Efficacy and safety of Simiao decoction in the treatment of cervical HPV infection: A systematic review and meta-analysis of randomized clinical trials

Background

Persistent HPV infection can easily lead to the occurrence and development of cervical cancer and its precancerous lesions. Many studies have shown that Simiao Decoction may be effective in treating HPV infection, but the efficacy and safety of Simiao Decoction for HPV infection have never been systematically evaluated.

Purpose

To evaluate the efficacy and safety of Simiao Decoction in the treatment of cervical HPV infection.

Study design

A systematic review and meta-analysis of all randomized clinical trials (RCTs) comparing Simiao Decoction versus conventional treatment.

Materials and methods

Seven databases were searched from their inception until May 14, 2023. All the RCTs comparing the efficacy and safety of Simiao Decoction versus conventional treatment were selected. Analyses were performed using Review Manager 5.3. HPV negative conversion rate (NCR) was defined as the primary endpoint, and treatment response rate (TRR), and adverse reaction (AR) were defined as the secondary endpoints. The quality of each endpoint was assessed by The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system.

Results

Ten RCTs recruiting 799 patients with HPV infection were included. The results showed that compared with conventional treatment, Simiao Decoction improved NCR (RR = 1.45, 95 % CI 1.31, 1.61, P < 0.00001), TRR (RR = 1.24, 95%CI 1.15, 1.33, P < 0.000 01), while it did not increase AR (RR = 0.79, 95%CI 0.46, 1.33, P = 0.37). Most results were robust and the quality of evidence was moderate.

Conclusion

Simiao Decoction is safer and more effective than conventional treatment for HPV infection. However, the efficacy and safety of Simiao Decoction should be further assessed by more high-quality RCTs with the outcome of HPV viral load and long-term follow-ups.

Gut microbiota mediated the therapeutic efficiency of Simiao decoction in the treatment of gout arthritis mice

BACKGROUND

Gut microbiota plays a significant role in the development and treatment of gouty arthritis. Simiao decoction has been shown to alleviate gouty arthritis by inhibiting inflammation, regulating NLRP3 inflammasome, and altering gut microbiota. However, there is no evidence to prove whether gut microbiota directly mediates the therapeutic efficiency of Simiao decoction in treating gout arthritis.

METHODS

In this study, fecal microbiota transplantation (FMT) was used to transfer the gut microbiota of gout arthritis mice treated with Simiao decoction or allopurinol to blank gout arthritis mice, in order to investigate whether FMT had therapeutic effects on gout arthritis.

RESULTS

Both Simiao decoction and allopurinol effectively reduced the levels of serum uric acid, liver XOD activity, foot thickness, serum IL-1β, and G-CSF in gout arthritis mice. However, Simiao decoction also had additional benefits, including raising the pain threshold, reducing serum TNF-α and IL-6, alleviating gut inflammation, and repairing intestinal pathology, which were not observed with allopurinol treatment. Moreover, Simiao decoction had a greater impact on gut microbiota than allopurinol, as it was able to restore the abundance of phylum Proteobacteria and genus Helicobacter. After transplantation into gout arthritis mice, gut microbiota altered by Simiao decoction exhibited similar therapeutic effects to those of Simiao decoction, but gut microbiota altered by allopurinol showed no therapeutic effect.

CONCLUSIONS

These findings demonstrates that Simiao decoction can alleviate gout arthritis symptoms by regulating gut microbiota.

Simiao Decoction Alleviates Gouty Arthritis by Modulating Proinflammatory Cytokines and the Gut Ecosystem

Simiao decoction, a classical traditional Chinese medicine (TCM) formula, has been widely used for thousands of years due to its safety and efficiency in treating gouty arthritis. Utilizing serum proinflammatory cytokines and gut ecosystems, this study elucidated the mechanisms of alleviating gouty arthritis by Simiao decoction. Simiao decoction (4.0, 8.0, and 16.0 g/kg) was orally administered to gouty arthritis mice and febuxostat was given as a positive control. The spleen, kidney, and liver indexes indicated that Simiao decoction was safe for the treatment of gouty arthritis in C57BL/6 mice. Besides, our study demonstrated that Simiao decoction was effective for reducing the level of serum uric acid and decreasing MPO, XOD, and ADA activity, as well as alleviating gouty-related symptoms, such as foot swelling and pain. Moreover, Simiao decoction could also reduce some specific serum proinflammatory cytokines including IL-1β, IL-9, IFN-γ, MIP-1α and MIP-1β. We then surveyed the effects of Simiao decoction on the gut ecosystems in a systematic manner by combining network pharmacology, ELISA, western blot, and illumina sequencing. In the murine of model of gouty arthritis, Simiao decoction could suppress NLRP3 inflammasomes expression, reduce gut apoptosis through modulating TNF-α, Caspase 8, and AIFM1 protein expressions, affect lipid metabolism by regulating APOB, LPL, PPARα protein expressions and restore gut microbiota via reducing potential pathogens. Overall, these findings suggested that Simiao decoction was an effective therapeutic drug for gouty arthritis and the gut ecosystem might act as a potential anti-inflammatory target of Simiao decoction.