The Potential Mechanism Of San-Qi Oral Solution In The Treatment Of Membranous Nephropathy And The Systematic Review

Objective1.Systematic ReviewThis study is to evaluate the efficacy and safety of the oral Huangqi formulae fortreatment of IMN in adults by comprhensively analysing and estimating quality of the RCTs published.It can obtainthe evidence-based medicine basis for the treatment in patients of MN,serving for clinical application.2.Animal ExperimentThe expriment is to explore the potential mechanism of San Qi oral solution in the treatment of MN by evaluating the treatment effect of San Qi oral solution on rats with MN,which include urine protein,serumbiochemical indicators,the expression of Synaptopodin,Podocin in the renal tissues and renal pathology.Methods1.Systematic ReviewThe major databases(PubMed,EMBASE,CochraneCentral Register of Controlled Trials(CENTRAL),CBM,CNKI,VIP and Wanfang)were searched until July 2016 and supplemented with a manual search.Randomized controlled trials(RCTs)of the oral Huangqi formulae that reported 24hours urine protein,total effective rate,serum albumin,serumcreatinine,symptom scoreswere extracted by two reviewers.The Cochrane tool was used for the assessment of risk of bias in the included trials.Data were analyzed with RevMan 5.3 software.2.Animal Experiment40 Male Sprague-Dawley ratsweighing 180-200 g were used in our experiments.10 rats were randomly selected as control.The rat model of MN was induced by intravenous administration with C-BSA every other day.We operated injection on the tail for a month after a preliminary immune.All the rats with MN were divided into 3 groups randomly:model control group,San-Qi group,LosartanPotassium group,with 10 rats in each group.All the rats were treatedorally by gastricgavage for 4 weeks.After that we tested 24 h UP,ALB,Scr,TC,TG and so on.We also observedthe pathological changes of in kidney by electronmicroscopy,light microscopy and immunofluorescence.In addition,theSynaptopodin,Podocinexpression in renal tissues were detected by Western-blotand immunofluorescence assay.Results1.Systematic ReviewFifteen RCTs(1412 participants)were included.Compared with western therapyalone,oral Huangqi formulae included therapy strategy resulted in the reduction of 24hours urine protein,increased total effective rate,and the reduction of total cholesterol.Improvements in serum albumin and symptoms were observedin patients receiving Huangqi formulae plus conventional therapy strategy and ACEI/ARB,compared to those receiving conventional therapy strategy and ACEI/ARB.Serious adverse events were reported in only one trial.2.Animal Experiment2.1 San-Qi oral solution can improve the general condition of rats with membranous nephropathy,andreduce 24 h UP.There were significant differences,which was compared with model controlgroup(P<0.05).2.2 San-Qi oral solution can repairpathological damage of MN rats in renal tissues,lightening the deposition of immune complex to some extent.2.3 San-Qi oral solutioncan also induce up-regulation the expression of Synaptopodin,Podocin in renal tissues and reduce the podocyte injury.Conclusions1.Systematic ReviewThe benefits of the oral Huangqi formulae for IMN in adults were promising.However,its safety and efficacy have not been established due to weaknesses in methodology and possible bias in some studies.Further rigorously designed studies are warranted.2.Animal Experiment2.1.San-Qi oral solution can reduce urine protein,and have a treatment effects on MN rats.2.2.San-Qi oral solution can ameliorate the pathological damageof renal tissue in MN rats,inhibit the thickening of glomerular GMB to a certain extent.2.3.San-Qi oral solutioncan increaseSynaptopodin,Podocin expression of the MN rats in renal tissues,maintain glomerular podocyte in membrane structure and the integrity of thefiltrateon barrier function.