四妙剂治疗痛风及高尿酸血症的研究进展OA

Simiao Pill(四妙丸),from Chengfang Biandu,has the effect of clearing heat and removing dampness,reducing swelling and relieving pain,and is widely used in the treatment of gout and hyperuricemia(HUA),with good safety.The most commonly used compatibility ratio of Huangbai(Phellodendri Chinensis Cortex)∶Changzhu(Atractylodis Rhizoma)∶Niuxi(Achyranthis Bidentatae Radix)∶Yiyiren(Coicis Semen)is 1∶1∶1∶2.The research has demonstrated that Simiao For-mula can decrease the levels of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),receptor for advanced glycation end products(RAGE),cyclooxygenase-2(COX-2),tumor necrosis factor(TNF)-α,interleukin(IL)-6 and IL-1 β in acute gouty arthritis(AGA).This is achieved through the inhibition of nucleotide-binding oligomerization domain-like receptor pro-tein 3(NLRP3)/IL-1 β,stromal cell-derived factor(SDF)-1/C-X-C motif chemokine receptor 4(CXCR4)signaling path-way,as well as romotion of macrophage M2 polarization,aiming to reduce inflammation and improve TCM syndrome scores.It can also decrease uric acid synthesis by inhibiting the activities of xanthine oxidase(XOD),guanine deaminase(GDA),xanthine de-hydrogenase(XDH)and adenosine deaminase(ADA).It up-regulates the expressions of organic anion transporter(OAT)1,OAT3 and adenosine triphosphate binding cassette transporter G member 2(ABCG2),while down-regulating the expression of glucose transporter 9(GLUT9),uric acid transporter 1(URAT1)and PSD-95-discs large-zonula occludens 1 domain contai-ning 1(PDZK1).Additionally,it regulates intestinal flora to enhance renal and intestinal excretion of uric acid.This intervention can reduce the time for decreasing the serum uric acid(SUA)levels,alleviate renal inflammatory cell infiltration,as well as tubu-lointerstitial renal fibrosis and glomerular injury.While managing gout and hyperuricemia,Simiao Pill can potentially normalize abnormal glucose and lipid metabolism,enhance insulin resistance(IR)and decelerate the progression of atherosclerosis.Net-work pharmacology has revealed that the key components of Simiao Decoction in treating gout and HUA include berberine,epicberberine,stigmasterol and sitosterol;while the core compounds consist of quercetin,kaempferol,baicalein,baicalein and β-sitosterol.The mechanism of action may involve regulating signal transduction pathways associated with inflammation as well as glucose and lipid metabolism.