Treatment Of Lumbar Disc Herniation By Jiawei Sanbi Decoction And The Mechanism Of Its Effective Component Asperosaponin ? Inhibiting Intervertebral Disc Degeneration

Part ?:Clinical study on the treatment of lumbar disc herniation with Jiawei Sanbi DecoctionObjective:Objective To observe the clinical effect of Jiawei Sanbi Decoction in the treatment of lumbar disc herniation.Methods:In this study,80 patients from Department of orthopedics and traumatology,Affiliated Hospital of integrated traditional Chinese and Western medicine of Nanjing University of traditional Chinese medicine were selected from June 2020 to December 2020,and randomly divided into experimental group and control group,40 cases in each group.The experimental group was treated with Jiawei Sanbi Decoction and the control group was treated with Celebrex.VAS score and JOA score were performed before,2 weeks and 4 weeks after treatment to evaluate the efficacy.Results:In this study,3 patients in the experimental group and 2 patients in the control group fell off due to drug withdrawal,and 75 patients were actually completed,including 37 patients in the experimental group,19 male patients and 18 female patients,with an average age of 43.22±13.91 years old and an average course of disease of 24.00±30.25 months.The control group included 38 patients,including 18 male patients and 20 female patients,with an average age of 43.68±12.75years old and an average course of disease of 16.03±28.10 months.Statistical analysis showed no significant difference in gender,age or course of disease between the two groups(P>0.05).There was no significant difference in VAS and JOA scores between the two groups before enrollment(P>0.05),and the general situation of patients in the two groups before enrollment was not statistically significant and comparable.When evaluating the efficacy of the two drugs by VAS score and JOA score,respectively,for 2 weeks and 4 weeks,it was found that the symptoms of lumbago and leg pain in the experimental group and the control group were significantly improved after treatment,and no significant difference was found between the experimental group and the control group.Conclusion:Jiawei Sanbi Decoction can effectively improve the clinical symptoms of intervertebral disc herniation.Part ?:Study on network pharmacology of Jiawei Sanbi Decoction in the treatment of lumbar disc herniationObjective:To explore the network pharmacological mechanism of Jiawei Sanbi Decoctionin in the treatment of lumbar disc herniation.Methods:TCMSP and TCMID database were used to screen the pharmacodynamic targets of the monarch and Minister drugs(Dipsacus asperata,Angelica pubescens,Eucommia ulmoides,Achyranthes bidentata,Ligusticum chuanxiong,asarum,Corydalis yanhusuo,Gentiana macrophylla,Bombyx batrytica)in Jiawei Sanbi Decoction.Then,UniProt database was used to convert the target protein into Gene Symbol name.The targets of lumbar disc herniation were further searched and screened by genecards and OMIM database.The drug disease common targets screened by Excel were drawn by Venn map.The active ingredient target network diagram was constructed by Cytoscape 3.7.0 software.Protein interaction network was constructed by TRING database and analyzed by R4.1.0 software.The important targets of drug screening were analyzed by "cluster profiler" R package for GO and KEGG.Results:100 kinds of effective components of the monarch and Minister of Jiawei Sanbi Decoction and 79 drug disease common targets were screened.From the drug-disease target map,89 kinds of main medicinal ingredients,such as Quercetin,Kaempferol,?-Sitosterol,Wogonin,(3-Carotene,were obtained.The top five targets were PTGS2,PTGS1,ESR1,NOS2,CASP3.TNF,IL-6,VEGFA,TP53 and AKT1 were the nodes with degree>58 obtained from PPI network diagram.Through GO analysis,there were 1996 enrichment items,47 cell composition items,1854 biological processes items and 95 molecular functions items.139 signaling pathways were obtained by KEGG enrichment analysis.Conclusion:Jiawei Sanbi Decoction has many components and targets,and can regulate anti-inflammatory,immune response,anti-oxidation,tissue metabolism and cell apoptosis through a variety of signaling pathways to treat LDH.Part ?:Asperosaponin VI promotes the differentiation of HMSC into nucleus pulposus like cells and inhibits the degeneration of rat caudal intervertebral disc.Objective:Objective to investigate the mechanism of asperosaponin VI in promoting the differentiation of human mesenchymal stem cells into nucleus pulposus like cells and inhibiting the degeneration of rat caudal intervertebral disc.Method:Real time quantitative PCR and immunofluorescence were used to detect the expression of COL2A1,aggrecan and Paxl in nucleus pulposus cells to observe the promoting effect of asperosaponin ? on the differentiation of human mesenchy-mal stem cells into nucleus pulposus like cells.Western blot was used to detect the expression of p-ERK1/2 and p-Smad2/3 to observe the effect of asperosaponin? on ERK1/2 and Smad2/3 pathways.H-E staining and immunohisto chemis-try were used to observe the inhibitory effect of human mesenchymal stem cell after asperosaponin VI intervention on the degeneration of rat caudal intervertebral disc.Result:1.AsperosaponinVI can promote the differentiation of human mesenchymal stem cell into nucleus pulposus like cell;2.AsperosaponinVI can promote the differentiation of human mesenchymal stem cell into nucleus pulposus like cell,which may be related to the activation of ERK1/2 and Smad2/3 signaling pathway;3.After intervention with asperosaponinVI,human mesenchymal stem cell can inhibit the degeneration of rat caudal intervertebral disc.Conclusion:Asperosaponin ? can promote the differentiation of human mesenchymal stem cell into nucleus pulposus like cell and inhibit the degeneration of rat caudal intervertebral disc.