Abstract
Background & Aims: Liver fibrosis is a critical pathological process in the progression of chronic liver diseases into severe forms, liver cirrhosis, liver failure, and liver cancer, posing a major global health burden with approximately 2 million deaths each year. Yet its incomplete mechanistic understanding hinders the development of effective therapies. Stress response signaling has been found to play a role in fibrosis development. Traditional and complementary medicine have long been widely explored for anti-fibrotic treatments. Huaji Ruangan Decoction (HJRGD), a classic traditional Chinese medicinal formula, has shown therapeutic promise in treating liver fibrosis. However, its mechanisms of action remain largely unknown.
Methods: We used a mouse model of liver fibrosis induced by intraperitoneal injection of carbon tetrachloride (CCl4) to evaluate the effect of HJRGD on liver injury, inflammation, and fibrosis. Additionally, we used tissue-specific stress response protein ATF4-deficient mice to examine the role of stress signaling in fibrosis development. Histopathological analyses, including H&E, Sirius Red, Masson, immunohistochemical staining, were conducted on mice livers to evaluate the therapeutic effects of HJRGD. Western blot, qPCR analysis, and biochemical analyses of sera and livers to explore the mechanisms underlying the anti-fibrotic effects of HJRGD. Primary hepatic stellate cells (HSCs) were isolated and cultured to further elucidate the mechanisms. Moreover, UHPLC-MS and computer-aided drug analysis were utilized to identify the potential active components of HJRGD contributing to its therapeutic effects on liver fibrosis.
Results: HJRGD markedly decreased collagen and extracellular matrix deposition by inhibiting hepatic stellate cell activation in CCl4-induced mice livers, accompanied with alleviated liver pathological changes including liver injury and inflammation. ATF4 played an critical role in the anti-fibrotic effect of HJRGD, as ATF4-deficient mice exhibited worsened liver inflammation and fibrosis, and notably, the beneficial effects of HJRGD were abolished in these mice. Furthermore, a comprehensive analysis of the active components of HJRGD strongly indicates that some bioactive ingredients of HJRGD modulate ATF4 signaling to mitigate liver fibrosis.
Conclusion: Our data demonstrate a robust protective anti-fibrosis effect of HJRGD through the regulation of ATF4-mediated stress signaling in HSCs and hepatocytes. Notably, certain active ingredients of HJRGD show potential as effective modulators of ATF4 stress response signaling pathway to reverse the fibrosis, meriting further investigation in the future. These results signify a novel approach to anti-fibrosis treatment and shed the light for developing new therapeutic strategies.