Preclinical and clinical studies on Qin-Zhu-Liang-Xue decoction: insights from network pharmacology and implications for atopic dermatitis treatment

Atopic dermatitis (AD) is a chronic inflammatory skin disease with high prevalence, especially in children. Current treatments like topical glucocorticoids have limitations due to side effects and resistance. Traditional Chinese medicine (TCM) offers alternative solutions, with Qin-Zhu-Liang-Xue (QZLX) decoction showing efficacy in AD treatment. This study explores the mechanisms of QZLX using network pharmacology and evaluates its clinical effects through trials and animal experiments.

QZLX decoction, composed of ten herbal and mineral medicines, has been used clinically to treat AD with notable success and low recurrence rates. The primary active ingredients, baicalin and glycyrrhizic acid, are known for their anti-inflammatory properties. Network pharmacology analysis identified the glucocorticoid receptor (GR) as a central target of QZLX. This approach, aligning with TCM's holistic philosophy, helps unravel the complex interactions between the decoction's components and their targets.

The study included a prospective, randomized trial with 131 patients, where the treatment group received QZLX decoction, and the control group received mizolastine. QZLX significantly improved AD symptoms, as indicated by reduced SCORAD and DLQI scores, with no serious adverse effects. Network pharmacology analysis revealed 361 overlapping genes between QZLX targets and AD-related genes, identifying core genes like NFKBIA and NR3C1. GRα, encoded by NR3C1, was validated as a key target, with QZLX treatment increasing its expression in patients' serum.

Animal experiments using a DNFB-induced AD mouse model further confirmed QZLX's efficacy. The decoction alleviated skin lesions, reduced scratching behavior, and improved pathological conditions. It also decreased inflammatory markers like IgE and cytokines, and increased GRα expression in skin lesions. These findings suggest QZLX mitigates AD by enhancing GRα expression and reducing inflammation, offering a strategy to prevent glucocorticoid resistance.

In conclusion, the study demonstrates QZLX's therapeutic potential for AD through clinical and animal models, highlighting its ability to enhance GRα expression. Future research should focus on identifying specific active ingredients and elucidating the precise molecular mechanisms underlying QZLX's effects on GRα. This work paves the way for understanding AD's underlying mechanisms and developing effective treatments.

DOI: 10.1007/s11684-024-1101-7