Mechanisms of Lian-Gui-Ning-Xin-Tang in the treatment of arrhythmia: Integrated pharmacology and in vivo pharmacological assessment

Jinhong Chen; Zhichao Liu; Fangjun Deng; Jiayu Liang; Boya Fan; Xin Zhen; Rui Tao; Lili Sun; Shaoqiang Zhang; Zidong Cong; Xiaofeng Li; Wuxun Du

doi:10.1016/j.phymed.2022.153989

Mechanisms of Lian-Gui-Ning-Xin-Tang in the treatment of arrhythmia: Integrated pharmacology and in vivo pharmacological assessment

Phytomedicine. 2022 May:99:153989. doi: 10.1016/j.phymed.2022.153989. Epub 2022 Feb 12.

Authors

Jinhong Chen¹, Zhichao Liu¹, Fangjun Deng¹, Jiayu Liang¹, Boya Fan¹, Xin Zhen¹, Rui Tao², Lili Sun², Shaoqiang Zhang³, Zidong Cong³, Xiaofeng Li⁴, Wuxun Du⁵

Affiliations

¹ Graduate School, Tianjin University of TCM, Tianjin 301617, China.
² Department of TCM, Tianjin University of TCM, Tianjin, 301617, China.
³ Department of Cardiology, The Second Affiliated Hospital of Tianjin University of TCM, Tianjin 300150, China.
⁴ Department of Cardiology, The Second Affiliated Hospital of Tianjin University of TCM, Tianjin 300150, China. Electronic address: 1519411043@qq.com.
⁵ Department of Cardiology, The Second Affiliated Hospital of Tianjin University of TCM, Tianjin 300150, China. Electronic address: cnduwux@163.com.

PMID: 35272242
DOI: 10.1016/j.phymed.2022.153989

Abstract

Background: Lian-Gui-Ning-Xin-Tang (LGNXT), a classical traditional Chinese medicine (TCM) formula, has been widely used in clinical practice and has shown satisfactory efficacy in the treatment of arrhythmias. However, its mechanism of action in the treatment of arrhythmias is still unknown. Moreover, the complex chemical composition and therapeutic targets of LGNXT pose a challenge in pharmacological research.

Purpose: To analyze the active compounds and action mechanisms of LGNXT for the treatment of arrhythmias.

Methods: Here, we used an integrated pharmacology approach to identify the potential active compounds and mechanisms of action of LGNXT in treating arrhythmias. Potential active compounds in LGNXT were identified using ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF/MS) and the potential related targets of these compounds were predicted using an integrated in silico approach. The obtained targets were mapped onto relevant databases to identify their corresponding pathways, following the experiments that were conducted to confirm whether the presumptive results of systemic pharmacology were correct.

Results: Eighty-three components were identified in herbal materials and in animal plasma using UPLC-Q-TOF/MS and were considered the potential active components of LGNXT. Thirty key targets and 57 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were identified as possible targets and pathways involved in LGNXT-mediated treatment using network pharmacology, with the cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA)/Ca²⁺ system pathway being the most significantly affected. This finding was validated using an adrenaline (Adr)-induced rat model of arrhythmias. Pretreatment with LGNXT delayed the occurrence, shortened the duration, and reduced the severity of arrhythmias. LGNXT exerted antiarrhythmic effects by inhibiting cAMP, PKA, CACNA1C, and RyR2.

Conclusions: The findings of this study revealed that preventing intracellular Ca²⁺ overload and maintaining intracellular Ca²⁺ homeostasis may be the primary mechanisms of LGNXT in alleviating arrhythmias. Thus, we suggest that the β-adrenergic receptor (AR)/cAMP/PKA/Ca²⁺ system signaling hub may constitute a promising molecular target for the development of novel antiarrhythmic therapeutic interventions. Additionally, we believe that the approach of investigation of the biological effects of a multi-herbal formula by the combination of metabolomics and network pharmacology, as used in this study, could serve as a systematic model for TCM research.

Keywords: Action mechanisms; Active compounds; Arrhythmia; Ca(2+) homeostasis; Integrated pharmacology; Lian-Gui-Ning-Xin-Tang.