DN is a serious microvascular complication of diabetes and is the leading cause of ESRD [31]. Sinomenine has been widely applied to treat autoimmune diseases for many years. Zhang et.al found that SIN could ameliorate DOX-induced nephrotic syndrome in rats, causing the change of renal nephrin, podocin expression, hence improving the podocytes injury [32]. Qin et.al reported that SIN could effectively improve the altered expression of EMT-associated protein α-SMA, E-cadherin, fibronectin, and ECM expression that related to renal fibrosis via interrupting TGFβ/Smad3 and Wnt/β-catenin signaling [8]. SIN was also found to effectively reduce the kidney damage and inflammatory responses, balance renal oxidative stress, inhibit IkBa phosphorylation and NF-kB nuclear translocation, modulate macrophage M1/M2 polarization via an Nrf2-dependent manner. So, SIN would play a critical role in anti-inflammation and renal protection [33]. Taken together, the renal protective function of SIN has been extensively correlated with the resistance to inflammation and oxidative stress, as well as EMT progression [32–35].
In our study, a systematic method was applied to evaluate the therapeutic mechanism of SIN in treating DN rats. At first, network pharmacology and molecular docking analysis were used to predict the possible molecular mechanisms of SIN in treating DN, we found SIN may affect the progression of DN via pathways related to inflammation. Then, we selected top 10 potential targets and found that they all have low binding energy with SIN, which may suggest that SIN could improve DN via altering the expression level of these targets. Except for the bioinformatic analysis, we also performed animal experiment and we found that SIN could attenuate histological and functional injury in renal tissue and improve the renal function and reduce proteinuria of DN rats according to the biochemical parameters and morphological observation.
Our transcriptomics results indicated that DEGs involved multiple classical biological processes, including phosphatidylinositol 3-kinase regulator activity, Hsp90 protein binding, very long-chain fatty acid metabolic process, hyaluronic acid binding, positive regulation of collagen metabolic process, positive regulation of collagen biosynthetic process. These biological processes contribute to the processes of renal fibrosis [36], disturbed glomerular endothelial stabilization [37], hyperplasia of mesangial cells [38], and inflammation [39]. In addition, the enriched pathways were found to be involved in ECM proteoglycans, circadian rhythm, interleukin-6 family signaling, JAK-STAT signaling pathway, socs binding to JAK2, and tryptophan metabolism. The enriched pathways involved in hypertension [40], renal information [41], fibrosis [40, 42, 43], and cell apoptosis [9].
Our metabonomics results showed that SIN might improve DN via several metabolites and some metabolites have been found to be associated with the development of DN. Arbutin has anti-oxidative and anti-inflammatory activities, which could markedly improve renal function, and attenuate inflammation and cell apoptosis by modulating PI3K/Akt/Nrf2 signalling in acute kidney injury [44]. Phenilacetylglycine is a kind of fatty acid catabolites and has been reported as an early biomarker of kidney dysfunction in an animal model of ischemia/reperfusion injury [45]. Ganglioside is especially abundant in renal tissue and is known as maintaining the charge-selective filtration barrier of glomeruli. Altered expression of ganglioside was pathologically associated with glomerular hypertrophy occurring in DN kidneys [46].
In the results of combined analysis of transcriptomics and metabonomics, we discovered that SIN might inhibit the progression of DN through many significant pathways, including prostaglandin formation from arachidonate, pyrimidine metabolism, urea cycle and metabolism of arginine, proline, glutamate, aspartate and asparagine, arachidonic acid metabolism, glycerophospholipid metabolism, leukotriene metabolism, linoleate metabolism, purine metabolism, tryptophan metabolism, tyrosine metabolism.
Uric acid is an end product of the purine metabolism and excreted predominantly by the proximal tubules. For patients with DN, higher uric acid levels are associated with higher microalbuminuria, lower eGFR [47]; Linoleic acid would ameliorate hyperuricemia, insulin resistance and renal inflammation, accompanied with the downregulation of renal GLUT9 and URAT1 in fructose-fed rats and the inhibition of NLRP3 inflammasome and TLR4/MyD88 signaling [48]; Tyrosine metabolism is correlated with multiple diseases such as fatty liver, insulin resistance, and obesity [49]. Nitrotyrosine has been reported to participate in the progression of diabetes and its complications, the increased levels of nitrotyrosine can affect renal pathology and lead to renal dysfunction in diabetic rats [50]. Elevated levels of nitrotyrosine is positively correlated with patients with DN [51]. Nitrotyrosine has been found to induce glomerular mesangial cells to express NF-κB, MCP-1, and TGF-β1, leading to inflammation and aggravating nephropathy [52]; Recent study has confirmed that the increment of leukotriene in the kidneys after ischemia, which could further mediate multiple inflammatory reactions causing the kidney damage [53]. The role of leukotriene in glomerular injury has been confirmed, increased recruitment or activation of polymorphonuclear cells and elevated level of leukotriene B4 in the kidney would eventually decrease the glomerular filtration rate [54]; Glycerophospholipids are the major part of the cell membranes and involved in cell signaling, membrane anchoring and substrate transport. One study has discovered that abnormal glycerophospholipids were associated with patients and animals with CKD [55].