Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China.
West China-Washington Mitochondria and Metabolism Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
J Ethnopharmacol. 2021 Jun 28;274:114029. doi: 10.1016/j.jep.2021.114029. Epub 2021 Mar 14.
Chaiqin chengqi decoction (CQCQD) and its derivatives have been widely used in China for the early management of patients with acute pancreatitis (AP). Numerous studies demonstrate the anti-inflammatory and anti-oxidative effects of CQCQD and derivatives, but whether these effects can be attributed to suppressing neurogenic inflammation, has never been studied.
To investigate the effects of CQCQD on substance P (SP)-neurokinin 1 receptor (NK1R) based neurogenic inflammation in an experimental AP model.
For AP patients on admission, pain score was accessed by visual analog scale (VAS); the levels of serum SP and expressions of pancreatic SP and NK1R were also determined. For in vivo study, mice received 7 intraperitoneal injections of cerulein (50 μg/kg) at hourly intervals to induce AP, whilst controls received normal saline injections. In the treatment groups, CQCQD (10 g/kg, 200 μl) was intragastrically given at the third, fifth, and seventh of the cerulein injection or the NK1R antagonist CP96345 (5 mg/kg) was intraperitoneally injected 30 min before the first cerulein administration. The von Frey test was performed to evaluate pain behavior. Animals were sacrificed at 12 h from the first cerulein/saline injection for severity assessment. Pharmacology network analysis was used to identify active ingredients of CQCQD for AP and pain. In vitro, freshly isolated pancreatic acinar cells were pre-treated with CQCQD (5 mg/ml), CP96345 (1 μM), or selected active compounds of CQCQD (12.5, 25, and 50 μM) for 30 min, followed by SP incubation for another 30 min.
The VAS score as well as the levels of serum SP and expressions of pancreatic SP-NK1R were up-regulated in moderately severe and severe patients compared with those with mild disease. CQCQD, but not CP96345, consistently and significantly ameliorated pain, pancreatic necrosis, and systemic inflammation in cerulein-induced AP as well as inhibited NK1R internalization of pancreatic acinar cells. These effects of CQCQD were associated with reduction of pancreatic SP-NK1R and neuron activity in pancreas, dorsal root ganglia, and spinal cord. Baicalin, emodin, and magnolol, the top 3 active components of CQCQD identified via pharmacology network analysis, suppressed NK1R internalization and NF-κB signal pathway activation in isolated pancreatic acinar cells.
CQCQD ameliorated cerulein-induced AP and its associated pain via inhibiting neuron activation-mediated pancreatic acinar cell SP-NK1R signaling pathways and its active compounds baicalin, emodin, and magnolol contributed to this effect.
柴芩承气汤(CQCQD)及其衍生物在中国被广泛用于急性胰腺炎(AP)患者的早期治疗。大量研究表明 CQCQD 和衍生物具有抗炎和抗氧化作用,但这些作用是否归因于抑制神经原性炎症,尚未进行研究。
研究 CQCQD 对实验性 AP 模型中基于 P 物质(SP)-神经激肽 1 受体(NK1R)的神经原性炎症的影响。
对于入院的 AP 患者,通过视觉模拟量表(VAS)评估疼痛评分;还测定血清 SP 水平以及胰腺 SP 和 NK1R 的表达。在体内研究中,小鼠接受 7 次腹腔注射 Cerulein(50μg/kg),每隔 1 小时 1 次,以诱导 AP,而对照组接受生理盐水注射。在治疗组中,在 Cerulein 注射的第 3、5 和第 7 次时给予 CQCQD(10g/kg,200μl)灌胃,或在第 1 次 Cerulein 给药前 30 分钟给予 NK1R 拮抗剂 CP96345(5mg/kg)腹腔注射。使用 von Frey 测试评估疼痛行为。在第 1 次 Cerulein/生理盐水注射后 12 小时处死动物进行严重程度评估。使用药理学网络分析鉴定 CQCQD 治疗 AP 和疼痛的活性成分。在体外,用 CQCQD(5mg/ml)、CP96345(1μM)或 CQCQD 的选定活性化合物(12.5、25 和 50μM)预处理新鲜分离的胰腺腺泡细胞 30min,然后用 SP 孵育 30min。
与轻度疾病患者相比,中度和重度患者的 VAS 评分以及血清 SP 水平和胰腺 SP-NK1R 的表达均升高。CQCQD 一致且显著改善了 Cerulein 诱导的 AP 中的疼痛、胰腺坏死和全身炎症,同时抑制了胰腺腺泡细胞中 NK1R 的内化。CQCQD 的这些作用与胰腺、背根神经节和脊髓中胰腺 SP-NK1R 和神经元活性的降低有关。通过药理学网络分析鉴定的 CQCQD 的前 3 种活性成分黄芩苷、大黄素和厚朴酚,抑制了分离的胰腺腺泡细胞中 NK1R 的内化和 NF-κB 信号通路的激活。
CQCQD 通过抑制神经元激活介导的胰腺腺泡细胞 SP-NK1R 信号通路改善了 Cerulein 诱导的 AP 及其相关疼痛,其活性化合物黄芩苷、大黄素和厚朴酚促成了这种作用。