Fufang epimedium formula alleviates acute liver injury through dual modulation of PI3K/AKT/Bcl-2 anti-apoptotic signaling pathway and cGAS-STING-IRF3 anti-inflammatory signaling pathway.

ETHNOPHARMACOLOGICAL RELEVANCE: The Fufang Epimedium formula (FEF) is an empirical formulation utilized in Traditional Chinese Medicine for the treatment of hepatitis B and acute liver injury (ALI) in clinical settings. So far, the hepatoprotective properties and underlying mechanisms of action of FEF remain inadequately understood.

AIM OF THE STUDY: To explore the effects and mechanisms of FEF in the treatment of ALI.

MATERIALS AND METHODS: Firstly, the acute oral toxicity of FEF extract was evaluated using a maximum single dose. Following a 7-day pretreatment with optimized doses of FEF, an intraperitoneal injection of lipopolysaccharide combined with D - galactosamine was administered to induce ALI in mice. The components of FEF extract, as well as those absorbed into the serum of ALI mice were identified using UHPLC-QTOF-MS/MS. Subsequently, potential active components, key targets and signaling pathways associated with FEF's treatment of ALI were uncovered utilizing network pharmacology in conjunction with molecular docking. The effects of FEF on ALI in mice, including reductions in aminotransferase levels, inflammation, oxidative stress and liver pathology, were assessed using biochemical assays, ELISA kits, and hematoxylin and eosin staining. Furthermore, the mechanisms of action, including inhibiting apoptosis and modulating key proteins associated with the PI3K/AKT/Bcl-2 and cGAS-STING-IRF3 pathways, were confirmed through TUNEL, Western blot and immunohistochemical assays.

RESULTS: A single oral administration of FEF at the maximum dose of 17.6 g/kg did not result in acute toxicity in mice over a 14-day period. 479 components in the FEF extract and 138 prototype components in the ALI mice serum were identified. The primary components showed binding energies lower than -4.4 kcal/mol when interacting with key target proteins. Importantly, FEF treatment improved the pathological structure of the damaged liver, markedly reduced ALT, AST, and MDA levels, and increased GSH, SOD, and CAT levels, while decreasing TNF-α, IL-1β, and IL-6 levels in ALI mice. Furthermore, FEF treatment markedly suppressed hepatocyte apoptosis characterized by fewer TUNEL-positive cells, inhibited expressions of caspase-3 and PARP and enhanced phosphorylation of PI3K and AKT, as well as increased the Bcl-2/Bax ratio. Notably, FEF treatment also significantly down-regulated the cGAS and STING expressions, and suppressed the phosphorylation of TBK1 and IRF3.

CONCLUSIONS: These results confirm that FEF exerts hepatoprotective effects by reducing aminotransferase levels, countering oxidative stress, suppressing inflammation, and preventing apoptosis. These effects are mechanistically linked to the dual modulation of the PI3K/AKT/Bcl-2 anti-apoptotic and cGAS-STING-IRF3 anti-inflammatory pathways. The findings provide a scientific foundation for clinical translation of FEF and future development of targeted therapies for ALI.