Efficacy and Safety of the TCM Qi‐Supplementing Therapy in Patients with Myasthenia Gravis: A Systematic Review and Meta‐Analysis

Evidence-Based Complementary and Alternative Medicine

et al. 2023

The herbal pairing of Huangqi and Dangshen (HD) is traditional Chinese herbal medicine and has been widely used in China, especially to treat myasthenia gravis (MG). However, the mechanism of HD on MG is unclear. Aim of the Study. This study aims to investigate HD’s possible role in MG treatment. Materials and Methods. The TCMSP database was used to identify the active chemicals and their targets. The GeneCards, DisGeNET, and OMIM databases were used to search for MG-related targets. The STRING database was employed in order to identify the common PPI network targets. We next utilised Cytoscape 3.8.2 for target identification and the DAVID database for gene ontology (GO) function analysis as well as Encyclopaedia of Genomes (KEGG) pathway enrichment analysis on the selected targets. The AutoDock Vina software was used to test the affinity of essential components with the hub gene before concluding that the primary targets were corrected through molecular docking. Results. 41 active compounds were screened from HD, and the number of putative-identified target genes screened from HD was 112. There were 21 target genes that overlapped with the targets of MG, which were postulated to be potential treatment targets. Through further analysis, the results showed that the active compounds from HD (such as 7-methoxy-2-methylisoflavone, quercetin, luteolin, Kaempferol, and isorhamnetin) may achieve the purpose of treating MG by acting on some core targets and related pathways (such as EGFR, FOS, ESR2, MYC, ESR1, CASP3, and IL-6). Molecular docking findings demonstrated that these active molecules have a near-perfect ability to attach to the primary targets. Conclusion. Through network pharmacology, the findings in this study provide light on the coordinated action of several HD formula components, targets, and pathways. It provided a theoretical basis for further study of HD pharmacological action.

Section: Introductionmentioning

confidence: 99%

Investigation of the Underlying Mechanism of Huangqi‐Dangshen for Myasthenia Gravis Treatment via Molecular Docking and Network Pharmacology

Liu

Lü

Evidence-Based Complementary and Alternative Medicine

et al. 2023

“…MG is usually treated with conventional western medicine such as acetylcholinesterase inhibitors, glucocorticoid, and other non-steroidal immunosuppressants with dissatisfactory clinical effects in some patients, the risk of unconscionable dosage, and unwanted adverse effects where traditional Chinese medicine (TCM) can take a complementary and alternative effect. A study found that using TCM combined with western medicine might improve the total effect and reduce the risk of MG relapse [ 9 ]. According to the TCM characteristic theory of “spleen governing muscle,” MG is generally diagnosed as “spleen qi deficiency syndrome” and thereby, strengthening the spleen and replenishing qi is a common therapeutic strategy of MG in TCM, which has played a positive role in clinical practice of MG [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of modified Buzhong Yiqi decoction in treating myasthenia gravis: study protocol for a series of N-of-1 trials

Weng

et al. 2022

Trials

Background Myasthenia gravis (MG) is an acquired autoimmune disease with high heterogeneity. The disease is chronic, relapsing repeatedly and progressive with acute exacerbation occasionally. Although the treatment of MG has developed, it is still unsatisfactory and has some unexpected side effects. Traditional Chinese medicine (TCM) has shown great potential in MG treatment, including relief of muscle weakness syndrome, improvement of patient’s quality of life, and reduction of side effects of western medicine. The purpose of this study is to evaluate the effectiveness of modified Buzhong Yiqi decoction (MBYD) as an add-on therapy for MG through a small series of N-of-1 trials. Methods Single-centre, randomized, double-blind, 3 crossover N-of-1 trials will be conducted to enroll patients with MG diagnosed as spleen-stomach deficiency syndrome or spleen-kidney deficiency syndrome in TCM. Each N-of-1 trial has 3 cycles of two 4-week periods containing the MBYD period and placebo period. The wash-out interval of 1 week is prior to switching each period. Primary outcome: quantitative myasthenia gravis (QMG). Secondary outcomes: the following scales: myasthenia gravis composite (MGC), myasthenia gravis activities of daily living profile (MG-ADL), myasthenia gravis quality of life (MG-QOL); the level of CD4+FoxP3+Treg cells and cytokines (IL-4, IL-17A, INF-γ, TGF-β) in the peripheral blood; the alterations of the composition of gut microbiota; reduction of the side effects of western medicine. Discussion Used by WinBUGS software, we will conduct a hierarchical Bayesian statistical method to analyze the efficacy of MBYD in treating MG in individuals and populations. Some confounding variables such as TCM syndrome type and potential carryover effect of TCM will be introduced into the hierarchical Bayesian statistical method to improve the sensitivity and applicability of the trials, and the use of prior available information within the analysis may improve the sensitivity of the results of a series of N-of-1 trials, from both the individual and population level to study the efficacy of TCM syndrome differentiation. We assumed that this study would reveal that MBYD is effective for MG and provide robust evidence of the efficacy of TCM to treat MG. Trial registration Chinese Clinical Trial Register, ID: ChiCTR2000040477, registration on 29 November 2020.

“…The disorder of gut microbiota promotes immune in ammation response, which aggravates the severity of MG. (7,8) MG is usually treated with conventional western medicine such as acetylcholinesterase inhibitors, glucocorticoid and other non-steroidal immunosuppressants with dissatisfactory clinical effects in some patients, the risk of unconscionable dosage and unwanted adverse effect where Traditional Chinese medicine (TCM) can take a complementary and alternative effect. A study found that using TCM combined with western medicine might improve the total effect and reduce the risk of MG relapse (9) . According to the TCM characteristic theory of "spleen governing muscle", MG is generally diagnosed as "spleen qi de ciency syndrome" and thereby, strengthening spleen and replenishing qi is a common therapeutic strategy of MG in TCM, which has played a positive role in clinical practice of MG. (10,11) Buzhong Yiqi Decoction (BYD), a classical qi-supplementing formula in TCM, is the most frequently used prescription to treat MG. A study showed that BYD modulated the balance of Treg and Th17 cells in patients with MG, downregulated the serum AChR antibody level (12).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Modified Buzhong Yiqi Decoction In Treating Myasthenia Gravis: Study Protocol For A Series Of N-of-1 Trials

Weng

et al. 2021

Preprint

Background: Myasthenia gravis (MG) is an acquired autoimmune disease with high heterogeneity. The disease is chronic, relapsing repeatedly and progressive with acute exacerbation occasionally. Although the treatment of MG has developed, it is still unsatisfactory and has some unexpected side effects. Traditional Chinese medicine(TCM) has shown great potential in MG treatment, including relief of muscle weakness syndrome, improvement of patient’s quality of life and reduction of side effects of western medicine. The purpose of this study is to evaluate the effectiveness of Modified Buzhong Yiqi Decoction (MBYD) as an add-on therapy for MG through a small series of N-of-1 trials.Methods: Single-centre, randomized, double-blind, 3 crossover N-of-1 trials will be conducted to enroll 12 adult patients with MG diagnosed as spleen-stomach deficiency syndrome or spleen-kidney deficiency syndrome in TCM. Each N-of-1 trial has 3 cycles of two 4-week periods containing the MBYD period and placebo period. The wash-out interval of 1-week is prior to switching each period. Primary outcome: Quantitative Myasthenia Gravis (QMG). Secondary outcomes: the following scales: myasthenia gravis composite (MGC), myasthenia gravis activities of daily living profile (MG-ADL), myasthenia gravis quality of life (MG-QOL); the level of CD4+FoxP3+Treg cells and cytokines (IL-4, IL-17A, INF-γ, TGF-β) in the peripheral blood; the alterations of the composition of gut microbiota; reduction of the side effects of western medicine. Discussion: Paired t tests or Wilcoxon signed rank tests will be used to analyse this trials’ data and the results we arrived at will be interpreted cautiously. We assumed that this study would reveal that MBYD is effective for MG and provide robust evidence of the efficacy of TCM to treat MG. Trial registration: Chinese Clinical Trial Register, ID: ChiCTR2000040477, registration on 29 November 2020, http://www.chictr.org.cn/showprojen.aspx?proj=64688.