More and more studies have confirmed that TCM has a good effect on viral infectious diseases[16–18]. A prospective, randomized, controlled trial of 410 participants confirmed that YQP plus Maxingshigan decoction had shorter fever clearance time than oseltamivir in the treatment of influenza[5]. The challenge experiment of influenza A virus also confirmed that YQP had a protective effect on mice. YQP could prolong the survival time of infected mice and improve the survival rate[19].
At present, Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) database[6] is the most frequently used database for screening drug components and targets in network pharmacology research. The general method of network pharmacology research is to screen the components satisfying oral bioavailability (OB) and drug similarity (DL) in the TCMSP database and then screen their corresponding targets. The SymMap platform integrates target information from HIT, TCMSP, HPO, DrugBank, and NCBI databases, and is one of the largest target databases to date. However, only OB data of components are provided by this database, while DL data do not, and the corresponding targets of components cannot be obtained directly. Therefore, we skipped the step of screening active ingredients, and the target with FDR (Benjamini-Hochberg multiple testing correction) < 0.05 corresponding to each traditional Chinese medicine was directly included.
In this study, we performed PPI network analysis on potential targets of YQP for influenza treatment, which exhibited the characteristics of the YQP multi-target antiviral effect. A total of 37 key targets, including AKT1, TP53, INS, IL6, MAPK3, were screened according to the PPI network with a degree greater than twice the mean. TP53 is a major transcriptional regulator that is activated in various cellular stress responses and regulates a wide range of biological processes, such as cell cycle arrest, apoptosis and senescence[20, 21]. In addition, TP53 plays an important role in innate host immune control of viral infection and is the main target of viruses during infection[22, 23]. The Influenza virus can regulate the expression and post-transcriptional activity of TP53, which is helpful to maintain a cell state conducive to viral replication[24, 25].
In addition, we performed functional enrichment analysis, including GO and KEGG pathway, to elucidate the multiple mechanisms of YQP treatment for influenza. The results of GO enrichment include three parts: BP, MF, and CC. The top 10 GO terms with the largest number of hitlist are shown by us. Biological processes such as response to toxic substance, cytokine-mediated signaling pathway, response to lipopolysaccharide, response to extracellular stimulus, and positive regulation of cell death are closely related to influenza virus infection, replication and the generation of influenza symptoms. YQP may achieve the efficacy of treating influenza by intervening in these biological processes.
Metascape has a unique KEGG pathway clustering algorithm, so we show the results of KEGG enrichment after clustering, as well as enrichment results that are not clustered and disease pathways are removed. YQP can interfere with the infection process of the influenza virus by intervening PI3K/Akt, TNF, IL-17, MAPK, and other signaling pathways. PI3K/Akt signaling pathway plays an important role in many physiological processes, and its activation is a marker of cell survival[26]. After the influenza virus infects host cells, its non-structural protein NS1 can directly bind to the p85β subunit on the PI3K of host cells, thereby activating the PI3K/Akt pathway[27, 28]. Viruses reduce the apoptotic rate of host cells by utilizing the PI3K/Akt signaling pathway, thereby increasing the replication time of viruses[29].
Finally, the disease pathway map of influenza was drawn by us using KEGG Mapper, and potential targets enriched in this pathway were presented in the map. YQP can inhibit virus proliferation and alleviate clinical symptoms by interfering with the release of inflammatory factors mediated by the NF-κB signaling pathway and the expression of viral proteins mediated by the MAPK pathway. YQP was used by Fu to treat wild-type and TLR7 KO C57BL/6 mice infected with influenza virus FM1, respectively. The expression of TLR7, MyD88, IRAK4, and NF-κB was significantly decreased in the YQP group, but the therapeutic effect of YQP on TLR7 KO mice was poor. This suggests that YQP may play an anti-influenza role by regulating TLR7/NF-κB[30]. As for the MAPK pathway, some studies have reported that Raf/MEK/ERK signaling plays an important role in influenza virus proliferation. Mutation of Raf and ERK or treatment with MEK inhibitor (U0126) could significantly inhibit virus propagation[31, 32]. Berberine is a major component of a variety of traditional Chinese medicines, and it can hinder the replication of influenza A by inhibiting the nucleolar export of viral ribonucleoproteins mediated by the ERK pathway in vitro[33].
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