hyperalgesia. The expression of α7nAChR, BDNF, TrkB and KCC2 in the spinal cord were evaluated by Western blot and immunofluorescence. The results showed that preoperative 24 h PSD significantly decreased the PWTL and PWMT. The expression of α7nAChR and KCC2 significantly downregulated in the spinal cord of PSD-induced postoperative hyperalgesia rats, the opposite was observed for BDNF and TrkB expression. Moreover, intrathecal injection of alpha-bungarotoxin (α-BGT), a selective antagonist for α7nAChR, not only aggravated the pain hypersensitivity, but also demonstrated a further decrease of α7nAChR and KCC2 expression and a further increase of BDNF and TrkB expression. EA stimulation increased the PWTL and PWMT values of PSD-induced postoperative hyperalgesia rats, significantly upregulated α7nAChR and KCC2 expression, and significantly downregulated BDNF and TrkB expression. Moreover, intrathecal injection of α-BGT suppressed the analgesic effect of EA, inhibited the enhancement of α7nAChR and KCC2 expression and the reduction of BDNF and TrkB expression induced by EA. In conclusion, our study indicated that 24 h PSD can cause postoperative hyperalgesia, and the mechanism may be related to the disorder of α7nAChR mediated BDNF/TrkB-KCC2 signaling pathway. EA can alleviate postoperative hyperalgesia induced by PSD, which may be related to its effect in activating α7nAChR, inhibiting the expression of BDNF/TrkB, and up-regulating the expression of KCC2 in the spinal cord.

Medication Rules of Hub Herb Pairs for Insomnia and Mechanism of Action: Results of Data Mining, Network Pharmacology, and Molecular Docking

OBJECTIVES

To explore the medication rules of traditional Chinese medicine (TCM) and mechanism of action of hub herb pairs for treating insomnia.

METHODS

Totally 104 prescriptions were statistically analyzed. The association rule algorithm was applied to mine the hub herb pairs. Network pharmacology was utilized to analyze the mechanism of the hub herb pairs, while molecular docking was applied to simulate the interaction between receptors and herb molecules, thereby predicting their binding affinities.

RESULTS

The most frequently used herbs in TCM prescriptions for treating insomnia included Semen Ziziphi Spinosae, Radix Glycyrrhizae, Radix et Rhizoma Ginseng, and Poria cum Radix Pini. Among them, the most commonly used were the supplementing herbs, followed by heat-clearing, mind-calming, and exterior-releasing ones, with their properties of warm and cold, flavors of sweet, Pungent, and bitter, and meridian tropisms of liver, lungs, spleen, kidneys, heart, and stomach. The hub herb pairs based on the association rules included Radix Astragali-Radix et Rhizoma Ginseng, Rhizoma Chuanxiong-Radix Glycyrrhizae, Seman Platycladi-Semen Ziziphi Spinosae, Pericarpium Citri Reticulatae-Radix Glycyrrhizae, Radix Polygalae-Semen Ziziphi Spinosae, and Radix Astragali-Semen Ziziphi Spinosae. Network pharmacology revealed that the cAMP signaling pathway might play a key role in treating insomnia synergistically with HIF-1 signaling pathway, prolactin signaling pathway, chemical carcinogenesis receptor activation, and PI3K-Akt signaling pathway. Molecular docking indicated that there was good binding between the active ingredients of the hub herb pairs and the hub targets.

CONCLUSIONS

This study identified six hub herb pairs for treating insomnia in TCM. These hub herb pairs may synergistically treat insomnia with HIF-1 signaling pathway, prolactin signaling pathway, chemical carcinogenesis receptor activation, and PI3K-Akt signaling pathway through the cAMP signaling pathway.

The altered hypothalamic network functional connectivity in chronic insomnia disorder and regulation effect of acupuncture: a randomized controlled neuroimaging study

BACKGROUND

The hypothalamus has been recognized as a core structure in the sleep-wake cycle. However, whether the neuroplasticity of the hypothalamus is involved in the acupuncture treatment of insomnia remains elusive.

METHODS

We recruited 42 patients with chronic insomnia disorder (CID) and 23 matched healthy controls (HCs), with CID patients randomly assigned to receive real acupuncture (RA) or sham acupuncture (SA) for four weeks. Insomnia severity was evaluated using the Pittsburgh Sleep Quality Index (PSQI) score, and the resting-state functional connectivity (rsFC) of the hypothalamus was assessed via functional magnetic resonance imaging (fMRI).

RESULTS

In the cross-sectional investigation, CID patients showed increased rsFC between the medial hypothalamus (MH) and left lateral orbital frontal cortex (LOFC), and bilateral medial orbital frontal cortex (MOFC) compared to HCs. In the longitudinal experiment, PSQI scores significantly decreased in the RA group (p = 0.03) but not in the SA group. Interestingly, the increased MH-LOFC connectivity was found to be reduced following RA treatment. In addition, the altered rsFC of MH-LOFC significantly correlated with clinical improvement in the RA group (r = -0.692, p = 0.006).

CONCLUSION

This randomized neuroimaging study provides preliminary evidence that acupuncture may improve insomnia symptoms by restoring circuits associated with hypothalamic subregions.

TRIAL REGISTRATION

This trial has been registered on the Chinese Clinical Trial Registry ( www.chictr.org.cn ) with the identifier (ChiCTR1800017092). Registered date: 11/07/2018.

The Involvement of the Ventral Tegmental Area in the Electroacupuncture Alleviation of Anxiety-Like Behaviors Induced by Chronic Restraint Stress in Mice

Emotional stress is a significant environmental risk factor for various mental health disabilities, such as anxiety. Electroacupuncture (EA) has been demonstrated to have pronounced anxiolytic effects. However, the neural mechanisms underlying these effects and their contribution to behavioral deficits remain poorly understood. Here, we addressed these issues using a classical mouse anxiety model induced by chronic restraint stress (CRS).Anxiety-like behaviors were evaluated with the open field test and elevated plus maze. Neuronal activation in various brain regions was marked using c-Fos, followed by calculations of interregional correlation to characterize a network that became functionally active following EA at the HT7 acupoint (EA-HT7). We selected the hub regions and further investigated their functions and connections in regulating anxiety-like behaviors by using a combination of chemogenetic manipulations and behavioral testing. CRS exposure induced anxiety-like behaviors. Interestingly, EA-HT7 mitigated these behavioral abnormalities. The c-Fos expression in 30 brain areas revealed a vital brain network for acupuncture responsiveness in naïve mice. Neural activity in the NAcSh (nucleus accumbens shell), BNST (bed nucleus of the stria terminalis), VMH (Ventromedial Hypothalamus), ARC (arcuate nucleus), dDG (dorsal dentate gyrus), and VTA (ventral tegmental area) was significantly altered following acupuncture. Notably, both c-Fos immunostaining and brain functional connectivity analysis revealed the significant activation of VTA following EA-HT7. Interestingly, blocking the VTA eliminated the anxiolytic effects of EA-HT7, whereas chemogenetic activation of the VTA replicated the therapeutic effects of EA-HT7. EA-HT7 has demonstrated benefits in treating anxiety and enhances brain functional connectivity. The VTA is functionally associated with the anxiolytic effects of EA-HT7.

Current perspectives and trends in acupuncture for sleep disorders: a bibliometric analysis

Background

Limitations of conventional treatment methods for sleep disorders have driven the use and development of complementary and alternative therapies such as acupuncture. However, despite the surge in related studies, there is still a lack of visual analysis and detailed elaboration regarding the current status, international collaborations, and research hotspots of acupuncture for sleep disorders.

Methods

We conducted a bibliometric analysis of publications on acupuncture for sleep disorders using the Web of Science Core Collection database from 2004 to 2023. We utilized the R package "bibliometrix" to count publications and citations, VOSviewer to create an inter-institutional referencing network, and CiteSpace to identify references and keywords with the highest citation bursts. Additionally, we employed a bibliometric online analysis platform designed for analyzing national partnerships.

Results

A total of 432 pertinent papers were retrieved, with China being the most prolific contributor, accounting for 61.6% of the publications, followed by the United States and South Korea. Despite China's high output, its average article citation rate and proportion of international collaborations were notably lower than those of the United States. Key research institutions such as the University of Hong Kong, Shanghai University of Traditional Chinese Medicine, Memorial Sloan Kettering Cancer Center, and Guangzhou University of Chinese Medicine have played significant roles in this field. Among authors, Ka-Fai Chung from the University of Hong Kong stood out as the most productive. In terms of journals, MEDICINE was the most active, while SLEEP was considered the most authoritative. The clinical effects of acupuncture for insomnia have garnered significant attention in recent years, with electroacupuncture emerging as the prevailing technique for addressing sleep disorders.

Conclusion

This bibliometric study effectively outlines the basic framework of knowledge surrounding acupuncture for sleep disorders over the past two decades, covering publications, countries, institutions, authors, and sources. It highlights promising clinical effects and underlying mechanisms of acupuncture, particularly for secondary insomnia and specific sleep disorders like restless legs syndrome. Moving forward, the focus and challenge for future research lie in the development of standardized study protocols and harmonization of efficacy assessment metrics.

A comprehensive study on the regulation of Compound Zaoren Granules on cAMP/CREB signaling pathway and metabolic disorder in CUMS-PCPA induced insomnia rats

ETHNOPHARMACOLOGICAL RELEVANCE

Compound Zaoren Granules (CZG), an optimized herbal formulation based on the traditional Chinese medicine prescription Suanzaoren decoction, are designed specifically for insomnia treatment. However, the mechanisms underlying its efficacy in treating insomnia are not yet fully understood.

AIM OF THE STUDY

The research investigated the mechanisms of CZG's improvement in insomnia by regulating cAMP/CREB signaling pathway and metabolic profiles.

METHODS

The main components of CZG were characterized by liquid chromatography-mass spectrometry (LC-MS). Subsequently, these validated components were applied to network pharmacological analysis to predict signaling pathways associated with insomnia. We evaluated the effect of CZG on BV-2 cells in vitro. We also evaluated the behavioral indexes of CUMS combined with PCPA induced insomnia in rats. HE staining and Nissl staining were used to observe the pathological damage of hippocampus. ELISA was used to detect the levels of various neurotransmitters, orexins, HPA axis, and inflammatory factors in insomnia rats. Then we detected the expression of cAMP/CREB signaling pathway through ELISA, WB, and IHC. Finally, the metabolomics was further analyzed by using UHPLC-QTOF-MS/MS to investigate the changes in the hippocampus of insomnia rats and the possible metabolic pathways were also speculated.

RESULTS

The results of CZG in vitro experiments showed that CZG has protective and anti-inflammatory effects on LPS induced BV-2 cells. A total of 161 chemical components were identified in CZG. After conducting network pharmacology analysis through these confirmed components, we select the cAMP/CREB signaling pathway for further investigate. The behavioral research results on insomnia rats showed that CZG significantly prolonged sleep time, mitigated brain tissue pathological damage, and exhibited liver protective properties. CZG treats insomnia by regulating the content of various neurotransmitters, reducing levels of orexin, HPA axis, and inflammatory factors. It can also treat insomnia by upregulating the expression of the cAMP/CREB signaling pathway. Hippocampus metabolomics analysis identified 69 differential metabolites associated with insomnia. The metabolic pathways related to these differential metabolites have also been predicted.

CONCLUSION

These results indicate that CZG can significantly prolong sleep time. CZG is used to treat insomnia by regulating various neurotransmitters, HPA axis, inflammatory factors, cAMP/CREB signaling pathways, and metabolic disorders.

Association between exposure to organophosphorus pesticide and suicidal ideation among U.S. adults: A population-based study

OBJECTIVE

This study aims to investigate the potential link between exposure to organophosphorus pesticides (OPPs) and suicidal ideation (SI) among adults.

METHODS

This study encompassed four cycles of the National Health and Nutrition Examination Survey (NHANES), involving 5244 participants aged 20 and above. SI was assessed using the Patient Health Questionnaire-9. The levels of exposure to OPPs were estimated by analyzing concentrations of OPP metabolites in urine samples. Multivariate logistic regression models were used to explore the association between exposure to each OPP and SI. Stratified analyses and interaction tests were conducted across various groups, including pairwise combinations of gender and age, as well as body mass index, smoking status, hypertension, and diabetes. Weighted Quantile Sum (WQS) regression and Bayesian Kernel Machine Regression (BKMR) models were applied to assess the cumulative impact of exposure to the four OPPs on SI, along with their respective contributions. Additionally, the potential interactions among these four OPPs were evaluated.

RESULTS

Multivariate logistic regression revealed that only dimethylthiophosphate (DMTP) among OPPs demonstrated a statistically significant positive association with SI [OR: 1.18; 95 % CI: 1.02-1.37]. Stratified analyses indicated that the influence of OPPs on SI was particularly pronounced in young and older men. The WQS regression analysis revealed a statistically significant association between the mixed metabolites of OPPs and SI [OR = 1.10, 95 % CI: 1.04-1.16], with DMTP (weighted 0.63) contributing the most. Furthermore, the BKMR model supported a positive trend in the overall impact of these OPP metabolites on SI, displaying notable individual exposure-response relationships for DMTP (PIP: 0.77).

CONCLUSIONS

Our study suggests an association between exposure to DMTP and an increased risk of SI. Specifically, young adult males and older males appear particularly susceptible to the effects of OPP exposure.

Electroacupuncture protects against cerebral ischemia-reperfusion injury through mitochondrial dynamics

Background

Electroacupuncture (EA) has been shown to promote functional recovery after cerebral ischemia-reperfusion (I/R) injury. However, the contribution of mitochondrial dynamics to recovery remains unclear. The aim of this study was to investigate whether mitochondrial dynamics are involved in the effects of EA on cerebral I/R injury.

Methods

The rats with cerebral I/R injury were established by the middle cerebral artery occlusion/reperfusion. Subsequently, EA was applied to Baihui (GV20) and Dazhui (GV14) acupoints, with 2 Hz/5 Hz in frequency, 1.0 mA in intensity, 20 min each time, once a day for seven consecutive days. The therapeutic outcomes were assessed by modified neurological severity score (mNSS), 2,3,5-Triphenyte-trazolium chloride (TTC) staining, and hematoxylin-eosin (HE) staining. Mitochondrial morphology was observed under transmission electron microscopy. Adenosine triphosphate (ATP) content and ATP synthases (ATPases) activity were evaluated to measure mitochondrial function using ELISA. Finally, mitochondrial dynamics-related molecules, including dynamin-related protein 1 (Drp1), fission 1 (Fis1), mitofusin 1 (Mfn1), mitofusin 2 (Mfn2), and optic atrophy 1 (OPA1), were detected by Western blot and immunofluorescence staining.

Results

Cerebral I/R injury induced neurological dysfunction, cerebral infarction and neuronal injury, all of which were ameliorated by EA. And EA improved mitochondrial morphology and function. Moreover, EA altered the balance of mitochondrial dynamics. Specifically, the data showed a significant decrease in the expression of Drp1 and Fis1, leading to the inhibition of mitochondrial fission. Additionally, Mfn1, Mfn2 and Opa1, which are related to mitochondrial fusion, were effectively promoted after EA treatment. However, sham EA did not show any neuroprotective effects in rats with cerebral I/R injury.

Conclusions

In summary, our study indicates that the balance of mitochondrial dynamics is crucial for EA therapy to treat cerebral I/R injury.

Efficacy and safety of electroacupuncture for insomnia: A systematic review and meta-analysis

BACKGROUND

Electroacupuncture is often used to treat insomnia.

OBJECTIVE

To evaluate the efficacy and safety of electroacupuncture for insomnia.

SEARCH STRATEGY

Databases including PubMed, Cochrane Library, Embase, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data and VIP Full-text e-Journals Database were searched up to January 15, 2023.

INCLUSION CRITERIA

Randomized clinical trials were included if they compared the clinical efficacy and safety of electroacupuncture with sham acupuncture, no treatment or usual care (UC) and general acupuncture.

DATA EXTRACTION AND ANALYSIS

The full texts of the studies were reviewed to remove ineligible literature. The extracted data included authors, publication year, diagnostic criteria, sample size, population characteristics, interventions and outcomes. The above steps were performed independently by two reviewers and the data were cross-checked. Stata15.0 software was used to analyze the extracted outcome data. For continuous data (Pittsburgh Sleep Quality Index [PSQI] score and Insomnia Severity Index score), weighted mean difference (WMD) was calculated and 95% confidence interval (CI) was reported when the same scale was applied. For dichotomous variables (clinical response rate and adverse events), a meta-analysis was performed using risk ratio (RR) as the effect indicator.

RESULTS

Thirty-one trials with 2226 subjects were included. The meta-analysis suggested that electroacupuncture was more effective in improving insomnia compared with the control group (sham acupuncture, no treatment, UC and general acupuncture) (RR = 1.21; 95% CI: [1.16, 1.27]), significantly reducing the PSQI score in insomnia patients after treatment and at follow-up (WMD = -3.23; 95% CI: [-4.29, -2.17]; P < 0.001). There was no significant difference in the incidence of adverse events between the EA and control groups (sham acupuncture and no treatment or UC. RR = 1.48; 95% CI: [0.91, 2.40]; P = 0.117). In addition, the regression results revealed that receiving electroacupuncture for seven to nine weeks provided the best efficacy (P < 0.05).

CONCLUSION

Electroacupuncture can significantly promote better sleep quality in insomnia patients and is suitable for the treatment of various types of insomnia. However, the articles included were single-center trials with small sample sizes, and some articles were of poor quality. Therefore, further research is still needed to confirm these findings. Please cite this article as: Xu HY, Wu LN, Zhang Y, Ba T, Zhao XF. Efficacy and safety of electroacupuncture for insomnia: A systematic review and meta-analysis. J Integr Med. 2024; 22(4): 460-473.

Advancements in the physiopathological study of acupuncture treatment for insomnia: A review

Insomnia is a common sleep disorder that significantly impacts an individual's psychological and physical health, characterized by persistent difficulties in falling asleep, decreased sleep quality, and impaired daytime functioning. Traditional treatment approaches primarily rely on pharmacotherapy and behavioral therapy, yet not all patients benefit from these methods, and they often come with certain side effects. Thus, identifying safe and effective alternative or adjunctive treatments is of paramount importance. The purpose of this paper is to review the research progress on acupuncture in the treatment of insomnia and to explore the mechanisms by which acupuncture may treat insomnia through regulating neurotransmitters and nervous system, anti-inflammatory actions, and improving neuroplasticity, providing evidence to support the broad application of acupuncture in clinical practice.

Acupuncture for primary insomnia: Effectiveness, safety, mechanisms and recommendations for clinical practice

Primary insomnia (PI) is an increasing concern in modern society. Cognitive-behavioral therapy for insomnia is the first-line recommendation, yet limited availability and cost impede its widespread use. While hypnotics are frequently used, balancing their benefits against the risk of adverse events poses challenges. This review summarizes the clinical and preclinical evidence of acupuncture as a treatment for PI, discussing its potential mechanisms and role in reliving insomnia. Clinical trials show that acupuncture improves subjective sleep quality, fatigue, cognitive impairments, and emotional symptoms with minimal adverse events. It also positively impacts objective sleep processes, including prolonging total sleep time, improving sleep efficiency, reducing sleep onset latency and wake after sleep onset, and enhancing sleep architecture/structure, including increasing N3% and REM%, and decreasing N1%. However, methodological shortcomings in some trials diminish the overall quality of evidence. Animal studies suggest that acupuncture restores circadian rhythms in sleep-deprived rodents and improves their performance in behavioral tests, possibly mediated by various clinical variables and pathways. These may involve neurotransmitters, brain-derived neurotrophic factors, inflammatory cytokines, the hypothalamic-pituitary-adrenal axis, gut microbiota, and other cellular events. While the existing findings support acupuncture as a promising therapeutic strategy for PI, additional high-quality trials are required to validate its benefits.

Connecting the Dots: The Cerebral Lymphatic System as a Bridge Between the Central Nervous System and Peripheral System in Health and Disease

As a recently discovered waste removal system in the brain, cerebral lymphatic system is thought to play an important role in regulating the homeostasis of the central nervous system. Currently, more and more attention is being focused on the cerebral lymphatic system. Further understanding of the structural and functional characteristics of cerebral lymphatic system is essential to better understand the pathogenesis of diseases and to explore therapeutic approaches. In this review, we summarize the structural components and functional characteristics of cerebral lymphatic system. More importantly, it is closely associated with peripheral system diseases in the gastrointestinal tract, liver, and kidney. However, there is still a gap in the study of the cerebral lymphatic system. However, we believe that it is a critical mediator of the interactions between the central nervous system and the peripheral system.

Effect of acupuncture on BDNF signaling pathways in several nervous system diseases

In recent years, the understanding of the mechanisms of acupuncture in the treatment of neurological disorders has deepened, and considerable progress has been made in basic and clinical research on acupuncture, but the relationship between acupuncture treatment mechanisms and brain-derived neurotrophic factor (BDNF) has not yet been elucidated. A wealth of evidence has shown that acupuncture exhibits a dual regulatory function of activating or inhibiting different BDNF pathways. This review focuses on recent research advances on the effect of acupuncture on BDNF and downstream signaling pathways in several neurological disorders. Firstly, the signaling pathways of BDNF and its function in regulating plasticity are outlined. Furthermore, this review discusses explicitly the regulation of BDNF by acupuncture in several nervous system diseases, including neuropathic pain, Parkinson's disease, cerebral ischemia, depression, spinal cord injury, and other diseases. The underlying mechanisms of BDNF regulation by acupuncture are also discussed. This review aims to improve the theoretical system of the mechanism of acupuncture action through further elucidation of the mechanism of acupuncture modulation of BDNF in the treatment of neurological diseases and to provide evidence to support the wide application of acupuncture in clinical practice.

The effects of acupuncture on sleep disorders and its underlying mechanism: a literature review of rodent studies

Sleep is a set of physiological processes mainly under neurobiological regulation that affect several physiological systems, and sleep disorders are a condition where normal sleep patterns are disturbed. Clinical studies have confirmed the effects of acupuncture on sleep duration and quality. Although many studies have explored the therapeutic effects of acupuncture on sleep disorders, the mechanisms are unclear. We investigated the mechanism of acupuncture efficacy in a rodent model of sleep disorders and evaluated the therapeutic effects of acupuncture treatment. According to our results, sleep disorders are associated with several brain regions and neurotransmitters. Furthermore, this review showed that neurological processes, such as catecholamine and BDNF signaling pathways, can be regulated by acupuncture, which is a crucial aspect of the acupuncture mechanism in sleep disorders.