Zhilong Huoxue Tongyu Capsule regulates the macrophage polarization and inflammatory response via the let-7i/TLR9/MyD88 signaling pathway.

ETHNOPHARMACOLOGICAL RELEVANCE: Zhilong Huoxue Tongyu Capsule (ZL) is clinically prescribed for acute ischemic stroke (AIS). However, only a few studies have addressed the mechanisms of ZL in treating AIS. AIM OF THE STUDY: To explore the underlying mechanism of macrophage polarization and inflammation mediated by ZL, and to provide a reference for AIS treatment. MATERIALS AND METHODS: Sixteen SD rats were fed with different dose of ZL (0, 0.4, 0.8, and 1.6 g/kg/d) for 4 days to prepare ZL serum. After 500 ng/mL lipopolysaccharide (LPS) stimulation, RAW264.7 cells were administrated with ZL serum. Then, experiments including ELISA, flow cytometry, real-time quantitative PCR and Western blot were performed to verify the effects of ZL on macrophage polarization and inflammation. Next, let-7i inhibitor was transfected in RAW264.7 cells when treated with LPS and ZL serum to verify the regulation of ZL on the let-7i/TLR9/MyD88 signaling pathway. Moreover, the interaction between let-7i and TLR9 was confirmed by the dual-luciferase assay. RESULTS: ZL serum significantly decreased the expression of interleukin (IL)-6 and tumor necrosis factor-α (TNF-α), and increased the expression of IL-10 and transforming growth factor ß1 (TGF-ß1) of LPS stimulated-macrophages. Furthermore, ZL serum polarized macrophages toward M2, decreased the expressions of TLR9, MyD88, and iNOS, as well as increased the expressions of let-7i, CHIL3, and Arginase-1. It is worth mentioning that the effect of ZL serum is dose-dependent. However, let-7i inhibitor restored all the above effects in LPS stimulated-macrophages. In addition, TLR9 was the target of let-7i. CONCLUSIONS: ZL targeted let-7i to inhibit TLR9 expression, thereby inhibiting the activation of the TLR9/MyD88 pathway, promoting the M2 polarization, and inhibiting the development of inflammation in AIS.

Zhilong Huoxue Tongyu Capsule attenuates hemorrhagic transformation through the let-7f/TLR4 signaling pathway.

ETHNOPHARMACOLOGICAL RELEVANCE: Hemorrhagic transformation after acute ischemic stroke is a life-threatening disease that currently has no effective chemotherapy. Zhilong Huoxue Tongyu Capsule (ZL) is an empirical prescription of traditional Chinese medicine that is used to prevent and treat cardiovascular and cerebrovascular diseases in China. However, only a few studies have addressed the mechanisms of ZL in treating hemorrhagic transformation. AIM OF THE STUDY: To evaluate the anti-inflammatory effects of ZL on hemorrhagic transformation model rats and lipopolysaccharide (LPS)-induced RAW264.7 macrophages and to explore the underlying molecular mechanisms. MATERIALS AND METHODS: Murine RAW264.7 cells were treated with ZL and LPS (1 µg/mL), and cell viability was detected by cell counting kit-8 assay. RT-qPCR was used to detect the expression of inflammatory chemokines, microRNA let-7a/e/i/f, toll like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88), and nuclear factor kappa-B (NF-κB) p65. The protein expression levels of TLR4, MyD88, NF-κB p65, and apoptosis related molecules were determined by Western blotting. The apoptosis rate of RAW264.7 macrophages was detected by Annexin V-FITC/PI double staining. A hemorrhagic transformation model in rats was established by intraperitoneal injection of high glucose solution combined with thread embolization. Then, the model rats were observed behaviourally, pathologically, and molecularly. The gene expression of TLR4, MyD88, and NF-κB p65 was measured by RT-qPCR and used to evaluate the protective effect of ZL against hemorrhagic transformation in rats. RESULTS: ZL (5, 20, 40 µg/mL) was beneficial in cell proliferation. LPS (1 µg/mL) stimulated the production of inflammatory chemokines and inhibited the production of let-7a/e/i/f, with let-7f being influenced most strongly. Moreover, overexpression of let-7f decreased the gene and protein levels of TLR4, MyD88, and NF-κB p65, downregulated TLR4, and inhibited its transcriptional activity. ZL (5, 20, and 40 µg·mL-1) inhibited the production of TLR4, MyD88, and NF-κB p65 and promoted the production of let-7f in a concentration-dependent manner. Furthermore, the blockade of TLR4 antagonized the promoting effects of TLR4 pathway activation in cell inflammation and apoptosis by downregulating let-7f. Critically, it was confirmed in vivo and in vitro that ZL upregulated the expression of let-7f and inhibited the gene expression of TLR4, MyD88, and NF-κB p65 to reduce inflammatory cell infiltration, which determined the occurrence of hemorrhagic transformation. CONCLUSIONS: ZL can reduce inflammatory response by upregulating let-7f and subsequently inhibiting the TLR4 signaling pathway, thereby decreasing the occurrence of hemorrhagic transformation.

Leaf Mycobiome and Mycotoxin Profile of Warm-Season Grasses Structured by Plant Species, Geography, and Apparent Black-Stroma Fungal Structure.

Grasses harbor diverse fungi, including some that produce mycotoxins or other secondary metabolites. Recently, Florida cattle farmers reported cattle illness, while the cattle were grazing on warm-season grass pastures, that was not attributable to common causes, such as nutritional imbalances or nitrate toxicity. To understand correlations between grass mycobiome and mycotoxin production, we investigated the mycobiomes associated with five prominent, perennial forage and weed grasses [Paspalum notatum Flügge, Cynodon dactylon (L.) Pers., Paspalum nicorae Parodi, Sporobolus indicus (L.) R. Br., and Andropogon virginicus (L.)] collected from six Florida pastures actively grazed by livestock. Black fungal stromata of Myriogenospora and Balansia were observed on P. notatum and S. indicus leaves and were investigated. High-throughput amplicon sequencing was applied to delineate leaf mycobiomes. Mycotoxins from P. notatum leaves were inspected using liquid chromatography-mass spectrometry (LC-MS/MS). Grass species, cultivars, and geographic localities interactively affected fungal community assemblies of asymptomatic leaves. Among the grass species, the greatest fungal richness was detected in the weed S. indicus. The black fungal structures of P. notatum leaves were dominated by the genus Myriogenospora, while those of S. indicus were codominated by the genus Balansia and a hypermycoparasitic fungus of the genus Clonostachys. When comparing mycotoxins detected in P. notatum leaves with and without M. atramentosa, emodin, an anthraquinone, was the only compound which was significantly different (P < 0.05). Understanding the leaf mycobiome and the mycotoxins it may produce in warm-season grasses has important implications for how these associations lead to secondary metabolite production and their subsequent impact on animal health. IMPORTANCE The leaf mycobiome of forage grasses can have a major impact on their mycotoxin contents of forage and subsequently affect livestock health. Despite the importance of the cattle industry in warm-climate regions, such as Florida, studies have been primarily limited to temperate forage systems. Our study provides a holistic view of leaf fungi considering epibiotic, endophytic, and hypermycoparasitic associations with five perennial, warm-season forage and weed grasses. We highlight that plant identity and geographic location interactively affect leaf fungal community composition. Yeasts appeared to be an overlooked fungal group in healthy forage mycobiomes. Furthermore, we detected high emodin quantities in the leaves of a widely planted forage species (P. notatum) whenever epibiotic fungi occurred. Our study demonstrated the importance of identifying fungal communities, ecological roles, and secondary metabolites in perennial, warm-season grasses and their potential for interfering with livestock health.

Chinese Herbal Medicine Dingji Fumai Decoction for Ventricular Premature Contraction: A Real-World Trial.

BACKGROUND: Chinese herbal medicine Dingji Fumai Decoction (DFD) is widely clinically used for ventricular premature contraction (VPC). This real-word trial was designed to assess the safety and effectiveness of DFD for VPC. METHODS: This was a double-blinded, randomized placebo-controlled trial. Patients with VPC were randomized (1 : 1) to treatment with DFD combined with metoprolol (DFD arm) or metoprolol combined with placebo (MET arm). A primary end point was a composite of clinical symptoms and signs determined by the traditionalChinese medicine syndrome score and the number of VPC determined by the Holter examination. Second outcomes were adverse events, medication compliance, and laboratory examination. RESULTS: 144 patients were randomized to DFD arm (76 patients) or MET arm (68 patients), and 136 cases (71 in DFD arm and 65 in MET arm) finally completed this trial. After a 12-week follow-up, DFD arm significantly decreased traditional Chinese medicine syndrome score and the number of VPC compared with MET arm (P = 0.003 and 0.034, respectively). There was no adverse drug effect and patient medication compliance was good. CONCLUSIONS: Superiority with DFD arm for VPC was demonstrated over MET arm for both the safety and effectiveness end points.

Reappraisal on pharmacological and mechanical treatments of heart failure.

Heart failure (HF) is a highly frequent disorder with considerable morbidity, hospitalization, and mortality; thus, it invariably places pressure on clinical and public health systems in the modern world. There have been notable advances in the definition, diagnosis, and treatment of HF, and newly developed agents and devices have been widely adopted in clinical practice. Here, this review first summarizes the current emerging therapeutic agents, including pharmacotherapy, device-based therapy, and the treatment of some common comorbidities, to improve the prognosis of HF patients. Then, we discuss and point out the commonalities and areas for improvement in current clinical studies of HF. Finally, we highlight the gaps in HF research. We are looking forward to a bright future with reduced morbidity and mortality from HF.

Antiarrhythmic Mechanisms of Chinese Herbal Medicine Dingji Fumai Decoction.

BACKGROUND: Dingji Fumai decoction (DFD) is used to treat ventricular arrhythmia, and it has provided a very good curative effect. However, its cellular electrophysiological mechanism is unknown. METHODS: Electrocardiogram was recorded, and oxidative stress response and ion-channel-related molecules were detected in rats with barium chloride- and aconitine-induced ventricular arrhythmia. Moreover, whole-cell patch-clamp assay was used to investigate the inhibitory effect of DFD on Nav1.5 in Chinese hamster ovary cells. RESULTS: DFD prolonged the occurrence time and shortened the duration of ventricular arrhythmia, decreased the malondialdehyde and increased the superoxide dismutase, and alleviated the activation of Na+-K+-ATPase and connexin-43. DFD suppressed Nav1.5dose-dependently with an IC50 of 24.0 ± 2.4 mg/mL. CONCLUSIONS: The clinical antiarrhythmic mechanisms of DFD are based on its antioxidant potential, alleviation of Na+-K+-ATPase and connexin-43, and class I antiarrhythmic properties by suppressing Nav1.5dose-dependently with an IC50 of 24.0 ± 2.4 mg/mL.

Rivaroxaban for cancer-associated venous thromboembolism: A systematic review and meta-analysis protocol.

BACKGROUND: All cancers increase developing venous thromboembolism risk, and VTE is the second-leading cause of death among cancer patients. The anticoagulant drugs are considered to be the optimal treatment for patients with cancer-associated VTE. However, there is still controversy whether rivaroxaban, a new oral anticoagulant, can lead to better outcomes globally. METHODS: We will search PubMed, Web of Science, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure for relevant published studies before 1 September, 2019, without any language restrictions. Only published randomized controlled trials that meet the inclusion criteria will be included. Subgroup analysis of the type of cancer, the type of VTE, cancer stage, age, sex, ethnicity, history of smoking and drinking as well as the mean, dose and duration of anticoagulants will be performed. DISCUSSION: Our study aims to estimate the efficacy and safety of rivaroxaban for patients with cancer-associated VTE and to provide recommendations to key stakeholders. TRIAL REGISTRATION: PROSPERO, October 23, 2019, CRD42019143265, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=143265.

Concurrent use of corticosteroids with licorice-containing TCM preparations in Taiwan: a National Health Insurance Database study.

OBJECTIVES: This study used a nationwide population-based dataset from the 1997-2003 National Health Insurance claims to explore the prevalence, frequency, and relative risk of concurrent use of systemic corticosteroids with licorice-containing Traditional Chinese Medicine (TCM) preparations that might possibly result in drug-herb interactions. DESIGN: This study was based on the complete datasets of Western medicine and TCM outpatient reimbursement claims from 1997 to 2003 contained in the National Health Insurance Research Database of Taiwan. According to the date and duration of prescriptions, the patients who concurrently used systemic corticosteroids with licorice-containing TCM preparations were derived for statistical analysis. SETTING: This study was set in Taiwan. OUTCOME MEASURES: Descriptive statistics were used to analyze the demographics of patients who used corticosteroids with licorice-containing TCM preparations concurrently, including age, gender, and the frequency and percentage of major diseases in International Classification of Diseases, 9th version, Clinical Modification (ICD-9-CM) categories. The relative risk of potential corticosteroid-herb interaction was also analyzed with respect to different characteristics of the patients (age, sexuality etc.). RESULTS: The prevalence of concurrent use of systemic corticosteroids with licorice-containing TCM preparations through prescriptions from different Chinese medicine and Western medicine physicians was 1.495%. Among the major disease categories, ICD-9-CM codes 280-289 had the highest prevalence rate of 3.803%. CONCLUSIONS: Potential risk of corticosteroid-licorice interactions may happen, even through formal medical services. In the future, such educational propagations should be reinforced. Furthermore, an alert device that includes well-recognized drug-herb interactions should be built into every hospital's computer system to remind physicians to be cautious on drug safety.

Factors influencing the purchasing behavior of TCM outpatients in Taiwan.

OBJECTIVES: To test the factors that influence Chinese medicine outpatients' behavior patterns in purchasing Traditional Chinese Medicine (TCM) under the National Health Insurance (NHI) system in Taiwan. METHODS: A structural questionnaire was developed and administered to randomly selected outpatients waiting for Chinese Medicine at pharmacies in two academic hospitals that offered Chinese Medicine services in central Taiwan. A total of 641 effective questionnaires were collected. SPSS 10.0 (Statistical Package for Social Sciences, SPSS Inc., Chicago, IL) was used to run descriptive analysis and one-way analysis of variance (ANOVA). In addition, LISREL 8.30 (Analytical Package, Scientific Software International, Inc., Chicago, IL) was used to modify and analyze the relationship between the variables of the hypothetical pathway model. RESULTS: Path analysis showed that "behavioral intention" and "suffering from disease" had positive and direct influences on the outpatients' patterns of purchasing TCM. Furthermore, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly influenced the purchasing behavior of TCM outpatients. In addition, one-way ANOVA showed that the purchasing behavior was significantly influenced by the number of diseases that an individual suffered. The results of the pathway model showed that "behavioral intention" and "suffering from disease" had positive and direct influence on the TCM purchasing behavior of Chinese Medicine outpatients. However, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly had influence on the TCM purchasing behavior. Furthermore, the analysis result of one-way ANOVA showed that the more chronic diseases the surveyed subject suffered, the more significant the influence on purchasing behavior became. CONCLUSIONS: Under the current NHI system, patients with multiple chronic diseases are the major purchasers of TCM products not covered by NHI. Therefore, increasing the usable resources of TCM products for the patients with chronic diseases will help hospitals in developing TCM services under the current NHI system.