PMID- 37311503 OWN - NLM STAT- MEDLINE DCOM- 20230824 LR - 20230824 IS - 1872-7573 (Electronic) IS - 0378-8741 (Linking) VI - 317 DP - 2023 Dec 5 TI - Clinical efficacy and metabolomics study of Wendan Decoction in the treatment of phlegm-dampness obstructive sleep apnea-hypopnea syndrome with type 2 diabetes mellitus. PG - 116775 LID - S0378-8741(23)00643-8 [pii] LID - 10.1016/j.jep.2023.116775 [doi] AB - ETHNOPHARMACOLOGICAL RELEVANCE: Wendan Decoction (WDD) is one of the classic traditional Chinese prescriptions that has been used in the treatment of type 2 diabetes mellitus (T2DM), metabolic syndrome, obstructive sleep apnea-hypopnea syndrome (OSAHS) and so on. The therapeutic effects and mechanism of WDD remain to be explored, especially from the perspective of metabolomics, oxidative stress and inflammation. AIM OF THE STUDY: To investigate the therapeutic and metabolic regulatory effects and the underlying mechanism of WDD in OSAHS with T2DM patients. MATERIALS AND METHODS: All included patients were from Rudong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu Province, China. Both groups received lifestyle interventions; at the same time, all of them were administered metformin (1500 mg/day) and dapagliflozin (10 mg/day), and the treatment group was administered WDD orally. All patients were treated for two months. Before and after treatment, the changes in clinical symptoms and signs of the two groups of patients were evaluated, and the detection indicators such as body mass index (BMI), apnea-hypopnea index (AHI), lowest arterial oxygen saturation (LSaO(2)), Epworth sleepiness scale (ESS), percentage of total sleep time with oxygen saturation <90% (TST90), fasting plasma glucose (FPG), 2-h post-load glucose(2h-PG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR)，hemoglobin A1c (HbA1c), blood lipid levels, as well as the adverse reactions and compliance of the patients were observed and detection of serum metabolites in patients to screen out specific biomarkers. The serum metabolic profile of WDD in OSAHS with T2DM patients was explored using ultra-high-performance liquid chromatography-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry (UPLC-Q Orbitrap HRMS). RESULTS: After treatment with WDD for 8 weeks, biochemical indicators, including BMI, FPG, 2h-PG, blood lipid, FINS, HbA1c, AHI, ESS, LSaO(2), TST90, and HOMA-IR, were significantly improved. Serum metabolomic analysis showed that metabolites were differentially expressed before and after WDD-treated patients. Metabolomics results revealed that WDD regulated the biomarkers, such as DL-arginine, guaiacol sulfate, azelaic acid, phloroglucinol, uracil, L-tyrosine, cascarillin, Cortisol and L-alpha-lysophosphatidylcholine. Pathway enrichment analysis showed that the metabolites were associated with oxidative stress and inflammation. CONCLUSION: The study based on clinical research and metabolomics indicated that WDD can improve OSAHS with T2DM through multiple targets and pathways, and it may be a useful alternative therapy for the treatment of OSAHS with T2DM patients. CI - Copyright (c) 2023 Elsevier B.V. All rights reserved. FAU - Zhou, Sifeng AU - Zhou S AD - Department of Endocrinology, Rudong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, 226400, China; School of Traditional Chinese Medicine.Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China. Electronic address: zhousifeng1987@126.com. FAU - Xu, Haishu AU - Xu H AD - Department of Pharmacy, Rudong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, 226400, China. Electronic address: 570499816@qq.com. FAU - Zhu, Jieyun AU - Zhu J AD - Department of Ophthalmology, Rudong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, 226400, China. Electronic address: icehappy2020@163.com. FAU - Fan, Xinsheng AU - Fan X AD - School of Traditional Chinese Medicine.Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China. Electronic address: fanxsh126@126.com. FAU - Zhang, Jinming AU - Zhang J AD - Department of Endocrinology, Rudong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, 226400, China. Electronic address: zjm_625403@163.com. LA - eng PT - Journal Article DEP - 20230611 PL - Ireland TA - J Ethnopharmacol JT - Journal of ethnopharmacology JID - 7903310 RN - 0 (wendan) RN - 0 (Glycated Hemoglobin) SB - IM MH - Humans MH - *Diabetes Mellitus, Type 2/complications/drug therapy MH - Glycated Hemoglobin MH - *Sleep Apnea, Obstructive/drug therapy/metabolism MH - Treatment Outcome MH - Inflammation MH - Metabolomics OTO - NOTNLM OT - Metabolomics OT - OSAHS OT - Phlegm-dampness OT - Type 2 diabetes mellitus OT - Wendan Decoction COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/06/14 01:10 MHDA- 2023/08/24 06:42 CRDT- 2023/06/13 19:10 PHST- 2023/01/17 00:00 [received] PHST- 2023/04/23 00:00 [revised] PHST- 2023/06/10 00:00 [accepted] PHST- 2023/08/24 06:42 [medline] PHST- 2023/06/14 01:10 [pubmed] PHST- 2023/06/13 19:10 [entrez] AID - S0378-8741(23)00643-8 [pii] AID - 10.1016/j.jep.2023.116775 [doi] PST - ppublish SO - J Ethnopharmacol. 2023 Dec 5;317:116775. doi: 10.1016/j.jep.2023.116775. Epub 2023 Jun 11.