[Study on mechanism of Danzha Tongmai Pills against atherosclerosis based on theory of "phlegm-stasis intermingling"].

Based on the TCM theory of "phlegm-stasis intermingling", this study aims to investigate the mechanism of Danzha Tongmai Pills(DZTMW) in treating atherosclerosis(AS), focusing on elucidating its in vivo active components, metabolic regulatory effects in serum, hepatoprotective effects, and anti-inflammatory efficacy. An AS model was established in apolipoprotein E knockout(ApoE~(-/-)) mice, which were divided into a normal group, an model group, low/medium/high-dose DZTMW groups, and an atorvastatin positive control group. The normal group was fed a standard diet, while the other groups were fed a high-fat diet to induce AS lesions. During the intervention phase, the groups were administered corresponding drugs or an equal volume of solvent by gavage. A series of tests were conducted after continuous intervention. Ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry(UPLC-Q-TOF-MS) was used to identify the blood-entering components of DZTMW, and liquid chromatography-high-resolution mass spectrometry(LC-HRMS) was employed for non-targeted serum metabolomics analysis. Pearson correlation analysis was used to analyze the correlation between blood-entering components and differential metabolites. Levels of serum lipid [total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), and free fatty acids(FFA)] and liver function markers [alanine aminotransferase(ALT) and aspartate aminotransferase(AST)] were measured. Liver histopathology and lipid deposition were assessed by HE and oil red O staining, and serum levels of inflammatory factors [lipoprotein-associated phospholipase A2(LP-PLA2), high-sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6), tumor necrosis factor-alpha(TNF-α), and interleukin-1 beta(IL-1β)] were measured by enzyme-linked immunosorbent assay(ELISA). The results showed that 23 blood-entering components were identified from DZTMW, including three prototype compounds, 20 metabolites, and 142 differential metabolites of serum. Core blood-entering components such as hydroxyl asiatic acid M1 and neocryptotanshinone metabolite were highly/extremely correlated with differential metabolites like 5-hydroxytryptamine, lysophosphatidylcholine(P-18:1/0:0) and sphingomyelin(d18:1/15:0). DZTMW administration at various doses significantly reduced the serum levels of TC, TG, LDL-C, and FFA(P<0.01), increased the HDL-C level(P<0.01), decreased ALT and AST activities(P<0.05, P<0.01), alleviated hepatocyte steatosis and lipid droplet deposition, and down-regulated the expression of inflammatory factors in a dose-dependent manner(P<0.01). The effects of the high-dose DZTMW group were comparable to those of the atorvastatin group. In summary, DZTMW can effectively inhibit the progression of AS in ApoE~(-/-) mice. Its mechanism may involve the regulation of hepatic lipid metabolism by its in vivo active components to ameliorate the "phlegm-turbidity" pathology and reduce liver injury, and the inhibition of systemic inflammation to alleviate the "blood stasis" process. The study can provide a modern biological basis for the theory of "phlegm-stasis intermingling".