Single-Cell and Machine Learning Analyses Identify a PFKFB3-Centered Regulatory Network and Potential Salidroside Interaction in Coronary Heart Disease.

Coronary heart disease (CHD) is a leading cause of morbidity and mortality, driven by metabolic remodeling, vascular inflammation, and perivascular adipose tissue (PVAT) dysfunction. We integrated bulk transcriptomic datasets to develop a machine learning-based diagnostic model, evaluated 113 algorithms, and identified a seven-gene signature (PYGL, PTGS2, PFKFB3, MMP9, CYP1B1, CXCR1, ABCB1) with robust predictive performance. Single-cell RNA sequencing (scRNA-seq) of coronary PVAT revealed substantial cellular heterogeneity and prioritized PFKFB3 as a hub linking glycolytic activity to nuclear factor kappa B (NF-κB) regulon activity. Macrophage-centered communication via secreted phosphoprotein 1 (SPP1), migration inhibitory factor (MIF), and other pathways was enhanced in disease conditions. Virtual knockout of PFKFB3 induced transcriptional changes enriched in immune activation, phagocytosis, and oxidative stress, while molecular dynamics (MD) simulations suggested that salidroside can adopt a stable binding pose within the PFKFB3 pocket, providing structural plausibility for their interaction. Together, these analyses provide a multi-layered framework connecting glycolytic remodeling, inflammatory transcriptional activity, and intercellular signaling in CHD. The findings support PFKFB3 as a potential biomarker and mechanistic hub and suggest that salidroside may modulate its activity. This study offers an integrative computational foundation for future experimental validation and mechanistic exploration of PVAT dysfunction in CHD.