Deciphering Pharmacological Mechanism of Buyang Huanwu Decoction for Spinal Cord Injury by Network Pharmacology Approach

Efficacy and safety of Buyang Huanwu Decoction in patients with spinal cord injury: A meta-analysis of randomized controlled trials

BACKGROUND

There has been growing interest in using the traditional Chinese herb Buyang Huanwu Decoction (BHD) as a potential treatment for spinal cord injury (SCI), owing to its long-used treatment for SCI in China. However, the efficacy and safety of BHD treatment for SCI remain widely skeptical. This meta-analysis aims to assess the safety and efficacy of BHD in managing SCI.

METHOD

A comprehensive literature search was conducted across several databases, including PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, VIP, and Sinomed, up to January 1, 2024. Randomized controlled clinical trials evaluating the safety or efficacy of BHD in SCI treatment were included. The analysis focused on 8 critical endpoints: Patient-perceived total clinical effective rate, American Spinal Cord Injury Association (ASIA) sensory score, ASIA motor score, somatosensory evoked potential, motor evoked potential, visual analog scale pain score, Japanese Orthopaedic Association score, and adverse events.

RESULTS

Thirteen studies comprising 815 participants met the inclusion criteria. No significant heterogeneity or publication bias was observed across the trials. The findings revealed significant improvements in the patient-perceived total clinical effective rate (OR = 3.77; 95% confidence interval [CI] = [2.43, 5.86]; P < .001), ASIA sensory score (mean difference [MD] = 8.22; 95% CI = [5.87, 10.56]; P < .001), ASIA motor score (MD = 7.16; 95% CI = [5.15, 9.18]; P < .001), somatosensory evoked potential (MD = 0.25; 95% CI = [0.03, 0.48]; P = .02), motor evoked potential (MD = 0.30; 95% CI = [0.14, 0.46]; P = .0002), and Japanese Orthopaedic Association score (MD = 1.99; 95% CI = [0.39, 3.58]; P = .01) in the BHD combination group compared to the control group. Additionally, there was a significant reduction in visual analog scale pain scores (MD = -0.81; 95% CI = [-1.52, -0.11]; P = .02) with BHD combination treatment, without a significant increase in adverse effects (OR = 0.68; 95% CI = [0.33, 1.41]; P = .3).

CONCLUSION

The current evidence suggests that BHD is effective and safe in treating SCI, warranting consideration as a complementary and alternative therapy. However, given the low methodological quality of the included studies, further rigorous research is warranted to validate these findings.

Chinese herbal medicine Buyang Huanwu Decoction in treatment of peripheral nerve injury: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Peripheral nerve injuries (PNI) resulting from trauma can be severe and permanently disabling, approximately one-third of PNIs demonstrate incomplete recovery and poor functional restoration. However, despite extensive research on this aspect, complete functional recovery remains a challenge. In East Asian countries, Chinese herbal Buyang Huanwu Decoction (BHD) has been used to treat PNI for more than 200 years, and the studies of BHD to treat PNI have been increasing in recent years based on positive clinical outcomes. The purpose of this meta-analysis was to scientifically evaluate the safety and clinical efficacy of BHD in patients with PNI.

METHOD

A literature search was conducted on PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, VIP, and Sinomed databases for randomized controlled clinical trials that evaluated the safety and effects of BHD alone or combination treatment on PNI.

RESULTS

A total of 14 studies involving 1415 participants were included in this study. Each trial did not show significant heterogeneity or publication bias. The results showed that significant improvements of the total clinical effective rate (odds ratio = 3.55; 95% confidence interval [CI] = [2.62, 4.81]; P < .0001), radial nerve function score (standardized mean difference [SMD] = 1.28; 95% CI = [1.09, 1.47]; P = .007), motor nerve conduction velocity (SMD = 1.59; 95% CI = [1.40, 1.78]; P < .0001), sensory nerve conduction velocity (SMD = 1.69; 95% CI = [1.34, 2.05]; P < .0001), and electromyography amplitude (SMD = 2.67; 95% CI = [1.27, 4.06]; P = .0002), and significantly reduce of the visual analog scale scores (SMD = -3.85; 95% CI = [-7.55, -0.15]; P = .04) in the BHD group compared with the control group. In addition, there were no serious and permanent adverse effects in the 2 groups, the difference was not significant (odds ratio = 1.00; 95% CI = [0.40, 2.50]; P = 1.00).

CONCLUSION

Current evidence suggests that BHD is an effective and safe treatment for PNI and could be treated as a complementary and alternative option with few side effects compared to a single treatment with neurotrophic drugs or electrical stimulation. However, considering the low methodological quality of the included studies, further rigorous studies are required.

Exploring the mechanism of Buyang Huanwu Decoction in the treatment of spinal cord injury based on network pharmacology and molecular docking

Buyang Huanwu Decoction, a traditional Chinese medicine decoction, is widely used to treat spinal cord injury in China. However, the underlying mechanism of this decoction in treating spinal cord injury is unclear. This study used network pharmacology and molecular docking to examine the pharmacological mechanism of Buyang Huanwu Decoction in prevention and treatment of spinal cord injury. The active compounds and target genes of Buyang Huanwu Decoction were collected from the Traditional Chinese Medicine Systems Pharmacology and the SwissTargetPrediction Database. The network diagram of "traditional Chinese medicine compound target" was constructed by Cytoscape software. Genetic data of spinal cord injury were obtained by GeneCards database. According to the intersection of Buyang Huanwu Decoction's targets and disease targets, the core targets were searched. The protein-protein interaction network were constructed using the STRING and BisoGenet platforms. Meanwhile, gene ontology enrichment and Kyoto encyclopedia of genes, and genome pathway were performed on the intersection targets by Metascape. Molecular docking technology was adopted to verify the combination of main components and core targets. A total of 109 active compounds and 5440 prediction targets were screened from 7 Chinese herbal medicines of Buyang Huanwu Decoction, with 98 active components and 49 related prediction targets being strongly linked to Spinal Cord Injury. By studying protein-protein interaction network, a total of 8 core proteins were identified, primarily interleukin-6, tumor protein P53, epidermal growth factor receptor, and others. Positive regulation of kinase activity regulation of reaction to inorganic chemicals are the basic biological processes. Buyang Huanwu Decoction cures Spinal Cord Injury primarily by moderating immunological inflammation, apoptosis, and oxidative stress, which involves the cancer pathway, the HIF-1 signaling pathway, the p53 signaling pathway, the MAPK signaling pathway, and so on. The results of molecular docking demonstrated that the primary components could attach to the target protein effectively. Finally, the mechanism of Buyang Huanwu Decoction in the treatment of spinal cord injury through multicomponent, multitarget, and multichannel was deeply explored. And it offers new ideas and directions for future research on the mechanism of the treatment of spinal cord injury.