Discovering the compatibility of Coptidis Rhizoma and Gardeniae Fructus in attenuating hepatotoxicity through the association rules analysis of related formula

Ethnopharmacological relevance: Gardenia jasminoides J. Ellis (Gardeniae Fructus, GF) is a widely used herbal medicine in many prescriptions. However, inappropriate application of GF may induce hepatotoxicity, which greatly challenges its clinical application. In the field of Traditional Chinese Medicine, the principle of "Compatibility for Toxicity Attenuation" is a pivotal concept. So far, the basis and mechanisms of compatibility with GF remain unclear.

Aims of the study: We aimed to investigate the toxicity attenuating effects and potential mechanisms of compatibility of Coptis chinensis Franch (Coptidis Rhizoma, CR) and GF in hepatotoxicity.

Methods and results: Association rules analysis was performed in 817 GF-related formulas, and 49 associated items were selected, among which CR and GF were ranked in the top two. Network pharmacology was used to elucidate the potential mechanisms of combination of CR and GF in mitigating hepatotoxicity. Nine potential hepatotoxic components of GF and 14 active components of CR were focused on, and 9 common targets for CR and GF were identified. Further GO and KEGG analyses showed that the toxicity attenuating effect of CR on GF-induced hepatotoxicity may be closely correlated with inflammatory response, response to hypoxia, cancer signaling pathways, PI3K-Akt and HIF-1 signaling pathway. The in vitro results indicated that the combined use of CR and GF increased the viability of HepG2 cells. Furthermore, the in vivo data demonstrated that CR inhibited GF-induced increase in serum ALT and AST levels and pathological changes in the livers of KM mice. Besides, CR reduced the accumulation of ROS and MDA, inhibited the release of TNF-α and IL-6, while elevated GSH level in the mouse liver tissues. Finally, the molecular docking results indicated that the active components of CR had strong binding affinity with the monooxygenase cytochrome P450 3A4 (CYP3A4). CR combination restored the expression of CYP3A4 in the liver tissues of mice challenged with GF.

Conclusion: Co-administration with CR effectively reduced GF-induced hepatotoxicity through alleviating oxidative damage, inflammatory response and enhancing CYP3A4 expression.