Traditional Chinese Medicine as a Treatment for Rheumatoid Arthritis:From Empirical Practice to Evidence-Based Therapy

Rheumatoid arthritis(RA)is a common autoimmune condition with an elusive etiology.Conventional and biological disease-modifying drugs sometimes fail or produce only partial responses.Traditional Chinese medicine(TCM)has long been used in China as a treatment for RA and is achieving everincreasing acceptance worldwide.TCM treatments are traditionally guided by the theory of treatment based on TCM syndrome differentiation;however,they remain a matter of empirical practice relying on TCM theories and doctors’own experience,which places severe restrictions on worldwide TCM application.Nevertheless,TCM is a treasure trove for drug discovery,particularly as a treatment for complicated human conditions.The discoveries of artemisinin as a treatment for malaria and of TCM–arsenic trioxide(As2O3)combination therapy as a treatment for acute promyelocytic leukemia(APL)are excellent examples of the great value of TCM.Regarding RA treatments,many Chinese medicinal herbs and their formulas,extracts,ingredients,and even single compounds have been used in clinical applications.Several Chinese proprietary medicines(CPMs)derived from TCM formulas or herbal bioactive components,such as the controlled-release ZhengQingFengTongNing(ZQFTN)Tablets,Tripterygium Glycoside Tablets,and Total Glucosides of Peony(TGP)Capsules,have been included in the National Health Insurance Directory of China,and show comparable therapeutic efficacies to those of western chemical drugs with fewer side effects.As TCM research has advanced,particularly in the use of multidisciplinary technologies,the scientific foundations and characteristics of the use of TCM to treat RA have been revealed,and the quality of TCM treatments have been increasingly enhanced.However,TCM generally lacks sufficient clinical and laboratory data to be consistent with international standards for quality,safety,and efficacy in order to support its application worldwide.Therefore,intensive basic and clinical studies on TCM are required.In particular,investigations that use cutting-edge technologies in analytical chemistry,biology,and biomedical sciences,and the development of randomized clinical trials(RCTs)and personalized pragmatic randomized controlled trials(PPRCTs)are necessary.Researchers should also collaborate to advance TCM from empirical practice to evidence-based therapy,thus consistently promoting TCM development and globalization in a vital,beneficial,and contributable manner.

The Scientific Foundation of Chinese Herbal Medicine against COVID-19

新近暴发的新冠病毒肺炎(COVID-19)已成为危害全球健康的紧急事件。现有证据表明,新冠病毒(SARS-CoV-2)与其他冠状病毒(如SARS-CoV和MERS-CoV)的基因序列具有相似性。因此,针对现存冠状病毒的引发疾病的机制研究和在治疗SARS时所取得的经验和教训,可咨今天对抗新冠病毒引发疾病的参考。COVID-19患者的临床病理特征提示患者在病情进展过程中通常会经历五个发展阶段:大量病毒感染、免疫系统抑制、细胞因子风暴、多器官损伤及后期的肺纤维化样改变,严重者常导致死亡。早期阻断疾病进展是取得治疗成功的关键。但是,目前尚无针对COVID-19的特效药物或疫苗,世界卫生组织(WHO)正敦促尽快建立新型预防和治疗策略。传统中医药(TCM)对于疫病的防治的实践已经积累了几千年的有用经验,它通过整体调节机体功能发挥疗效。在此次疫情中,中医药作为替代治疗或与西药联合使用,在疫情防控中发挥了重要的作用。本文总结了此次抗疫过程中中国国家和省级机构推荐使用的中药复方和中成药的潜在用途和治疗机制,以期发现其治疗COVID-19的潜在科学内涵。同时,整合应用多种组学及转化医学技术开展基础与临床研究有望进一步证实中药复方的治疗机制。

ROS-Responsive Berberine Polymeric Micelles Effectively Suppressed the Inflammation of Rheumatoid Arthritis by Targeting Mitochondria

Rheumatoid arthritis(RA)is an autoimmune disease,which attacks human joint system and causes lifelong inflammatory condition.To date,no cure is available for RA and even the ratio of achieving remission is very low.Hence,to enhance the efficacy of RA treatment,it is essential to develop novel approaches specifically targeting pathological tissues.In this study,we discovered that RA synovial fibroblasts exhibited higher reactive oxygen species(ROS)and mitochondrial superoxide level,which were adopted to develop ROS-responsive nano-medicines in inflammatory microenvironment for enhanced RA treatment.A selenocystamine-based polymer was synthesized as a ROS-responsive carrier nanoplatform,and berberine serves as a tool drug.By assembling,ROS-responsive berberine polymeric micelles were fabricated,which remarkably increased the uptake of berberine in RA fibroblast and improved in vitro and in vivo efficacy ten times higher.Mechanistically,the anti-RA effect of micelles was blocked by the co-treatment of AMPK inhibitor or palmitic acid,indicating that the mechanism of micelles was carried out through targeting mitochondrial,suppressing lipogenesis and finally inhibiting cellular proliferation.Taken together,our ROS-responsive nano-medicines represent an effective way of preferentially releasing prodrug at the inflammatory microenvironment and improving RA therapeutic efficacy.

Tanshinone IIA Suppresses Non-Small Cell Lung Cancer Through Beclin-1-Mediated Autophagic Apoptosis

It is necessary to develop a new strategy for treatment of lung cancer since it is the main cause of cancer death.Tanshinone IIA(Tan IIA),an active ingredient of a commonly used traditional Chinese herb Salvia miltiorrhiza,provides a new direction to develop a new strategy for the treatment.It has been found that Tan IIA could inhibit lung cancer in vitro and in vivo by inducing autophagic apoptosis.Tan IIA increased apoptotic cells and the expression of cleaved caspase 3 and cleaved caspase 9,decreased B-cell lymphoma-2(Bcl-2)/Bcl-2 associated X protein(Bax)ratio in human non-small cell lung cancer(NSCLC)cell lines,which was promoted by an autophagy activator Rapamycin,and weaken by autophagy inhibitor 3-methyladenine(3-MA).In addition,Tan IIA induced more autophagosomes,up-regulated light chain 3b(LC-3B)I and LC-3B II conversion and less sequestosome 1(SQSTM1/p62)expression,which cannot be weakened by the caspase 3 antagonist.Moreover,overexpression of LC-3B gene(LC3B)and downregulation of autophagic gene 5(ATG5)further confirmed that Tan IIA induced autophagic apoptosis in NSCLC cell lines.Beclin-1 gene(BECN1)overexpression and silence attenuated the effects of Tan IIA,suggesting autophagic apoptosis that Tan IIA induced was dependent on Beclin-1.Overall,our study demonstrated a new treatment mechanism of Tan IIA and suggested that Tan IIA is a potential new anti-cancer therapeutic option.

Genome engineering of the human gut microbiome

The human gut microbiome,a complex ecosystem,significantly influences host health,impacting crucial aspects such as metabolism and immunity.To enhance our comprehension and control of the molecular mechanisms orchestrating the intricate interplay between gut commensal bacteria and human health,the exploration of genome engineering for gut microbes is a promising frontier.Nevertheless,the complexities and diversities inherent in the gut microbiome pose substantial challenges to the development of effective genome engineering tools for human gut microbes.In this comprehensive review,we provide an overview of the current progress and challenges in genome engineering of human gut commensal bacteria,whether executed in vitro or in situ.A specific focus is directed towards the advancements and prospects in cargo DNA delivery and high-throughput techniques.Additionally,we elucidate the immense potential of genome engineering methods to enhance our understanding of the human gut microbiome and engineer the microorganisms to enhance human health.

Curcumenol triggered ferroptosis in lung cancer cells via lncRNA H19/miR-19b-3p/FTH1 axis

Curcumenol,an effective ingredient of Wenyujin,has been reported that exerted its antitumor potential in a few cancer types.However,the effect and molecular mechanism of curcumenol in lung cancer are largely unknown.Here,we found that curcumenol induced cell death and suppressed cell proliferation in lung cancer cells.Next,we demonstrated that ferroptosis was the predominant method that contributed to curcumenol-induced cell death of lung cancer in vitro and vivo for the first time.Subsequently,using RNA sequencing,we found that the long non-coding RNA H19(lncRNA H19)was significantly downregulated in lung cancer cells treated with curcumenol,when compared to untreated controls.Overexpression of lncRNA H19 eliminated the anticancer effect of curcumenol,while lncRNA H19 knockdown promoted ferroptosis induced by curcumenol treatment.Mechanistically,we showed that lncRNA H19 functioned as a competing endogenous RNA to bind to miR-19b-3p,thereby enhanced the transcription activity of its endogenous target,ferritin heavy chain 1(FTH1),a marker of ferroptosis.In conclusion,our data show that the natural product curcumenol exerted its antitumor effects on lung cancer by triggering ferroptosis,and the lncRNA H19/miR-19b-3p/FTH1 axis plays an essential role in curcumenol-induced ferroptotic cell death.Therefore,our findings will hopefully provide a valuable drug for treating lung cancer patients.

Herbal formula BaWeiBaiDuSan alleviates polymicrobial sepsis-induced liver injury via increasing the gut microbiota Lactobacillus johnsonii and regulating macrophage anti-inflammatory activity in mice

Sepsis-induced liver injury(SILI)is an important cause of septicemia deaths.BaWeiBaiDuSan(BWBDS)was extracted from a formula of Panax ginseng C.A.Meyer,Lilium brownie F.E.Brown ex Miellez var.viridulum Baker,Polygonatum sibiricum Delar.ex Redoute,Lonicera japonica Thunb.,Hippophae rhamnoides Linn.,Amygdalus Communis Vas,Platycodon grandiflorus(Jacq.)A.DC.,and Cortex Phelloderdri.Herein,we investigated whether the BWBDS treatment could reverse SILI by the mechanism of modulating gut microbiota.BWBDS protected mice against SILI,which was associated with promoting macrophage anti-inflammatory activity and enhancing intestinal integrity.BWBDS selectively promoted the growth of Lactobacillus johnsonii(L.johnsonii)in cecal ligation and puncture treated mice.Fecal microbiota transplantation treatment indicated that gut bacteria correlated with sepsis and was required for BWBDS anti-sepsis effects.Notably,L.johnsonii significantly reduced SILI by promoting macrophage anti-inflammatory activity,increasing interleukin-10+M2 macrophage production and enhancing intestinal integrity.Furthermore,heat inactivation L.johnsonii(HI-L.johnsonii)treatment promoted macrophage anti-inflammatory activity and alleviated SILI.Our findings revealed BWBDS and gut microbiota L.johnsonii as novel prebiotic and probiotic that may be used to treat SILI.The potential underlying mechanism was at least in part,via L.johnsonii-dependent immune regulation and interleukin-10+M2 macrophage production.

miR-7/TGF-β2 axis sustains acidic tumor microenvironment-induced lung cancer metastasis

Acidosis,regardless of hypoxia involvement,is recognized as a chronic and harsh tumor microenvironment(TME)that educates malignant cells to thrive and metastasize.Although overwhelming evidence supports an acidic environment as a driver or ubiquitous hallmark of cancer progression,the unrevealed core mechanisms underlying the direct effect of acidification on tumorigenesis have hindered the discovery of novel therapeutic targets and clinical therapy.Here,chemical-induced and transgenic mouse models for colon,liver and lung cancer were established,respectively.miR-7 and TGF-β2 expressions were examined in clinical tissues(n=184).RNA-seq,miRNA-seq,proteomics,biosynthesis analyses and functional studies were performed to validate the mechanisms involved in the acidic TME-induced lung cancer metastasis.Our data show that lung cancer is sensitive to the increased acidification of TME,and acidic TME-induced lung cancer metastasis via inhibition of miR-7-5 p.TGF-β2 is a direct target of miR-7-5 p.The reduced expression of miR-7-5 p subsequently increases the expression of TGF-β2 which enhances the metastatic potential of the lung cancer.Indeed,overexpression of miR-7-5 p reduces the acidic p H-enhanced lung cancer metastasis.Furthermore,the human lung tumor samples also show a reduced miR-7-5 p expression but an elevated level of activated TGF-β2;the expressions of both miR-7-5 p and TGF-β2 are correlated with patients’survival.We are the first to identify the role of the miR-7/TGF-β2 axis in acidic p H-enhanced lung cancer metastasis.Our study not only delineates how acidification directly affects tumorigenesis,but also suggests miR-7 is a novel reliable biomarker for acidic TME and a novel therapeutic target for non-small cell lung cancer(NSCLC)treatment.Our study opens an avenue to explore the p H-sensitive subcellular components as novel therapeutic targets for cancer treatment.

IKKβ mediates homeostatic function in inflammation via competitively phosphorylating AMPK and IκBα

Inhibitor of nuclear factor kappa-B kinase subunit beta(IKKβ)is one of important kinases in inflammation to phosphorylate inhibitor of nuclear factor kappa-B(IκBα)and then activate nuclear factor kappa-B(NF-κB).Inhibition of IKKβhas been a therapeutic strategy for inflammatory and autoimmune diseases.Here we report that IKKβis constitutively activated in healthy donors and healthy Ikkβ^(C46A)(cysteine 46 mutated to alanine)knock-in mice although they possess intensive IKKβ-IκBα-NF-κB signaling activation.These indicate that IKKβactivation probably plays homeostatic role instead of causing inflammation.Compared to IkkβWTlittermates,lipopolysaccharides(LPS)could induce high mortality rate in Ikkβ^(C46A) mice which is correlated to breaking the homeostasis by intensively activating p-IκBα-NF-κB signaling and inhibiting phosphorylation of 5’adenosine monophosphate-activated protein kinase(p-AMPK)expression.We then demonstrated that IKKβkinase domain(KD)phosphorylates AMPKa1 via interacting with residues Thr183,Ser184,and Thr388,while IKKβhelix-loop-helix motifs is essential to phosphorylate IκBαaccording to the previous reports.Kinase assay further demonstrated that IKKβsimultaneously catalyzes phosphorylation of AMPK and IκBαto mediate homeostasis.Accordingly,activation of AMPK rather than inhibition of IKKβcould substantially rescue LPS-induced mortality in Ikkβ^(C46A) mice by rebuilding the homeostasis.We conclude that IKKβactivates AMPK to restrict inflammation and IKKβmediates homeostatic function in inflammation via competitively phosphorylating AMPK and IκBα.

Microbiome technology empowers the development of traditional Chinese medicine

Application of microbiome technology to traditional Chinese medicine (TCM). Microbiome refers to the integration of composition, genetic information and bio-function of all microbial species under a specific environment.

Author correction to‘Herbal formula BaWeiBaiDuSan alleviates polymicrobial sepsisinduced liver injury via increasing the gut microbiota Lactobacillus johnsonii and regulating macrophage anti-inflammatory activity in mice'[Acta Pharmaceutica Sinica B 13(2023)1164-1179]

The authors regret that there were some picture errors in Fig.7C and Supporting Information Fig.S10B owing to the negligence of the picture typesetting and careless mistakes.In Fig.7C,the H&E picture of PBS+Lipo+CLP group was the inverted picture of CLP group in Fig.5G.In Fig.7C,the H&E picture of Clo-Lipo+CLP group was zoom-in picture of L johnsoni+CLP group in Fig.8F.In Fig.SI0B,the H&E picture of ileum in CLP group was zoom-in picture of Anti-IL-10R+CLP group in Fig.S11C.The authors revise the H&E picture of liver in PBS+Lipo+CLP group and the H&E picture of liver in Clo-Lipo+CLP group in Fig.7C.Also,the H&E picture of ileum in CLP group of Fig.S10B have been revised.The correct figures are presented as below.