Multiple Traditional Chinese Medicine interventions for idiopathic pulmonary fibrosis: A protocol for systematic review and meta-analysis of overview.

BACKGROUND: The therapeutic strategies of idiopathic pulmonary fibrosis (IPF) tend to be comprehensive. Improving the major symptoms and quality of life (QoL) is as important as postponing the process of fibrosis. However, only pirfenidone and nintedanib conditionally recommended by guidelines and no definite proof indicate that they can significantly ameliorate the main symptoms and QoL of IPF sufferers. At present, multiple types of Traditional Chinese Medicine (TCM) interventions alone or in combination with conventional western medicine managements are widespreadly applied in IPF treatment, which seemingly have a promising clinical effect, especially in ameliorating the main symptoms and improving QoL. Subsequently, the number of relevant studies in systematic reviews(SRs) and meta-analyses of randomized controlled trials(RCTs) increased significantly. Hence, we plan to implement an overview to collect, evaluate, and summarize the results of these SRs. METHODS: An all-round literature retrieval will be conducted in 9 electronic databases, including PubMed, EMBASE, CINAHL, Cochrane Library, Epistemonikos, CNKI, CBM, Wanfang, and VIP. We will focus on the systematic review and meta-analysis of RCTs for multiple TCM interventions alone or in combination with routine western medicine measures in IPF treatment. The main outcomes we follow with interest include the improvement of major symptoms (cough, dyspnea) and QoL. Secondary outcomes will consist of minor symptoms improvement, clinical total effective rate, lung function, blood gas analysis, 6-minute walk text, adverse events, acute exacerbation, all-cause mortality, and IPF-related mortality. Two reviewers will independently select the SRs satisfactory with the enrolling criteria, extract key characteristics, and datas on predefined form, evaluate methodological quality by AMSTAR-2, ROBIS and PRISMA tools, and the quality of evidences adopting GRADE method. In case of any divergence will be reached an agreement by discussion or adjudicated by a third senior reviewer. We will perform a narrative synthesis of the proofs from SRs included. RESULTS: The findings of this overvew will be presented at relevant conferences and submitted for peer-review publication. CONCLUSIONS: We expect to obtain comprehensive and reliable evidence of IPF treated by diversified TCM interventions from the potential standard SRs, which may provide suggestions for future RCTs and SRs. REGISTRATION NUMBER: INPLASY 202080110.

Effects of Chinese herbal medicine Shenlong Decoction on mRNA expressions of matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-1 in lung tissue of rats with pulmonary fibrosis induced by bleomycin.

OBJECTIVE: To observe the expressions of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in rats with pulmonary fibrosis (PF) induced by bleomycin, and to explore the mechanisms of Shenlong Decoction in preventing and treating PF. METHODS: A total of 230 Wistar rats were divided into normal control group, untreated group, prednisone group, and low-, medium- and high-dose Shenlong Decoction groups. Wistar rats were intratracheally injected with bleomycin to induce PF. From the 2nd day, rats in the normal control and untreated groups were lavaged with normal saline (NS), and rats in the other groups were lavaged with prepared Shenlong Decoction by the same amount. Hematoxylin-eosin (HE) staining and Masson staining were used to observe pathological changes in lung tissue at different time points, and to evaluate whether the model was successfully induced. Expressions of MMP-2 and TIMP-1 mRNAs in rats' lung tissue were measured by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Expressions of MMP-2 and TIMP-1 mRNAs in lung tissue of rats were observed from all groups at each time point. In comparison with the normal control group, on the 7th day, the transcription levels of MMP-2 and TIMP-1 mRNAs, especially the former, of the untreated group increased significantly (P<0.05 or P<0.01). On the 14th day, the transcription levels of MMP-2 and TIMP-1 mRNAs kept rising, especially the latter (P<0.05 or P<0.01). On the 28th day, the transcription level of MMP-2 decreased a little, while the transcription level of TIMP-1 mRNA did not stop increasing (P<0.05 or P<0.01). Compared with the untreated group, decrease of the transcription levels of MMP-2 and TIMP-1 mRNAs were observed in the treatment groups, especially the former, and this effect continued to the 28th day with the medium-dose Shenlong Decoction group decreasing most obviously (P<0.05 or P<0.01). CONCLUSION: Shenlong Decoction may inhibit the expression of MMP-2 mRNA by up-regulating the expression of TIMP-1 mRNA so as to slow the progression of PF.