UC is a refractory disease that requires long-lasting treatment and novel drugs are urgently needed. Fuzi, a traditional Chinese medicine, plays an important role in UC treatment. It has been reported that the Yiyi Fuzi Baijiang decoction has an anti-inflammatory effect by regulating the balance of Th17/Treg cells[21]. Furthermore, fuzi has a significant anti-inflammatory effect on DSS-induced colitis via inhibition of the MAPK/NF-κB/STAT3 signalling pathway[9]. To investigate the possible mechanism of fuzi in the treatment of UC, we first performed network pharmacological analysis. Through enrichment analysis, we identified the PI3K-AKT, MAPK, and Ras signaling pathways as the main pathways by which the active fuzi components exert their effects in the treatment of UC. The findings of the GO enrichment study suggested that the active components of fuzi may exhibit effects in the treatment of UC in response to xenobiotic stimulus and lipopolysaccharide. Fuzi may regulate HSP90AA1, AKT1, SRC, and other molecules to relieve colitis. Therefore, we speculated that the active components of fuzi that exert its therapeutic effect on UC are most likely by acting on the AKT1 molecule and regulating the PI3K/AKT pathway under the application of xenobiotic stimulus and lipopolysaccharide.
Hig is a benzylisoquinoline alkaloid extracted from fuzi that has various pharmacological effects, including anti-inflammatory, antioxidant, anti-apoptotic, lipid-lowering, anti-fibrotic, and anti-platelet activities[22]. Hig exhibits a strong anti-inflammatory effect. Wei et al. found that Hig inhibited the secretion of IL-6 and IL-8 as well as the phosphorylation of NF-κB in allergic rhinitis mice[23]. Yang et al. found that Hig significantly inhibited the production of TNF-α, IL-6, ROS, NO, and PGE2 in LPS-activated mouse microglial cells, possibly by suppressing the NF-κB signaling pathway [24]. To determine whether Hig can treat UC, we first performed network pharmacological analysis. Similar to the results of the network pharmacology analysis of fuzi, we found that Hig exerts its therapeutic effect on UC by acting on AKT1 and regulating the PI3K/AKT pathway under the influence of lipopolysaccharide and molecules of bacterial origin. For further verification, we used Hig intervention in mice with colitis. By analyzing daily recorded body weight and stool characteristics, colon length, and H&E-stained slices of the terminal colon, we found that Hig ameliorated weight loss, hematochezia, and other symptoms in DSS-treated mice. Hig also alleviates colonic shortening in mice with colitis. H&E staining showed that the colonic mucosa of mice was less damaged, and inflammatory cell infiltration was reduced after Hig treatment. Interestingly, Shao et al. also reported that Hig improves DSS-induced UC in mice through the Galectin-3/TLR4/NF-κB pathway recently[25]. Based on the above findings, we conclude that Hig can improve DSS-induced colitis in mice.
The intestinal barrier is mainly composed of a mucus layer secreted by goblet cells, antimicrobial peptides, secretory IgA (slgA), epithelial cells, microbiota, and the mucosal immune system[26]. Numerous studies have shown that damage to the intestinal barrier plays an indispensable role in UC occurrence and development. UC is a polymicrobial infectious disease characterized by sustained breakdown of the mucus barrier[27]. Bacterial products in the gut, such as LPS, inflammatory factors, and bacterial flagellin A, can activate NF-κB, thereby promoting goblet cells to over-secrete MUC2. Long-term over-secretion eventually leads to goblet cell function depletion and mucous barrier destruction[28]. In our study, PAS staining was used to stain goblet cells to observe the mucous barrier in the colons of mice. We found that the number of goblet cells was significantly reduced in DSS-treated mice. The number of colonic goblet cells was normal in DSS-induced colitis mice treated with Hig, indicating a significant improvement in the mucosal barrier. There are many tight junction proteins in intestinal epithelial cells, including transmembrane proteins, peripheral membrane proteins, and cytoskeletal proteins [29]. Occludin is a transmembrane protein that regulates the permeability of tight junctions in epithelial cells and maintains their polarity of epithelial cells. As a peripheral membrane protein, ZO-1 is mainly responsible for connecting claudins, occludins, and the cytoskeleton to maintain the integrity of tight junctions. Under inflammatory conditions, the expression of ZO-1 and occludin decreases, thereby increasing intestinal epithelial permeability[30]. The decrease in tight junction proteins in UC patients leads to damage of the intestinal barrier, which increases the permeability of the intestinal epithelium. Damage to the intestinal barrier is an important pathological mechanism of UC[31]. In our experiment, western blot and immunohistochemical techniques were used to detect the expression levels and locations of the tight junction proteins ZO-1 and occludin. Compared to normal mice, the expression of ZO-1 and occludin in DSS-treated mice decreased drastically. Treatment with Hig, particularly at higher doses, reversed the expression of ZO-1 and occludin in DSS-induced colitis. In conclusion, Hig showed a significant protective effect on the intestinal barrier damaged by DSS, as indicated by the improvement of the mucus barrier as well as the tight junctions of epithelial cells.
During colitis, NKT cells strongly express TNF-α, which stimulates the epithelial cells to express CXCL1, CXCL2, and CXCL3. These chemokines induce migration and infiltration of neutrophils into the intestine[32]. Patients with UC without mucosal neutrophils had a 60–70% relative reduction in the risk of recurrence. Complete elimination of neutrophil inflammation should be defined as a therapeutic target for disease remission in patients with UC [33]. Therefore, we examined the expression levels of inflammatory cytokines and chemokines, and the degree of neutrophil infiltration to detect the severity of colitis and to evaluate the effect of drug therapy. In addition, reduction of neutrophil infiltration should be considered as a therapeutic goal. In this experiment, the expression levels of IL-6, TNF-α, CXCL1, and CXCL2 were detected using ELISA, and the level of colon neutrophils was evaluated using immunofluorescence staining. Our results showed that Hig significantly alleviated colon inflammation and reduced infiltration of colon neutrophils in mice with colitis.
The PI3K/AKT pathway is involved in the regulation and release of pro-inflammatory cytokines such as TNF-α and plays an important role in the progression of UC. Inhibition of the PI3K/AKT pathway can improve UC[34]. Based on the results of network pharmacological analysis, we speculate that Hig may reduce intestinal damage by inhibiting the PI3K/AKT pathway. Furthermore, we found that Hig ameliorated AKT activation in mice with DSS-induced colitis. However, our study is contrary to Wu's finding that Hig activates the PI3K/AKT signaling pathway in cardiomyocytes[35], which may be explained by the following reasons. First, animal models are different. Second, Hig may act on other signaling pathways, such as NF-κB at the same time, resulting in decreased cytokine secretion and thus decreased activation of the PI3K/AKT signaling pathway[24]. Based on our results, we concluded that Hig alleviated DSS-induced colitis, possibly by regulating the PI3K/AKT pathway.