Jianpi Qinghua Formula Alleviates Diabetic Myocardial Injury Through Inhibiting JunB/c-Fos Expression

Objective Diabetic cardiomyopathy(DCM)represents a substantial risk factor for heart failure and increased mortality in individuals afflicted with diabetes mellitus(DM).DCM typically manifests as myocardial fibrosis,myocardial hypertrophy,and impaired left ventricular diastolic function.While the clinical utility of the Jianpi Qinghua(JPQH)formula has been established in treating diabetes and insulin resistance,its potential efficacy in alleviating diabetic cardiomyopathy remains uncertain.This study aims to investigate the impact and underlying molecular mechanisms of the JPQH formula(JPQHF)in ameliorating myocardial injury in nonobese diabetic rats,specifically focusing on apoptosis and inflammation.Methods Wistar rats were assigned as the normal control group(CON),while Goto-Kakizaki(GK)rats were randomly divided into three groups:DM,DM treated with the JPQHF,and DM treated with metformin(MET).Following a 4-week treatment regimen,various biochemical markers related to glucose metabolism,cardiac function,cardiac morphology,and myocardial ultrastructure in GK rats were assessed.RNA sequencing was utilized to analyze differential gene expression and identify potential therapeutic targets.In vitro experiments involved high glucose to induce apoptosis and inflammation in H9c2 cells.Cell viability was evaluated using CCK-8 assay,apoptosis was monitored via flow cytometry,and the production of inflammatory cytokines was measured using quantitative real-time PCR(qPCR)and ELISA.Protein expression levels were determined by Western blotting analysis.The investigation also incorporated the use of MAPK inhibitors to further elucidate the mechanism at both the transcriptional and protein levels.Results The JPQHF group exhibited significant reductions in interventricular septal thickness at end-systole(IVSs)and left ventricular internal diameter at end-systole and end-diastole(LVIDs and LVIDd).JPQHF effectively suppressed high glucose-induced activation of IL-1βand caspase 3 in cardiomyocytes.Furthermore,JPQHF downregulated the expression of myocardial JunB/c-Fos,which was upregulated in both diabetic rats and high glucose-treated H9c2 cells.Conclusion The JPQH formula holds promise in mitigating diabetic myocardial apoptosis and inflammation in cardiomyocytes by inhibiting JunB/c-Fos expression through suppressing the MAPK(p38 and ERK1/2)pathway.

Zuogui Jiangtang Jieyu Formula ameliorating hippocampal neuronal apoptosis in diabetic rats with depression by inhibiting JNK signaling pathway

Objective To investigate the effect of Zuogui Jiangtang Jieyu Formula(左归降糖解郁方,ZJJF)on hippocampal neuron apoptosis in diabetic rats with depression and to ascertain whether its mechanism involves the regulation of JNK signaling pathway.Methods(i)A total of 72 specific pathogen-free(SPF)grade male Sprague Dawley(SD)rats were randomly divided into six groups,with 12 rats in each group:control,model,metformin(Met,0.18 g/kg)+fluoxetine(Flu,1.8 mg/kg),and the high-,medium-,and low-ZJJF dosages(ZJJF-H,20.52 g/kg;ZJJF-M,10.26 g/kg;ZJJF-L,5.13 g/kg)groups.All groups except control group were injected once via the tail vein with streptozotocin(STZ,38 mg/kg)combined with 28 d of chronic unpredictable mild stress(CUMS)to establish diabetic rat models with depression.During the CUMS modeling period,treatments were administered via gavage,with control and model groups receiving an equivalent volume of distilled water for 28 d.The efficacy of ZJJF in reducing blood sugar and alleviating depression was evaluated by measuring fasting blood glucose,insulin,and glycated hemoglobin levels,along with behavioral assessments,including the open field test(OFT),forced swim test(FST),and sucrose preference test(SPT).Hippocampal tissue damage and neuronal apoptosis were evaluated using hematoxylin-eosin(HE)staining and terminal deoxynucleotidyl transferase-mediated dUTP nickend labeling(TUNEL)staining.Apoptosis-related proteins Bax,Bcl-2,caspase-3,and the expression levels of JNK/Elk-1/c-fos signaling pathway were detected using Western blot and real-time quantitative polymerase chain reaction(RT-qPCR).(ii)To further elucidate the role of JNK signaling pathway in hippocampal neuronal apoptosis and the pharmacological effects of ZJJF,an additional 50 SPF grade male SD rats were randomly divided into five groups,with 10 rats in each group:control,model,SP600125(SP6,a JNK antagonist,10 mg/kg),ZJJF(20.52 g/kg),and ZJJF(20.52 g/kg)+Anisomycin(Aniso,a JNK agonist,15 mg/kg)groups.Except for control group,all groups were established as diabetic rat models with depression,and treatments were administered via gavage for ZJJF and intraperitoneal injection for SP6 and Aniso for 28 d during the CUMS modeling period.Behavioral changes in rats were evaluated through the OFT,FST,and SPT,and hippocampal neuron damage and apoptosis were observed using HE staining,Nissl staining,TUNEL staining,and transmission electron microscopy(TEM).Changes in apoptosis-related proteins and JNK signaling pathway in the hippocampal tissues of rats were also analyzed.

Protective effects of Zuogui Jiangtang Jieyu Formula on hippocampal neurons in rats of diabetes complicated with depression via the TRP/KYN metabolic pathway

Objective To explore the protective effects and mechanism of Zuogui Jiangtang Jieyu Formula(左归降糖解郁方,ZGJTJYF)on hippocampal neurons in rats of diabetes complicated with depression(DD)via the TRP/KYN metabolic pathway.Methods(i)In vivo experiments:60 specified pathogen free(SPF)grade male Sprague-Dawley(SD)rats were randomly divided into six groups with 10 rats in each groups:control,DD model,positive(1.8 mg/kg fluoxetine+0.18 g/kg metformin),high-dose ZGJTJYF(ZGJTJYFH,40.500 g/kg ZGJTJYF),middle-dose ZGJTJYF(ZGJTJYF-M,20.250 g/kg ZGJTJYF),and lowdose ZGJTJYF(ZGJTJYF-L,10.125 g/kg ZGJTJYF)groups.Except for the control group,other groups were established DD model by high-fat emulsion intake with single tail vein streptozotocin(STZ)and four weeks of chronic unpredictable mild stress(CUMS).All drug administration groups were treated by gavage during CUMS modeling,and the control and model groups were given equal amount of distilled water.After four weeks,the serum levels of blood glucose and glycosylated hemoglobin were measured to determine the hypoglycemic effect of ZGJTJYF.Moreover,the open field test and Morris water maze test were performed to evaluate the antidepressant effect of ZGJTJYF.Changes in 5-hydroxytryptamine(5-HT)level were detected via high-performance liquid chromatography with electrochemical detection(HPLC-ECD);the levels of tryptophan(TRP),kynurenine(KYN),and indoleamine 2,3-dioxygenase(IDO)in the hippocampus were detected using enzyme-linked immunosorbent assay(ELISA);the protein expression levels of synaptophysin(SYN)and postsynaptic density material-95(PSD-95)were detected via immunohistochemistry(IHC);and the protein expression levels of N-methyl-D-aspartate receptor(NR)2 A and NR2 B were detected using Western blot.(ii)In vitro experiments:five SPF grade SD pregnant rats(E16–18)were used to obtain primary hippocampal neurons(Ne),six SD new-born rats were used to collected primary astrocytes(As)and microglia(MG),and to establish a Ne-As-MG co-culture system.All co-culture systems were divided into six groups:control(PBS),model[150 mmol/L glucose+200μmol/L corticosterone(G&P)+PBS],blank(G&P+blank serum),positive(G&P+positive drug-containing serum),ZGJTJYF(G&P+ZGJTJYF serum),and 1-methyl-D-tryptophan(1-MT,IDO inhibitor)(G&P+1-MT)groups.After 18 h of intervention by corresponding treatment,immunofluorescence was used to analyze the protein expression levels of SYN,PSD-95,NR2 A,and NR2 B;ELISA was performed to measure the levels of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-α,and TRP/KYN metabolic pathway-related factors[TRP,KYN,kynurenine acid(KYNA),quinolinic acid(QUIN)].Results(i)In vivo experimental results showed that ZGJTJYF-M and ZGJTJYF-L significantly improved the elevated blood glucose state of DD rats(P<0.01 and P<0.05,respectively);ZGJTJYF-H,ZGJTJYF-M,and ZGJTJYF-L increased their autonomous activity,learning,and memory ability(P<0.01,P<0.01,and P<0.05,respectively).Moreover,the levels of 5-HT and TRP were significantly increased(P<0.01),and the levels of KYN and IDO were significantly decreased in the hippocampus(P<0.01)of rats after ZGJTJYF-M treatment.The protein expression levels of SYN and PSD-95 were significantly upregulated in hippocampal neurons(P<0.01),while the abnormal activation of NR2A and NR2B was markedly inhibited in hippocampus(P<0.05)of rats after ZGJTJYF-M treatment.(ii)In vitro experimental results showed that ZGJTJYF-containing serum significantly increased the protein expression levels of SYN and PSD-95 in hippocampal neurons(P<0.01),decreased the levels of IL-1β(P<0.01),IL-6(P<0.05),TNF-α(P<0.01),IDO(P<0.05),KYN(P<0.05),and QUIN(P<0.01),and increased the levels of TRP and KYNA(P<0.01)in the simulated DD state.ZGJTJYF also had an significantly inhibitory effect on the abnormal activation of NR2A and NR2B in neurons(P<0.05)in a stimulated DD state.Conclusion ZGJTJYF can effectively improve 5-HT deficiency in the hippocampus of rats by inhibiting IDO expression and regulating the TRP/KYN metabolic pathway,and it has a favorable protective effect on hippocampal neuron injury caused by DD.Therefore,ZGJTJYF is an effective potential therapeutic drug for the prevention and treatment of DD.

Analysis of new therapeutic strategies for diabetes mellitus based on traditional Chinese medicine'xiaoke'formulae

Objective:To develop new therapeutic strategies for diabetes mellitus(DM)by analyzing the mechanisms of action of traditional Chinese medicine(TCM)'xiaoke'formulae(TCM prescriptions for remedying xiaoke).Methods:We characterized 291 xiaoke formulae,including the herbs contained,chemical composition,constituents'targets,and corresponding genes.Xiaoke-related genes were retrieved based on the relationships of constituents'targets and xiaoke formulae,and a threshold of over 95.88%occurrence of each constituent target in the 291 TCM formulae served as a definition for xiaoke-related genes.Upon comparison with DM-related genes in the DisGeNET database,the genes differing in expression between cases administered TCM and synthetic drugs were explored using a TCM grammar system.Results:The results showed that xiaoke formulae and 14 exclusively xiaoke-related genes were significantly associated with multiple biological processes closely related to DM and diabetic complications(P<.01).Moreover,intervention in the expression of these xiaoke-related genes would affect DM-related genes directly or indirectly.Conclusion:The 14 xiaoke-related genes APEX1,EHMT2,TSHR,CBX1,FEN1,GMNN,JUN,KMT2A,MAPT,POLl,USP1,PIN1,POLB,and POLK can serve as candidate genes for antidiabetic drug design.Compared with DM-related genes in DisGeNET,intervention in the expression of 14 xiaoke-related genes by TCM formulae has the potential to not only lower blood glucose,but also reduce the occurrence of some side effects and inhibit the development of diabetic complications.These findings will contribute to the discovery of new strategies for treating DM.

Effect of Shenqi Compound Formula on PPARγ in White Adipose Tissue of Rats with Macrovascular Lesion in Early Stage of Diabetes

Objective:To investigate the effect of Shenqi Compound Formula (SCF) on peroxisome proliferators-activated receptor γ (PPARγ) in white adipose tissue of rats with macrovascular lesion in early stage of diabetes. Methods: Corresponding treatment was given to rats in model group, Ramipril group, normal control group, low dosage SCF group and high dosage SCF group respectively for 32 days. The expressions of PPARγ and adiponectin Messenger RNA (mRNA) were detected by real-time reverse transcriptase poly-merase chain reaction. Results: The expressions of PPARγ and adiponectin mRNA increased significantly in both low and high dosage SCF groups as compared with the model group, and a positive linear correlation was found between the expressions of PPARγ and adiponectin mRNA. Conclusions: SCF can prevent macrovascular lesion in early stage of diabetes, which is possibly related with up-regulating expressions of PPARγ and activating PPARγ.

Effects of Chinese Fructus Mume Formula and Its Separated Prescription Extract on Insulin Resistance in Type 2 Diabetic Rats

The effect of Fructus Mume formula and its separated prescription extract on insulin resis- tance in type 2 diabetic rats was investigated. The rat model of type 2 diabetes was established by feed- ing on a high-fat diet for 8 weeks and by subsequently intravenous injection of small doses of strepto- zotocin. Rats in treatment groups, including the Fructus Mume formula treatment group （FM）, the cold property herbs of Fructus Mume formula treatment group （CFM）, the warm property herbs of Fructus Mume formula treatment group （WFM）, were administrated with Fructus Mume formula and its sepa- rated prescription extract by gavage, while the rats in diabetic model group （DM） and metformin group （MET） were given by gavage with normal saline and metformin correspondingly. The body weight be- fore and after treatment was measured, and the oral glucose tolerance test （OGTT） and the insulin re- lease test （IRT） were performed. The homeostasis model assessment-insulin resistance index （HOMA-IR） was calculated. The protein and mRNA expression levels of Insr, β-arrestin-2, Its-1 and Glut-4 in the liver, skeletal muscle and fat tissues were detected by using Western blotting and RT-PCR respectively. The results demonstrated that, as compared with DM group, OGTT, IRT （0 h, 1 h） levels and HOMR-IR in treatment groups were all reduced, meanwhile their protein and mRNA expression levels of Insr, Irs-1 and Glut-4 in the liver, skeletal muscle and fat tissues were obviously increased, and their protein and mRNA expression levels of β-arrestin-2 in the liver and skeletal muscle tissues were also markedly increased. It was suggested that the Fructus Mume formula and its separated prescription extracts could effectively improve insulin resistance in type 2 diabetic rats, which might be related to the up-regulated expression of Insr, Irs-1 and Glut-4 in the liver, skeletal muscle and fat tissues, and β-arrestin-2 in the liver and skeletal muscle tissues.

Four-hour evaluation of a medical food in subjects with type 2 diabetes receiving oral hypoglycemic medication

Background: Postprandial hyperglycemia is an independent risk factor for diabetes-associated complications in individuals with type 2 diabetes. Dietary modification plays an important role in glycemic control. This study was to examine the efficacy of a diabetes specific formula (DSF) during a 4-hour postprandial meal tolerance test (MTT) in Russian subjects with type 2 diabetes receiving oral hypoglycemic medication. Methods: In a randomized, cross-over design, 168 eligible subjects from 11 study centers consumed, in a random order, the DSF (230 mL) or a common light hospital breakfast (i.e. standard meal) on two different occasions. The amounts of macronutrients were similar between the two meals providing ~200 kcal, 11 g protein, 26 g carbohydrate and 8 g fat. Capillary glucose levels were measured at baseline (before meal consumption), and post-meal consumption at 30, 60, 90, 120, 180 and 240 min. Results: The DSF was well tolerated in all subjects. There were 111 subjects completed the study per protocol (mean ± SEM: age: 58.6 ± 0.8 yr, BMI: 31.8 ± 0.42 kg/m2, waist circumference: 101 ± 1.3 cm, HbA1c: 8.0% ± 0.1%). Glucose levels reached peak values at 60 min (median) and the lowest levels at the end of the 240-min MTT test. The mean positive area under the curve (PAUC), the primary outcome, was significantly smaller after DSF consumption (mean ± SEM: 183.02 ± 18.74, median: 132.55) than the PAUC after consumption of the standard meal (mean ± SEM: 239.95 ± 23.11, median: 166.89;p = 0.027). The actual and adjusted peak glucose concentrations were similar between the two treatments. Conclusions: In patients with type 2 diabetes receiving oral hypoglycemic agents, compared to a hospital meal, the DSF improves postprandial glucose control. Combining results from earlier studies, long-term use of DSF may be beneficial to improve glucose management and decrease diabetes-associated complications.

Yiqi Qingre Xiaozheng formula protects against diabetic nephropathy by restoring autophagy in mice

Objective:To evaluate the protective effect of Yiqi Qingre Xiaozheng formula(YQQRXZF)via the regulation of autophagy in diabetic nephropathy(DN)mice induced by injection of streptozotocin(STZ)after high fat diet(HFD).Methods:The composition of YQQRXZF was analyzed by high performance liquid chromatographyelectrospray ionization/mass spectrometry(HPLC-ESI/MSn).The DN model was induced by intraperitoneally injection of 50 mg/kg STZ within 5 days,followed by HFD feeding for 8 weeks in C57BL/6J mice.Mice were randomly separated into DN group,YQQRXZF group,irbesartan group,and control group.Blood glucose was calculated,and body weight was measured every 2 weeks.An enzyme-linked immunosorbent assay was used to measure the urinary albumin-to-creatinine ratio(uACR)before and after treatment,and the serum concentrations of total cholesterol(TC),low-density lipoprotein(LDL),triglycerides(TG),high-density lipoprotein(HDL),blood urea nitrogen(BUN),and serum creatinine(Scr)were measured.In addition,hematoxylin-eosin(H&E)staining,periodic acid-Schiff(PAS)staining,Masson's trichrome staining,and transmission electron microscopy(TEM)were used to observe pathological changes in renal tissue.Autophagy levels were determined by immunofluorescence staining.Results:In this study,21 dominant chemical constituents were identified in YQQRXZF.The treatment group reduced u ACR in a more significant way than the DN group(P=.018).The treatment group reduced TC,TG,and LDL concentrations after YQQRXFF treatment(P=.021,P=.014 and P=.026,respectively).H&E,PAS,and Masson staining showed that pathological damage to mice kidneys improved,the volume of renal glomeruli was reduced,and glomerular sclerosis and fibrosis were reduced.Immunofluorescence analysis revealed that expressions of LC3-Ⅱprotein increased in the treatment group(P=.013).In contrast,the protein expressions of P62 were reduced after treatment(P=.025).

Efficacy of integrative medicine in deficiency of both qi and yin in the rat model of type 2 diabetes

Objective:To establish a rat model of type 2 diabetes(T2DM)manifesting the Chinese medicine syndrome pattern of both qi and yin deficiency for evaluating the efficacy of a Chinese herbal formula(CHF),integrative medicine(IM),and pioglitazone(PIO)on T2DM indicators in the animal model.Methods:The rat model was induced by a high-fat diet(HFD)and streptozotocin(STZ,30 mg/kg).CHF(3.4 g/kg),PIO(2.7 mg/kg),and IM(3.4 g CHF+2.7 mg PIO)were administered to rats once daily for 14 days.Related laboratory parameters were observed.Results:Diabetic rats showed unsmooth fur,alopecia,reduced activity,huddling,somnolence,depression,pale or reddened tongue,damp/dark red tail,and high levels of water and food intake,urine volume,and stool weight,but weakened grip strength.Low levels of serum SOD,Nat-Kt-ATPase,cAMP/cGMP,and a high level of iNOS were observed.Hyperglycemia,hyperinsulinemia,insulin resistance,high levels of serum glucagon/IDE and pancreatic amylin,and low serum and pancreatic SS levels were evident as well.Conclusions:A rat model of T2DM with both qi and yin deficiency was successfully replicated.CHF appeared to be more efficacious than IM and PIO in the rat model of qi and yin deficiency pattern of T2DM,though IM and PIO were each found to have their merits and drawbacks in attenuating T2DM indicators in the rat model.

Effects of Suoquan Yishen Formula on Mice with Diabetic Nephropathy (DN)

[Objectives]The purpose of this paper was to study the effects of Suoquan Yishen formula on mice with diabetic nephropathy(DN).[Methods]The mice were randomly divided into normal group,model group,irbesartan group,and high and low-dose Suoquan Yishen formula groups.The blood glucose level,BUN,Scr excretion and GSH activity and CAT activity were detected.[Results]The blood glucose levels of mice in the irbesartan group and high and low-dose Suoquan Yishen formula groups decreased.The BUN,PRO and Scr levels were higher and the GSH and CAT activity was lower in the model group compared with the normal group.After administration of Suoquan Yishen formula,the BUN,PRO and Scr levels of the DN mice decreased significantly,and the GSH and CAT activity increased significantly.[Conclusions]Suoquan Yishen formula can reduce blood glucose level,reduce PRO,BUN and Scr levels,and increase CAT and GSH activity in DN mice,thus protecting the ND mice.

EFFECTS OF JIANG TANG FANG LONG FORMULA ON INSULIN PRODUCTION AND FUNCTION IN AN ANIMAL MODEL OF DIABETIC HEARING LOSS

Objective To study the influence of Jiang Tang Fang Long formula on insulin production and function in an animal model of diabetic hearing loss. Methods Wistar rats (n=60) were randomly divided into 6 groups (10 in each) to receive no treatment (the normal control, Group A), or to receive intra-peritoneal 55 mg/kg streptozotocin with (Groups C, D and E) or without (Group B) subsequent Jiang Tang Fang Long formula treatment at various doses or Yu Long Wan treatment (Group F). After 60 days, fasting blood glucose (FBG), body weight (BW) and fasting insulin (FINS) were recorded and the HOMA-IR and HOMA-βcalcu-lated. Insulin expression in pancreatic tissues was measured by radioimmunoassay. Results Compared with animals that received streptozotocin without rescue treatment (Group B), animals that received higher doses of Jiang Tang Fang Long formula(Groups D and E) showed improved indices of diabetes manifestation (P<0.05) and improved HOMA-β(P<0.05) in a dose-dependent manner, as well as improved insulin expression in pancreatic islets (P<0.05). The difference between low dose Jiang Tang Fang Long formula treatment (Group C) and Group B was not significant (P>0.05). Conclusion Our results suggest that Jiang Tang Fang Long formula may improve pancreatic β-cells function which may explain its efficacy in treating diabetic hearing loss.

Clinical evidence and potential mechanisms of Chinese medicines for the treatment of diabetic retinopathy

Diabetic retinopathy is one of the main causes of visual impairment and blindness on a global scale. At present, thelimitations of anti-vascular endothelial growth factor agents, steroids, laser photocoagulation, and vitreous surgery haveled to a growing awareness of the role of Chinese medicines in the treatment of diabetic retinopathy. This review firstdescribes the ingredients and characteristics of the formulae including Chinese herbal formulaes, Chinese patent drugsand ancient processed drugs and summarizes the application of Chinese medicines and their mechanisms of action in thetreatment of diabetic retinopathy. Due to the complexity of Chinese medicines, in-depth mechanisms, side effects of herb,and drug interactions need to be elaborated in future research. Chinese medicines have the potencial to protect theresidual eyesight and delay the progression of disease, thereby offering a beneficial, exploitable option in thetreatment/prevention of diabetic retinopathy.

糖肾灌肠方联合缬沙坦治疗2型糖尿病肾病的效果及对大鼠肾脏组织TLR2和TLR4表达的影响

目的观察糖肾灌肠方联合缬沙坦对2型糖尿病肾病的疗效及对大鼠肾脏组织Toll样受体2(Toll-like receptor 2,TLR2)、Toll样受体4(Toll-like receptor 4,TLR4)表达的影响。方法选取无特定病原体(Specific pathogen free,SPF)级8周龄SD雌性大鼠60只,适应性喂养7 d后,随机选取10只作为空白对照组,其余50只进行右侧肾脏摘取手术,构建2型糖尿病肾病大鼠模型。造模过程中死亡10只,造模成功的40只大鼠随机分为模型组、糖肾灌肠方干预组(糖肾灌肠方0.13 mL/10 g)、缬沙坦干预组(缬沙坦0.12 mg/10 g,)、缬沙坦+糖肾灌肠方干预组(糖肾灌肠方0.13 mL/10 g联合缬沙坦0.12 mg/10 g),每天1次,连续灌肠4周。观察5组大鼠空腹血糖水平,肾组织形态学改变情况,尿蛋白、尿素氮(Urea nitrogen,BUN)及肌酐(Creatinine,Cr)水平,肾湿质量及肾脏肥大指数,TLR2、TLR4信使核糖核酸(Messenger RNA,mRNA)及蛋白表达情况。结果与空白对照组比较,各造模组血糖和尿蛋白含量均显著升高(P<0.05);与模型组比较,糖肾灌肠、缬沙坦干预组与缬沙坦+糖肾灌肠方干预组的血糖降低但差异无统计学意义(P>0.05),糖肾灌肠方干预组、缬沙坦片干预组及缬沙坦+糖肾灌肠方干预组的尿蛋白含量下降(P<0.05),且缬沙坦+糖肾灌肠方干预组的尿蛋白含量显著下降(P<0.05)。与空白对照组比,模型组肾组织病变显著,如肾小管扩张、纤维化、炎性细胞浸润及坏死细胞脱落;与模型组比较,糖肾灌肠干预方组和缬沙坦片干预组的大鼠肾小管扩张程度、炎性细胞浸润及坏死细胞脱落情况有所减轻,缬沙坦+糖肾灌肠方干预组的大鼠肾小管基本无扩张,仅有少量炎性细胞浸润及坏死细胞脱落,肾脏结构更接近空白对照组。与空白对照组比较,模型组的血清Cr含量、粪便Cr含量、血清BUN含量、血/粪BUN比值、肾湿重、肾肥大指数、TLR2mRNA、TLR4mRNA、TLR2蛋白及TLR4蛋白表达均显著升高(P<0.05);与模型组比较,糖肾灌肠方干预组、缬沙坦干预组及缬沙坦+糖肾灌肠方干预组以上指标均下降(P<0.05),且缬沙坦+糖肾灌肠方干预组的降幅最大。结论糖肾灌肠方联合缬沙坦治疗2型糖尿病肾病效果更佳,并能抑制大鼠肾脏组织TLR2、TLR4表达,因此值得在临床上推广应用。

二冬消渴方治疗阴虚热盛型2型糖尿病性干眼的临床疗效及对血清IL-17、IL-1β的影响

目的观察二冬消渴方治疗阴虚热盛型2型糖尿病性干眼的临床疗效及对血清白细胞介素-17(IL-17)、白细胞介素-1β(IL-1β)的影响,探讨二冬消渴方疗效机制。方法纳入江苏省中医院阴虚热盛证2型糖尿病性干眼患者110例,随机分为治疗组及对照组各55例,治疗组脱落5例,对照组脱落4例。对照组予基本降糖方案联合玻璃酸钠滴眼液外用治疗,治疗组在对照组治疗基础上加服二冬消渴方,2组疗程均为4周。治疗前后观察2组患者中医证候积分变化情况并评估中医临床疗效,检测血糖及胰岛功能相关指标[空腹血糖(FBG)、空腹胰岛素(FINS)、空腹C肽(FCP)、餐后2 h血糖(PBG)、胰岛素分泌功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)]、眼表指标[泪膜破裂时间(BUT)、角膜荧光素钠染色(FL)、SchirmerⅠ试验(SⅠT)]及炎症相关指标(IL-17、IL-1β)的变化情况,治疗期间观察2组患者不良反应发生情况。结果治疗后,2组患者中医证候总积分均明显减少(P<0.01),治疗组优于对照组(P<0.01),治疗组中医临床总有效率高于对照组(P<0.01);2组患者SⅠT和BUT均明显增加(P<0.01),治疗组优于对照组(P<0.05,P<0.01);2组患者FL均显著降低(P<0.01),组间无显著差异;治疗组患者血清IL-17、IL-1β均显著下降(P<0.01),明显优于对照组(P<0.05)。治疗前后2组患者血糖及胰岛功能相关指标未见明显变化(P>0.05)。治疗期间,2组患者均未见明显不良反应。结论二冬消渴方可改善糖尿病性干眼患者SⅠT、BUT、FL及眼部症状,有效治疗糖尿病干眼,减轻眼表炎症,其机制可能与降低血清炎症因子IL-17、IL-1β有关。

左归降糖舒心方调控TLR4/NF-κB通路抑制糖尿病心肌病小鼠心肌纤维化的机制研究

目的 基于Toll样受体4(Toll-like receptor 4,TLR4)/核因子κB(nuclear factor-κB,NF-κB)信号通路探讨左归降糖舒心方对糖尿病心肌病MKR小鼠心肌纤维化及炎症因子的影响。方法 以8周龄雄性MKR小鼠为实验对象,采用高脂饮食联合腹腔注射链脲佐菌素(streptozotocin,STZ)40 mg/kg构建糖尿病心肌病模型,随机分为中药高剂量组[33.67 g/(kg·d)左归降糖舒心方2 g/mL]、中药低剂量组[16.84 g/(kg·d)左归降糖舒心方2 g/mL]、西药联合组[0.23 g/(kg·d)二甲双胍联合1.5 mg/(kg·d)依那普利]和模型组(等容量蒸馏水);另设FVB小鼠为空白对照组(等容量蒸馏水)。每组10只,连续给药8周后取材。收集尾静脉血液检测空腹血糖水平;采用HE、Masson染色观察心肌病理改变,电镜观察心肌组织超微结构变化;采用ELISA检测小鼠血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)及白细胞介素-1β(interleukin-1β,IL-1β)含量;采用Western blot法检测TLR4、NF-κB p56、p-NF-κB p56/NF-κB p56蛋白表达情况;RT-qPCR及Western blot检测小鼠心肌组织Ⅰ型胶原(collagen type I,CollagenⅠ)、Ⅲ型胶原(collagen typeⅢ,CollagenⅢ)及α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)的表达水平。结果 与空白对照组比较,模型组小鼠空腹血糖及血清中TNF-α、IL-1β含量增高(P<0.01);心肌细胞结构紊乱,胶原含量增加,心肌细胞重度退行性变;心肌组织中TLR4、NF-κB p56、p-NF-κB p56/NF-κB p56蛋白表达上调(P<0.01),CollagenⅠ、CollagenⅢ、α-SMA mRNA及蛋白表达增加(P<0.05,P<0.01),中药高剂量组小鼠心肌组织CollagenⅠ、CollagenⅢ蛋白表达增加(P<0.01)。与模型组比较,中药高、低剂量组和西药联合组小鼠空腹血糖及血清中TNF-α、IL-1β含量均降低(P<0.01);心肌结构改善,胶原沉积减少;心肌组织中TLR4、NF-κB p56、p-NF-κB p56/NF-κB p56蛋白表达下调(P<0.01),CollagenⅠ、CollagenⅢ、α-SMA蛋白及mRNA表达下调(P<0.01)。与西药联合组比较,中药低剂量组小鼠空腹血糖及血清中TNF-α、IL-1β含量均升高(P<0.01),心肌结构无明显改善,胶原沉积无显著减少;心肌组织中TLR4、NF-κB p56、p-NF-κB p56/NF-κB p56蛋白表达上调(P<0.01),CollagenⅠ、CollagenⅢ、α-SMA蛋白及mRNA表达上调(P<0.01)。结论 左归降糖舒心方能抑制心肌炎性反应、改善心肌细胞结构,其作用机制可能与调控TLR4/NF-κB通路、下调细胞炎症因子表达、抑制心肌纤维化有关。

苍柴调中方辅助改善肝郁脾虚型肥胖2型糖尿病的疗效及对胰岛素抵抗、FFA、LDL-C水平的影响

目的:探讨苍柴调中方辅助改善肝郁脾虚型肥胖2型糖尿病(T2DM)的疗效,并分析其对胰岛素抵抗、游离脂肪酸(FFA)、低密度脂蛋白胆固醇(LDL-C)水平的影响。方法:选取2020年4月至2023年4月该院收治的肝郁脾虚型肥胖T2DM患者100例,根据随机数字表法分为两组,各50例。对照组患者使用二甲双胍治疗,观察组患者在对照组基础上联合苍柴调中方辅助治疗。观察两组患者的治疗效果,比较两组患者治疗前后中医症状积分、糖代谢指标[空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]、血清FFA、LDL-C、肿瘤坏死因子α(TNF-α)水平的差异,并对不良反应发生率进行统计。结果:观察组患者的治疗总有效率高于对照组,不良反应发生率低于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组患者倦怠乏力、精神抑郁、脘腹闷胀及大便黏滞等中医症状积分均低于对照组,差异均有统计学意义(P<0.05)。与治疗前比较,两组患者治疗后的FBG、HOMA-IR、FINS水平均明显降低,其中观察组患者治疗后的FINS、FBG及HOMA-IR水平低于对照组,差异均有统计学意义(P<0.05)。观察组患者治疗后的血清LDL-C、FFA、TNF-α水平均低于对照组,差异均有统计学意义(P<0.05)。结论:苍柴调中方辅助治疗可明显提高肝郁脾虚型肥胖T2DM患者的治疗效果,改善胰岛素抵抗,下调血清FFA、LDL-C水平。

益气解毒活络中药通过上调自噬发挥对糖尿病肾病大鼠保护作用的机制研究

目的探讨益气解毒活络中药通过上调自噬水平减轻糖尿病肾病大鼠肾组织损伤的机制。方法采用高糖高脂饲料联合链脲佐菌素(streptozotocin,STZ)建立糖尿病肾病(diabetic kidney disease,DKD)大鼠模型,并将DKD大鼠模型按体质量随机分为以下7组:模型组,白藜芦醇组(resveratrol,RES组),尼克酰胺组(nictotinamide,NAM组),益气解毒活络方高剂量组(中药高剂量组),益气解毒活络方中剂量组(中药中剂量组),益气解毒活络方低剂量组(中药低剂量组),洛汀新组。连续给药8周后检测各组大鼠肾脏指数、血糖(blood glucose,BG)、血肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)及24 h尿蛋白水平(24 h-UAlb);采用逆转录—聚合酶链反应(RT-PCR)检测各组大鼠肾脏组织中纤维连接蛋白(fibronectin,FN)、四型胶原蛋白(typeⅣcollagen,COLIV)、人沉默信息调节因1(silent infor-mation regulator 1,Sirt1)、叉头状转录因子O1(forkhead transcription factor O1,FoxO1)、自噬蛋白5(autophagy Protein 5,Atg5)mRNA的表达水平;WesternBlot法分析肾组织LC3-Ⅱ/I及Atg5蛋白表达。HE染色观察肾组织形态变化。结果与正常组比较,模型组及NAM组大鼠肾脏指数、血糖、血肌酐、尿素氮、24 h尿蛋白水平明显升高,Sirt1和FoxO1 mRNA表达下降,LC3-Ⅱ/I比值下降,FN、COLIV mRNA表达升高,Atg5蛋白及mRNA表达均明显降低。与模型组相比较,除NAM组外,其余各治疗组大鼠肾脏指数、血糖、血肌酐、尿素氮、24 h尿蛋白水平均有不同程度的下降,Sirt1、FoxO1 mRNA表达升高,LC3-Ⅱ/I蛋白表达均有不同程度的升高,Atg5蛋白及mRNA表达均明显升高,其中以RES组、中药高剂量及洛汀新组效果明显。HE染色显示各治疗组肾组织病理损伤有不同程度的改善。结论益气解毒活络中药减缓了糖尿病肾病的发病进程,其机制可能与上调Sirt1-FoxO介导的肾脏自噬有关。

《世医得效方》中消渴病用药规律探讨

目的:利用数据挖掘技术,深入分析《世医得效方》中所记载方剂治疗消渴的用药规律。方法:归纳《世医得效方》中治疗消渴所记载的方剂,利用Excel 2016软件及中医传承辅助平台(V2.5)软件创建消渴处方及中药数据库,采用数据挖掘技术,对中药频次、属性、功效进行统计分析,并对其进行关联分析、聚类分析。结果:《世医得效方》中用于治疗消渴的处方共50首,包含中草药118味;排名前4味的高频药物是人参、白茯苓、黄连、天花粉;药性以寒性为主,药味以甘味为主,主归脾经;且补虚药出现频次最高。高频用药配伍模式共7组,其中频次排名前4组依次为人参-白茯苓,五味子-白茯苓,麦冬-人参,人参-甘草。置信度≥0.6的药物关联规则按频度大小排列依次为麦冬→人参,五味子→熟地黄,熟地黄→五味子,五味子→人参等。基于无监督的熵层次聚类算法共获得4个治疗消渴的潜在新方组合,分别为麝香-山药-茯苓-辰砂,菟丝子-石斛-鹿角胶-沉香,黄芪-远志-茯苓-辰砂,麝香-木香-桔梗-茯苓-辰砂。结论:通过对《世医得效方》消渴处方用药规律进行分析,发现消渴病遵循阴虚为本,燥热为标的基本病机,治疗以甘寒养阴为主,兼顾健脾补肾、益肺生津等,配伍药物以补虚药、清热药等为主,能为现代临床合理、有效用药提供理论借鉴。

基于肠道菌群及其代谢产物SCFA探讨左归降糖通脉方对2型糖尿病大鼠糖脂代谢的影响

目的基于肠道菌群及代谢产物短链脂肪酸(short-chain fatty acid,SCFA)探讨左归降糖通脉方(Zuogui Jiangtang Tongmai formula,ZJTF)干预2型糖尿病(type 2 diabetes mellitus,T2DM)的可能机制。方法取12只SD大鼠为空白(Control)组,喂食普通饲料;48只大鼠为造模组,以高脂饲料联合链脲佐菌素(streptozocin,STZ)制备T2DM模型。造模成功后随机分为模型(DM)组、ZJTF低剂量(ZJTF.L,12 g·kg^(-1))组、ZJTF高剂量(ZJTF.H,24 g·kg^(-1))组、二甲双胍150 mg·kg^(-1)+阿托伐他汀10 mg·kg^(-1)(M.A)组,药物干预4周。监测大鼠精神状态、体质量与随机血糖;ELISA检测血清胰岛素(insulin,INS)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、炎症因子的水平;生化分析法检测血脂常规含量;HE染色观察结肠病理改变;16SrRNA观察肠道菌群结构;GC-MS检测血清SCFA水平。结果与Control组比较,DM组出现多饮、多食、多尿、体质量减轻等症状;血糖、INS、HbA1c明显上升(P<0.01);总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)水平升高,高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)明显降低(P<0.01);白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-6(interleukin-6,IL-6)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均明显升高(P<0.01);结肠固有层出现部分中断和消失,细胞肿胀、绒毛紊乱。DM组厚壁菌门和变形菌门、肠杆菌科、埃希菌-志贺菌属的相对丰度增加;血清乙酸、丁酸含量下降(P<0.05,P<0.01)。与DM组比较,ZJTF组血糖、INS、HbAlc均明显降低(P<0.05,P<0.01);TC、TG、LDL-C明显降低,HDL-C明显升高(P<0.01);IL-1β、IL-6及TNF-α水平明显降低(P<0.01);结肠细胞肿胀及炎性浸润缓解;拟杆菌门和疣微菌门、乳酸菌科、阿克曼菌属丰度增加;血清丁酸、乙酸含量升高(P<0.05,P<0.01)。结论左归降糖通脉方可能通过调节肠道菌群和SCFAs水平起到降血糖、稳血脂、减轻炎症反应的作用。

大黄及其类方应用于糖尿病的研究进展

近年来相关研究发现大黄及其类方对糖尿病的治疗有着广阔的前景,其通过对糖脂代谢的影响、血管活性因子的影响、相关细胞因子的调节等多个环节及多方面机制发挥其降糖、降脂、降低胰岛素水平、提高胰岛素敏感度、改善胰岛素抵抗、降低糖尿病并发症等功能。通过对临床及实验文献的整理和归纳从病因病机、临床用药、机理研究等方面对大黄及其类方治疗糖尿病及其并发症的研究进展进行了分析和研究,为大黄及其类方在临床上辨证治疗糖尿病,灵活精准用药奠定一定的理论研究基础。