Literature DB >> 32357187

Berberine inhibits free fatty acid and LPS-induced inflammation via modulating ER stress response in macrophages and hepatocytes.

Yanyan Wang1,2, Xiqiao Zhou2,3, Derrick Zhao2, Xuan Wang2, Emily C Gurley2, Runping Liu2, Xiaojiaoyang Li2, Phillip B Hylemon2, Weidong Chen1, Huiping Zhou2.   

Abstract

Inflammation plays an essential role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Berberine (BBR), an isoquinoline alkaloid isolated from Chinese medicinal herbs, has been widely used to treat various diseases, including liver diseases for hundreds of years. The previous studies have shown that BBR inhibits high fat-diet-induced steatosis and inflammation in rodent models of NAFLD. However, the underlying molecular mechanisms remain unclear. This study is aimed to identify the potential mechanisms by which BBR inhibits free fatty acid (FFA) and LPS-induced inflammatory response in mouse macrophages and hepatocytes. Mouse RAW264.7 macrophages and primary mouse hepatocytes were treated with palmitic acid (PA) or LPS or both with or without BBR (0-10 μM) for different periods (0-24 h). The mRNA and protein levels of proinflammatory cytokines (TNF-α, IL-6, IL-1β, MCP-1) and ER stress genes (CHOP, ATF4, XBP-1) were detected by real-time RT-PCR, Western blot and ELISA, respectively. The results indicated that BBR significantly inhibited PA and LPS-induced activation of ER stress and expression of proinflammatory cytokines in macrophages and hepatocytes. PA/LPS-mediated activation of ERK1/2 was inhibited by BBR in a dose-dependent manner. In summary, BBR inhibits PA/LPS-induced inflammatory responses through modulating ER stress-mediated ERK1/2 activation in macrophages and hepatocytes.

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Year:  2020        PMID: 32357187      PMCID: PMC7194368          DOI: 10.1371/journal.pone.0232630

Source DB:  PubMed          Journal:  PLoS One        ISSN: 1932-6203            Impact factor:   3.752


1. Introduction

Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases. An increasing body of evidence suggests that the disease progression of NAFLD is closely associated with inflammation, obesity, insulin resistance, and metabolic syndrome [1,2]. However, the exact molecular/cellular mechanisms underlying NAFLD remain obscure and the effective therapeutic strategies are still limited. The elevated circulating levels of lipopolysaccharide (LPS) due to disruption of intestinal barrier function and free long-chain fatty acids (FFA) are implicated in insulin resistance and systemic inflammation, both of which are positively associated with the development and progression of NAFLD [3,4]. Although the mechanism by which LPS/FFA induce hepatic lipotoxicity is still not fully understood, LPS/FFA-induced expression of inflammatory cytokines, such as TNF-α and IL-6, and activation of the endoplasmic reticulum (ER) stress signaling pathway, known as the unfolded protein response (UPR), are major contributors [5-8]. Berberine (BBR), an isoquinoline alkaloid isolated from many medicinal herbs, is one of the widely used traditional Chinese medicines and has been used to treat various infectious disorders for more than 3,000 years [9]. During the last few decades, many studies have shown that BBR exerts various beneficial effects on cardiovascular and metabolic diseases [10]. It also has been reported that BBR can prevent NAFLD disease progression by regulating multiple metabolic pathways and reducing inflammation response [11]. We have previously reported that BBR could inhibit HIV protease inhibitor-induced ER stress and TNF-α and IL-6 expression through regulating the RNA-binding protein (RBP) HuR in macrophages [12]. In this study, we specifically examined the effect of BBR on PA/LPS-induced inflammatory response in macrophages and hepatocytes. The results indicated that BBR significantly inhibited PA/LPS-induced inflammatory response via modulating ER stress and ERK1/2 activation.

2. Materials and methods

2.1. Materials

Antibodies against phospho-ERK1/2, ERK1, ERK2, CHOP, ATF-4, XBP-1, IL-1β, ATF6, GRP78, IRE1α, β-Actin were from Santa Cruz Biotechnology (Santa Cruz, CA, USA). The detailed information of the antibodies was listed in S1 Table. Berberine (BBR), lipopolysaccharides (LPS), and Palmitic acid (PA) were purchased from Sigma (St. Louis, MO, USA). Bovine Serum Albumin Fraction V, heat shock, fatty acid-free, was from Roche (Roche Diagnostics GmbH, Mannheim, Germany). All cell culture media were purchased from Thermo Fisher (Waltham, MA, USA).

2.2. Cell culture and treatment

Mouse 264.7 macrophages (ATCC, Rockville MD, USA) were cultured as previously described [13]. BBR was dissolved in DMSO while LPS was dissolved in the culture medium. PA was firstly dissolved in ethanol at 200 mM followed by combination with 10% FFA-free, low-endotoxin BSA, giving a final concentration of 5 mM. The working solution was prepared fresh by diluting the stock solution (1:10) in the culture medium.

2.3. Isolation of primary mouse hepatocytes

Primary mouse hepatocytes were isolated from C57BL/6 wild type mice (male, 6–8 weeks old, from Jackson Laboratories, Bar Harbor, ME, USA) by the collagenase-perfusion technique, which has been previously described [14]. Mice were anesthetized with continuous 2% isoflurane in O2 (500 cc/min) during the isolation. After that, mice were euthanized by cervical dislocation. The procedures for isolation of primary mouse hepatocytes were approved by the Virginia Commonwealth University Institutional Animal Care and Use Committee (Approved protocol number: AD1001773). Hepatocytes were plated at the collagen-coated 60-mm dish or 6-well plate in serum-free Williams E medium containing penicillin, dexamethasone (0.1μM), and thyroxine (1μM) [15].

2.4. RNA isolation and real-time Quantitative RT-PCR

Total RNA was isolated using TRIzol Reagent (QIAGEN, Valencia, CA, USA) following the manufacturer’s protocol. The first-strand cDNA was reverse transcribed and Quantitative PCR analysis of relative mRNA levels of target genes was performed, as previously described [16]. The mRNA levels of CHOP, ATF4, XBP-1s, XBP-1us, TNF-α, IL-6, IL-1β, and MCP-1 were quantified by real-time PCR using gene-specific primers. Primer sequences used are provided in S2 Table.

2.5. Enzyme-linked immunosorbent assay (ELISA) of TNF-α, IL-6, MCP-1

Mouse RAW264.7 macrophages were pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25 mM) or LPS (25 ng/mL) or PA plus LPS for 6 h. Wild type-derived primary hepatocytes were pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25 mM) or LPS (25 ng/mL) for 6h. At the end of the treatment, the culture medium was collected and centrifuged to remove the cell debris. The protein levels of TNF-α, IL-6, and MCP-1 in the media were measured using mouse TNF-α, IL-6, and MCP-1 ELISA Max™ Set Deluxe Kits (Biolegend, San Diego, CA, USA) as previously described [17,18]. The total protein concentrations of the viable cells were measured using Bio-Rad Protein Assay reagent and Bradford protein assay. Total amounts of the TNF-α, IL-6, and MCP-1 were normalized to the total protein amount of the viable cells and expressed as pg/mg protein.

2.6. Western blot analysis

Total cellular proteins were prepared using cold RIPA buffer as previously described [19]. Protein concentration was measured using the Bio-Rad Protein Assay reagent. Proteins were resolved by 10% SDS-PAGE and transferred to nitrocellulose membranes. After blocking with 5% nonfat milk in TBS-T, the membranes were incubated with the primary antibodies overnight at 4℃ followed by detection using horseradish peroxidase-conjugated secondary antibody. The antibody-antigen complexes were detected using the ECL system (Thermo Scientific, Rockford, IL, USA). The density of immunoblotted bands was analyzed using Bio-Rad Image Lab computer software and normalized with β-Actin [15].

2.7. Statistical analysis

Results are expressed as the mean ± SEM and are from at least three independent experiments. One-way analysis of variance was performed to compare the differences between multiple groups using GraphPad Prism 5.0 (GraphPad Software Inc., San Diego, CA, USA). A value of p≤0.05 was considered statistically significant.

3. Results

3.1. Effect of BBR on PA and LPS-induced upregulation of the proinflammatory cytokines in RAW264.7 cells

Activation of the inflammatory response is a critical driving force of NAFLD disease progression. Macrophages are the major sources of proinflammatory cytokines and chemokines, such as TNF-α, IL-6, IL-1β, and MCP-1 [20]. Our previous studies reported that BBR could inhibit HIV protease inhibitor-induced inflammatory response via modulating ER stress in mouse J774A.1 macrophages [12]. To investigate the potential anti-inflammatory properties of BBR on PA and LPS-induced inflammation in macrophages, we first determined the mRNA expression levels of the proinflammatory cytokines and chemokine, including TNF-α, IL-6, IL-1β, and MCP-1 using real-time RT-PCR. As shown in Fig 1A, LPS significantly induced the expression of TNF-α. PA alone had minimal effect, but PA further promoted LPS-induced TNF-α expression, which was inhibited by BBR. Similarly, LPS/PA-induced upregulation of IL-6, IL-1β, and MCP-1 mRNA levels was also inhibited by BBR in mouse RAW264.7 macrophages (Fig 1B–1D).
Fig 1

Effect of BBR on PA and LPS-induced mRNA expression of proinflammatory mediators in RAW264.7 cells.

RAW264.7 cells were pretreated with BBR (5 μM) for 1 h, then treated with palmitic acid (PA, 0.25 mM) or LPS (25 ng/mL) or both for 6 h. The mRNA levels of TNF-α, IL-6, MCP-1, and IL-1β were detected by real-time RT-PCR and normalized to HPRT1 as an internal control as described under Materials and Methods. Values are mean ± S.E. of three independent experiments. Statistical significance relative to vehicle control, **p<0.01, ***p<0.001; relative to LPS, $p<0.05; relative to PA+LPS, #p<0.05. A. TNF-α; B. IL-6; C. IL-1β; D. MCP-1.

Effect of BBR on PA and LPS-induced mRNA expression of proinflammatory mediators in RAW264.7 cells.

RAW264.7 cells were pretreated with BBR (5 μM) for 1 h, then treated with palmitic acid (PA, 0.25 mM) or LPS (25 ng/mL) or both for 6 h. The mRNA levels of TNF-α, IL-6, MCP-1, and IL-1β were detected by real-time RT-PCR and normalized to HPRT1 as an internal control as described under Materials and Methods. Values are mean ± S.E. of three independent experiments. Statistical significance relative to vehicle control, **p<0.01, ***p<0.001; relative to LPS, $p<0.05; relative to PA+LPS, #p<0.05. A. TNF-α; B. IL-6; C. IL-1β; D. MCP-1. In a parallel experiment, we measured the protein levels of TNF-α, IL-6, and MCP-1 secreted into cell culture media using ELISA. As shown in Fig 2A–2C, the protein levels of TNF-α, IL-6, and MCP-1 were significantly increased in the culture media of LPS-stimulated mouse RAW264.7 macrophages. PA alone also had no significant effect on protein expression of proinflammatory cytokines, but further potentiated LPS’ effect. Both LPS and LPS+PA-induced upregulation of TNF-α, IL-6, and MCP-1 were significantly inhibited by BBR. In addition, we measured the mature IL-1β protein levels by Western blot. As shown in Fig 2D and 2E, the combination of LPS with PA-induced activation of the inflammasome and mature IL-1β procession, which was inhibited by BBR.
Fig 2

Effect of BBR on PA and LPS-induced protein expression of proinflammatory mediators in RAW264.7 cells.

RAW264.7 cells were pretreated with BBR (5 μM) for 1 h, then treated with PA (0.25mM) or LPS (25 ng/mL) or both for 6 h. At the end of treatment, cell culture medium and total cell lysates were collected. The protein levels of TNF-α, IL-6, and MCP-1 were determined by ELISA as described under Materials and Methods. Relative protein levels of TNF-α, IL-6, and MCP-1 were normalized by total protein amounts and expressed as pg/mg of protein. The protein levels of mature IL-1β were determined by Western blot. β-Actin was used as the loading control. Values are mean ±S.E. of three independent experiments. Statistical significance relative to vehicle control, *p<0.05, **p<0.01, ***p<0.001; relative to LPS, $p<0.05, $p<0.01; relative to PA+LPS, #p<0.05, ##p<0.01. A. The relative protein levels of TNF-α; B. The relative protein levels of IL-6; C. The relative protein levels of MCP-1; D. Representative immunoblots of mature IL-1β and β-Actin; E. The relative protein levels of IL-1β.

Effect of BBR on PA and LPS-induced protein expression of proinflammatory mediators in RAW264.7 cells.

RAW264.7 cells were pretreated with BBR (5 μM) for 1 h, then treated with PA (0.25mM) or LPS (25 ng/mL) or both for 6 h. At the end of treatment, cell culture medium and total cell lysates were collected. The protein levels of TNF-α, IL-6, and MCP-1 were determined by ELISA as described under Materials and Methods. Relative protein levels of TNF-α, IL-6, and MCP-1 were normalized by total protein amounts and expressed as pg/mg of protein. The protein levels of mature IL-1β were determined by Western blot. β-Actin was used as the loading control. Values are mean ±S.E. of three independent experiments. Statistical significance relative to vehicle control, *p<0.05, **p<0.01, ***p<0.001; relative to LPS, $p<0.05, $p<0.01; relative to PA+LPS, #p<0.05, ##p<0.01. A. The relative protein levels of TNF-α; B. The relative protein levels of IL-6; C. The relative protein levels of MCP-1; D. Representative immunoblots of mature IL-1β and β-Actin; E. The relative protein levels of IL-1β.

3.2. Effect of BBR on PA and LPS-induced UPR activation in RAW264.7 macrophages

It has become increasingly evident that sustained activation of the UPR signaling pathways and upregulation of transcription factors, such as CHOP and ATF4, contribute to ER stress-induced liver injury [21]. CHOP is the major mediator responsible for ER stress-induced apoptosis. We have previously reported that activation of ER stress contributed to the HIV protease inhibitor (ER stress-inducer)-induced inflammatory response [22]. Here, we further examined whether BBR has an inhibitory effect on PA and LPS-induced UPR activation in macrophages. As shown in Fig 3A, LPS and PA synergistically induced the expression of CHOP mRNA, which was markedly inhibited by BBR in RAW264.7 macrophages. LPS and PA also upregulated mRNA levels of ATF4 and XBP-1, but to less extent compared to CHOP. BBR also inhibited LPS and PA-induced ATF4 mRNA expression, but not XBP1 (Fig 3B and 3C).
Fig 3

Effect of BBR on PA and LPS-induced mRNA expression of the UPR genes in RAW264.7 macrophages.

RAW264.7 cells pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25 mM) or LPS (25 ng/mL) or both for 6 h. The mRNA levels of CHOP, ATF4, XBP-1s, and XBP-1us were detected by real-time RT-PCR and normalized to HPRT1 as described under Materials and Methods. Values are mean ± S.E. of three independent experiments. Statistical significance relative to vehicle control, **p<0.01, ***p<0.001; relative to LPS, $p<0.05; relative to PA+LPS, #p<0.05, ##p<0.01. A. CHOP; B. ATF4; C. XBP-1s.

Effect of BBR on PA and LPS-induced mRNA expression of the UPR genes in RAW264.7 macrophages.

RAW264.7 cells pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25 mM) or LPS (25 ng/mL) or both for 6 h. The mRNA levels of CHOP, ATF4, XBP-1s, and XBP-1us were detected by real-time RT-PCR and normalized to HPRT1 as described under Materials and Methods. Values are mean ± S.E. of three independent experiments. Statistical significance relative to vehicle control, **p<0.01, ***p<0.001; relative to LPS, $p<0.05; relative to PA+LPS, #p<0.05, ##p<0.01. A. CHOP; B. ATF4; C. XBP-1s. In order to determine whether inhibition of the mRNA expression of CHOP and ATF4 by BBR is correlated to the reduction of protein levels, we measured the protein levels of CHOP, ATF4, and XBP1 by Western blot analysis. As shown in Fig 4, BBR significantly inhibited PA and LPS-induced protein expression of CHOP, ATF4.
Fig 4

Effect of BBR on PA and LPS-induced protein expression of the UPR genes in RAW264.7 macrophages.

RAW264.7 cells were pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25mM) or LPS (25 ng/mL) or both for 6 h. Total cell lysates were prepared for Western blot analysis as described under Materials and Methods. β-Actin was used as the loading control. Values are mean ± S.E. of three independent experiments. Statistical significance relative to control, *p<0.05, **p<0.01; relative to PA+LPS, #p<0.05. A. Representative immunoblots of CHOP, ATF4, XBP-1s, and β-Actin; B. The relative protein levels of CHOP; C. The relative protein levels of ATF4; D. The relative protein levels of XBP-1s;.

Effect of BBR on PA and LPS-induced protein expression of the UPR genes in RAW264.7 macrophages.

RAW264.7 cells were pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25mM) or LPS (25 ng/mL) or both for 6 h. Total cell lysates were prepared for Western blot analysis as described under Materials and Methods. β-Actin was used as the loading control. Values are mean ± S.E. of three independent experiments. Statistical significance relative to control, *p<0.05, **p<0.01; relative to PA+LPS, #p<0.05. A. Representative immunoblots of CHOP, ATF4, XBP-1s, and β-Actin; B. The relative protein levels of CHOP; C. The relative protein levels of ATF4; D. The relative protein levels of XBP-1s;.

3.3. Effect of BBR on PA and LPS-induced ERK activation in RAW264.7 macrophages

Activation of ERK1/2 has been reported to promote LPS-induced production of TNF-α, IL-6, IL-1β, and MCP-1 [23]. Our previous studies showed that BBR inhibits HIV protease inhibitor-induced inflammatory response by modulating ER stress signaling pathways in macrophages [12]. It also has been shown that BBR significantly inhibits the expression of inflammatory cytokines in ARPE-19 cells and that the inhibitory effect is mediated by inactivation of the ERK1/2, JNK, and p38 pathways [24]. In order to delineate the potential signaling pathways underlying the inhibitory effect of BBR on PA and LPS-induced TNF-α, IL-6, IL-1β, and MCP-1 expression and ER stress in macrophages, we further examined effects of PA/LPS and BBR on ERK activation. As shown in Fig 5, PA and LPS synergistically induced ERK activation, which was completely inhibited by BBR. As shown in the Supplementary S1 Fig, the effect of BBR on PA/LPS-induced ERK activation was time-dependent, the maximal effect was found at the 6 h time point. Furthermore, the inhibitory effect of BBR on PA/LPS-induced ERK activation was also dose-dependent (Fig 6).
Fig 5

Effect of BBR on PA and LPS-induced ERK activation in RAW264.7 macrophages.

RAW264.7 cells pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25mM) or LPS (25 ng/mL) or both for 6 h. Total cell lysates were prepared for Western blot analysis as described under Materials and Methods. Values are mean ± S.E. of three independent experiments. Statistical significance relative to vehicle control, *p<0.05, **p<0.01; relative to PA+LPS, #p<0.05. A. Representative immunoblots of phospho(p)-ERK and total (T)-ERK; B. The relative protein levels of p-ERK.

Fig 6

Effect of BBR on PA and LPS-induced ERK activation in RAW264.7 macrophages.

RAW264.7 cells are pre-treated with BBR (0, 1.25, 2.5, 5, 10 μM) for 1 h, then treated with PA(0.25mM) and LPS (25 ng/mL) for 6 h. Total cell lysates were prepared for Western blot analysis as described under Materials and Methods. Values are mean ±S.E. of three independent experiments. Statistical significance relative to vehicle control, *p<0.05; relative to PA+LPS, #p<0.05, ##p<0.01. A. Representative immunoblots of phospho(p)-ERK and total (T)-ERK; B. The relative protein levels of p-ERK/total ERK.

Effect of BBR on PA and LPS-induced ERK activation in RAW264.7 macrophages.

RAW264.7 cells pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25mM) or LPS (25 ng/mL) or both for 6 h. Total cell lysates were prepared for Western blot analysis as described under Materials and Methods. Values are mean ± S.E. of three independent experiments. Statistical significance relative to vehicle control, *p<0.05, **p<0.01; relative to PA+LPS, #p<0.05. A. Representative immunoblots of phospho(p)-ERK and total (T)-ERK; B. The relative protein levels of p-ERK. RAW264.7 cells are pre-treated with BBR (0, 1.25, 2.5, 5, 10 μM) for 1 h, then treated with PA(0.25mM) and LPS (25 ng/mL) for 6 h. Total cell lysates were prepared for Western blot analysis as described under Materials and Methods. Values are mean ±S.E. of three independent experiments. Statistical significance relative to vehicle control, *p<0.05; relative to PA+LPS, #p<0.05, ##p<0.01. A. Representative immunoblots of phospho(p)-ERK and total (T)-ERK; B. The relative protein levels of p-ERK/total ERK.

3.4. Effect of BBR on PA and LPS-induced activation of inflammation, UPR, and ERK in primary mouse hepatocytes

To further examine the effect of BBR on PA/LPS-induced activation of inflammation, UPR, and ERK in hepatocytes, we isolated primary mouse hepatocytes and pre-treated with BBR for 1 h, then treated with PA/LPS for 6 h. The protein levels of TNF-a, IL-6, and MCP-1 were measured by ELISA. The protein levels of mature IL-1β, CHOP, ATF4, XBP1, p-ERK, and total ERK were determined by Western blot analysis. As shown in Fig 7A–7C, PA/LPS-induced upregulation of the protein expression levels of TNF-α, IL-6, IL-1β, and MCP-1 were completely inhibited by BBR. The Western blot results further indicated that BBR not only inhibited PA/LPS-induced CHOP and ATF-4 activation but also significantly suppressed PA/LPS-induced ERK activation in primary mouse hepatocytes (Fig 7D–7G). However, LPS/PA had no effect on the protein expression levels of IRE1α, ATF6, and GRP78 (S2 Fig). Furthermore, the oil-red O staining showed that PA/LPS-induced hepatic lipid accumulation was also inhibited by BBR (S3 Fig). However, LPS alone did not induce lipid accumulation, which was consistent with the previous report [25].
Fig 7

Effect of BBR on PA and LPS-induced activation of inflammation, UPR, and ERK in primary mouse hepatocytes.

Primary mouse hepatocytes were isolated from C57BL/6 wild type mice and pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25mM) and LPS (25 ng/mL) for 6 h. At the end of treatment, cell culture medium and total cellular protein were collected. The protein levels of TNF-α, IL-6, and MCP-1 were determined by ELISA and were normalized by total protein amounts and expressed as pg/mg of protein. Total cell lysates were prepared for western blot analysis for IL-1β, CHOP, ATF4, XBP-1, phospho(p)-ERK, total (T)-ERK, and β-Actin. Values are mean ± S.E. of three independent experiments. Statistical significance relative to vehicle control, *p<0.05, **p<0.01; relative to PA+LPS, #p<0.05. A. The relative protein levels of TNF-α, IL-6, and MCP-1; B. Representative immunoblots of IL-1β and β-Actin; C. The relative protein levels of IL-1β; D. Representative immunoblots of CHOP, ATF4, XBP-1s, and β-Actin. E. The relative protein levels of CHOP, ATF4, and XBP-1s; F. Representative immunoblots of phospho(p)-ERK and total (T)-ERK. G. The relative protein levels of p-ERK/total ERK.

Effect of BBR on PA and LPS-induced activation of inflammation, UPR, and ERK in primary mouse hepatocytes.

Primary mouse hepatocytes were isolated from C57BL/6 wild type mice and pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25mM) and LPS (25 ng/mL) for 6 h. At the end of treatment, cell culture medium and total cellular protein were collected. The protein levels of TNF-α, IL-6, and MCP-1 were determined by ELISA and were normalized by total protein amounts and expressed as pg/mg of protein. Total cell lysates were prepared for western blot analysis for IL-1β, CHOP, ATF4, XBP-1, phospho(p)-ERK, total (T)-ERK, and β-Actin. Values are mean ± S.E. of three independent experiments. Statistical significance relative to vehicle control, *p<0.05, **p<0.01; relative to PA+LPS, #p<0.05. A. The relative protein levels of TNF-α, IL-6, and MCP-1; B. Representative immunoblots of IL-1β and β-Actin; C. The relative protein levels of IL-1β; D. Representative immunoblots of CHOP, ATF4, XBP-1s, and β-Actin. E. The relative protein levels of CHOP, ATF4, and XBP-1s; F. Representative immunoblots of phospho(p)-ERK and total (T)-ERK. G. The relative protein levels of p-ERK/total ERK.

Discussion

Macrophages play a critical role in activating the immune response against dangerous invaders, such as bacteria and viruses, by producing numerous proinflammatory mediators [26]. However, over activation of macrophages also causes tissue injury and promotes chronic disease progression, including metabolic liver disease, NAFLD. Therefore, inhibition of chronic inflammation becomes a potentially effective therapy to prevent the pathological progression of chronic diseases. In the rapid progression of the pandemic of obesity, NAFLD has emerged as the most common chronic liver disease. Inflammation is a major contributor to insulin resistance, dyslipidemia, and metabolic syndrome [27,28]. BBR, isolated from Rhizoma coptidis, has been widely used in traditional Chinese medicine to treat bacteria infection for thousands of years. The clinically beneficial effects of BBR on metabolic diseases are linked to its anti-inflammatory activity [29-31]. Recent advances in NAFLD studies indicate that saturated fatty acid (SFA) or LPS promotes hepatic lipid accumulation and inflammation, which contribute to NAFLD disease progression [32-34]. Consistent with recent studies, our results showed that PA, a major SFA, synergistically promoted LPS-induced inflammatory response in both RAW264.7 macrophages and hepatocytes [35-37]. We have previously reported that the effect of BBR on high-fat diet-induced NAFLD was mediated by modulating gut microbiomes [38]. Numerous pre-clinical studies also showed a promising therapeutic effect of BBR on NAFLD by its modulation of inflammatory responses [39-41]. Consistent with previous findings, this study clearly indicated that PA exacerbated LPS-induced inflammation by increasing the mRNA and protein expression of proinflammatory mediators in macrophages and primary mouse hepatocytes, which was inhibited by BBR. Interestingly, PA alone did not significantly induce an inflammatory response in both macrophages and hepatocytes, but markedly promoted LPS-mediated activation of the inflammatory response. BBR efficiently blocked PA/LPS-induced upregulation of TNF-α, IL-6, IL-1β, and MCP-1 (Figs 1, 2 and 7). As the major site in the cell for protein folding and trafficking, ER stress response has emerged as an essential cellular mechanism underlying numerous pathological conditions, such as inflammation and metabolic disorders [21,42,43]. Disruption of ER homeostasis leads to the activation of UPR. Extensive studies have shown that persistent activation of the UPR eventually induces inflammation and cell injury [6]. Our previous study reported that HIV protease inhibitors were strong ER stress inducers and activation of ER stress was responsible for HIV protease inhibitor-induced inflammation and dysregulation of lipid metabolism in macrophages and hepatocytes [12,44,45]. We also showed that BBR inhibited HIV protease inhibitor-induced inflammatory response by modulating ER stress response and inhibiting ERK activation in macrophages [12,46]. Here, we provide new evidence indicating that BBR-mediated beneficial effect against PA/LPS-induced inflammatory response is via modulating ER stress signaling pathways in both macrophages and hepatocytes. So far, three major branches of the UPR have been identified, including the IRE1 pathway, protein kinase RNA-like ER kinase (PERK) pathway, and ATF6 pathway [21]. Our results in the current study demonstrated that BBR significantly inhibited PA/LPS-induced activation of the PERK-ATF4-CHOP signaling pathway in macrophages and primary mouse hepatocytes, but no significant impact on protein levels of ATF6, IRE1α, and GRP78 in RAW264.7 macrophages (S2 Fig). Our previous study showed that activation of CHOP is responsible for ERK activation and subsequent upregulation of the expression levels of proinflammatory mediators in macrophages [46]. We also showed that knockout CHOP reduced ER stress-induced hepatic dyslipidemia and intestinal barrier dysfunction [47,48]. Most recent studies with high fat diet-induced NAFLD rodent models and Larval Zebrafish model indicated that several signaling pathways, such as the nuclear factor erythroid 2-related factor 2/antioxidant response element (Nrf2/ARE), sirtuin 3 (SIRT3)/AMPK/ACC, and AMPK-SREBP1c-SCD-1 pathways, are potential targets [39,41,49-51]. In summary, the current study identified a key cellular mechanism underlying the potential protective effect of BBR on PA and LPS-induced inflammatory response in macrophages and hepatocytes. BBR is an effective ER stress modulator, and its beneficial effects on preventing inflammatory and metabolic diseases may be largely through regulating the UPR signaling pathways. Therefore, further in vivo study using a clinically relevant NAFLD/NASH model and clinical studies are needed to evaluate the potential applications of BBR as a therapeutic agent for NAFLD. RAW264.7 cells were pre-treated with BBR (5 μM) for 1 h, then treated with PA(0.25mM) and LPS (25 ng/mL) for 2, 6, 12 and 24h. Total cell lysates were prepared for Western blot analysis as described under Materials and Methods. Values are mean ± S.E. of three independent experiments. Statistical significance relative to vehicle control, *p<0.05; relative to PA+LPS, #p<0.05, ##p<0.01. A. Representative immunoblots of phospho(p)-ERK and total (T)-ERK; B. The relative protein levels of p-ERK. (PDF) Click here for additional data file.

Effect of BBR on PA and LPS-induced protein expression of IRE1α, ATF6, and GRP78 in RAW264.7 macrophages.

RAW264.7 cells are pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25 mM) and LPS (25 ng/mL) for 6 h. Total cell lysates were prepared. The protein expression levels of IRE1α, ATF6, GRP78, and β-Actin were measured by Western blot analysis as described under Materials and Methods. β-Actin was used as the loading control. A. Representative immunoblots of IRE1α, ATF6, GRP78, and β-Actin are shown. (PDF) Click here for additional data file.

Effect of BBR on PA and LPS-induced lipid accumulation in mouse primary hepatocytes.

Primary mouse hepatocytes were plated on 22 × 22-mm glass coverslips in 6-well plates. Hepatocytes were pre-treated with BBR (5 μM) for 1 h, then treated with PA (0.25 mM) or LPS (25 ng/mL) or both for 6 h. At the end of the treatment, hepatocytes were fixed with 3.7% formaldehyde in PBS for 30 min followed by two washes with PBS. The hepatocytes were stained with 0.2% Oil Red O in 60% 2-propanol for 10 min and washed three times with PBS. The images of Oil Red O staining were taken with a microscope (Olympus, Tokyo, Japan) equipped with an image recorder under a 10 × lens. A. DMSO; B. BBR; C. PA; D.PA+BBR; E. LPS; F.LPS+BBR; G.PA/LPS; H. PA/LPS+BBR. (PDF) Click here for additional data file.

List of antibodies.

(DOCX) Click here for additional data file.

List of QPCR primers.

(DOCX) Click here for additional data file. (PDF) Click here for additional data file. 23 Mar 2020 PONE-D-20-07442 Berberine inhibits free fatty acid and LPS-induced inflammation via modulating ER stress response in macrophages and hepatocytes PLOS ONE Dear Dr. Zhou, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript within 30 days; congratulations on this wonderful study. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Gianfranco D. Alpini Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.plosone.org/attachments/PLOSOne_formatting_sample_main_body.pdf and http://www.plosone.org/attachments/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. To comply with PLOS ONE submission requirements, in your Methods section, please provide additional information regarding the experiments involving animals and ensure you have included details on (1) methods of sacrifice, (2) methods of anesthesia and/or analgesia, and (3) efforts to alleviate suffering. 3. PLOS ONE now requires that authors provide the original uncropped and unadjusted images underlying all blot or gel results reported in a submission’s figures or Supporting Information files. This policy and the journal’s other requirements for blot/gel reporting and figure preparation are described in detail at https://journals.plos.org/plosone/s/figures#loc-blot-and-gel-reporting-requirements and https://journals.plos.org/plosone/s/figures#loc-preparing-figures-from-image-files. When you submit your revised manuscript, please ensure that your figures adhere fully to these guidelines and provide the original underlying images for all blot or gel data reported in your submission. See the following link for instructions on providing the original image data: https://journals.plos.org/plosone/s/figures#loc-original-images-for-blots-and-gels. In your cover letter, please note whether your blot/gel image data are in Supporting Information or posted at a public data repository, provide the repository URL if relevant, and provide specific details as to which raw blot/gel images, if any, are not available. Email us at plosone@plos.org if you have any questions. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The current study showed that PA, a major SFA, synergistically promoted LPS-induced inflammatory response, ER stress in both RAW264.7 macrophages and primary mouse hepatocytes, and BBA, an herbal extract from Rhizoma coptidis, could repress the PA-LPS induced inflammation and induction of ER stress-related factors at both mRNA and protein levels. Liver fat accumulation and inflammation are two major factors in driving the progression from simple hepatic steatosis to steatohepatitis. There is no FDA approved medicine to prevent or treat non-alcoholic steatohepatitis (NASH) a more severe stage in the spectrum of non-alcoholic fatty liver diseases (NAFLD). In this regard, this study provide insight in using BBR as a preventative agent in preventing NAFLD transition to NASH in vivo. This study is well designed and conducted. The writing is clear and easy to follow. The current study showed specific modulation of the ER stress pathways by BBR with suppressing ERK activation as the potential molecular mechanism. A minor recommendation is to further provide the known mechanisms of action of BBR in the context of NAFLD and NASH studies, and how this study provides in vitro evidence supporting or contracting the known effects of BBR on liver lipid metabolism and inflammation. ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. 12 Apr 2020 Response to Reviewer’s comment Comment: A minor recommendation is to further provide the known mechanisms of action of BBR in the context of NAFLD and NASH studies, and how this study provides in vitro evidence supporting or contracting the known effects of BBR on liver lipid metabolism and inflammation. Response: We would like to thank the Reviewer for his or/her time spent reviewing our manuscript and helpful comment. In the revised manuscript, we provided the information regarding the potential mechanisms of Berberine-mediated therapeutic effect on NAFLD/NASH based on the most recent studies in the discussion. Submitted filename: Response to reviewer-Final-R.docx Click here for additional data file. 20 Apr 2020 Berberine inhibits free fatty acid and LPS-induced inflammation via modulating ER stress response in macrophages and hepatocytes PONE-D-20-07442R1 Dear Dr. Zhou We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Gianfranco D. Alpini Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: 22 Apr 2020 PONE-D-20-07442R1 Berberine inhibits free fatty acid and LPS-induced inflammation via modulating ER stress response in macrophages and hepatocytes Dear Dr. Zhou: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Gianfranco D. Alpini Academic Editor PLOS ONE
  50 in total

1.  Berberine attenuates nonalcoholic hepatic steatosis through the AMPK-SREBP-1c-SCD1 pathway.

Authors:  Xiaopeng Zhu; Hua Bian; Liu Wang; Xiaoyang Sun; Xi Xu; Hongmei Yan; Mingfeng Xia; Xinxia Chang; Yan Lu; Yu Li; Pu Xia; Xiaoying Li; Xin Gao
Journal:  Free Radic Biol Med       Date:  2019-06-18       Impact factor: 7.376

2.  Regulation of bile acid synthesis. I. Effects of conjugated ursodeoxycholate and cholate on bile acid synthesis in chronic bile fistula rat.

Authors:  D M Heuman; C R Hernandez; P B Hylemon; W M Kubaska; C Hartman; Z R Vlahcevic
Journal:  Hepatology       Date:  1988 Mar-Apr       Impact factor: 17.425

3.  Saturated fatty acid combined with lipopolysaccharide stimulates a strong inflammatory response in hepatocytes in vivo and in vitro.

Authors:  Yanchun Li; Zhongyang Lu; Ji Hyun Ru; Maria F Lopes-Virella; Timothy J Lyons; Yan Huang
Journal:  Am J Physiol Endocrinol Metab       Date:  2018-07-10       Impact factor: 4.310

4.  Cardiovascular and metabolic effects of Berberine.

Authors:  Flora Affuso; Valentina Mercurio; Valeria Fazio; Serafino Fazio
Journal:  World J Cardiol       Date:  2010-04-26

5.  HIV protease inhibitors activate the unfolded protein response in macrophages: implication for atherosclerosis and cardiovascular disease.

Authors:  Huiping Zhou; William M Pandak; Vijay Lyall; Ramesh Natarajan; Phillip B Hylemon
Journal:  Mol Pharmacol       Date:  2005-06-23       Impact factor: 4.436

6.  HIV protease inhibitor lopinavir-induced TNF-alpha and IL-6 expression is coupled to the unfolded protein response and ERK signaling pathways in macrophages.

Authors:  Li Chen; Sirikalaya Jarujaron; Xudong Wu; Lixin Sun; Weibin Zha; Guang Liang; Xuan Wang; Emily C Gurley; Elaine J Studer; Phillip B Hylemon; William M Pandak; Luyong Zhang; Guangji Wang; Xiaokun Li; Paul Dent; Huiping Zhou
Journal:  Biochem Pharmacol       Date:  2009-03-31       Impact factor: 5.858

7.  Berberine inhibits HIV protease inhibitor-induced inflammatory response by modulating ER stress signaling pathways in murine macrophages.

Authors:  Weibin Zha; Guang Liang; Jian Xiao; Elaine J Studer; Phillip B Hylemon; William M Pandak; Guangji Wang; Xiaokun Li; Huiping Zhou
Journal:  PLoS One       Date:  2010-02-09       Impact factor: 3.240

8.  Acid sphingomyelinase plays a key role in palmitic acid-amplified inflammatory signaling triggered by lipopolysaccharide at low concentrations in macrophages.

Authors:  Junfei Jin; Xiaoming Zhang; Zhongyang Lu; David M Perry; Yanchun Li; Sarah Brice Russo; L Ashley Cowart; Yusuf A Hannun; Yan Huang
Journal:  Am J Physiol Endocrinol Metab       Date:  2013-08-06       Impact factor: 4.310

Review 9.  Role of bioactive fatty acids in nonalcoholic fatty liver disease.

Authors:  Eva Juárez-Hernández; Norberto C Chávez-Tapia; Misael Uribe; Varenka J Barbero-Becerra
Journal:  Nutr J       Date:  2016-08-02       Impact factor: 3.271

10.  Vaccaria hypaphorine alleviates lipopolysaccharide-induced inflammation via inactivation of NFκB and ERK pathways in Raw 264.7 cells.

Authors:  Haijian Sun; Weiwei Cai; Xu Wang; Yanling Liu; Bao Hou; Xuexue Zhu; Liying Qiu
Journal:  BMC Complement Altern Med       Date:  2017-02-20       Impact factor: 3.659

View more
  10 in total

Review 1.  ER stress in obesity pathogenesis and management.

Authors:  Amir Ajoolabady; Simin Liu; Daniel J Klionsky; Gregory Y H Lip; Jaakko Tuomilehto; Sina Kavalakatt; David M Pereira; Afshin Samali; Jun Ren
Journal:  Trends Pharmacol Sci       Date:  2021-12-08       Impact factor: 14.819

2.  Isoschaftoside Reverses Nonalcoholic Fatty Liver Disease via Activating Autophagy In Vivo and In Vitro.

Authors:  Yanze Su; Yixing Kang; Jing Yi; Qirui Lin; Chaochuang Zhang; Zewei Lin; Zilong Yan; Jianhua Qu; Jikui Liu
Journal:  Evid Based Complement Alternat Med       Date:  2022-06-27       Impact factor: 2.650

3.  STIM1-Orai1 Interaction Exacerbates LPS-Induced Inflammation and Endoplasmic Reticulum Stress in Bovine Hepatocytes through Store-Operated Calcium Entry.

Authors:  Yang Xue; Shendong Zhou; Wan Xie; Meijuan Meng; Nana Ma; Hongzhu Zhang; Yan Wang; Guangjun Chang; Xiangzhen Shen
Journal:  Genes (Basel)       Date:  2022-05-13       Impact factor: 4.141

4.  Phloretin ameliorates hepatic steatosis through regulation of lipogenesis and Sirt1/AMPK signaling in obese mice.

Authors:  Chian-Jiun Liou; Shu-Ju Wu; Szu-Chuan Shen; Li-Chen Chen; Ya-Ling Chen; Wen-Chung Huang
Journal:  Cell Biosci       Date:  2020-09-29       Impact factor: 7.133

5.  Maternal Organic Selenium Supplementation Relieves Intestinal Endoplasmic Reticulum Stress in Piglets by Enhancing the Expression of Glutathione Peroxidase 4 and Selenoprotein S.

Authors:  Dajiang Ding; Daolin Mou; Heng Zhu; Xuemei Jiang; Lianqiang Che; Zhengfeng Fang; Shengyu Xu; Yan Lin; Yong Zhuo; Jian Li; Chao Huang; Yuanfeng Zou; Lixia Li; Bin Feng
Journal:  Front Nutr       Date:  2022-05-06

6.  Blocking the interaction between interleukin-17A and endoplasmic reticulum stress in macrophage attenuates retinal neovascularization in oxygen-induced retinopathy.

Authors:  Ya'nuo Wang; Shuang Gao; Sha Gao; Na Li; Bing Xie; Xi Shen
Journal:  Cell Biosci       Date:  2021-05-01       Impact factor: 9.584

7.  Combined Use of Bicyclol and Berberine Alleviates Mouse Nonalcoholic Fatty Liver Disease.

Authors:  Hu Li; Nan-Nan Liu; Jian-Rui Li; Biao Dong; Mei-Xi Wang; Jia-Li Tan; Xue-Kai Wang; Jing Jiang; Lei Lei; Hong-Ying Li; Han Sun; Jian-Dong Jiang; Zong-Gen Peng
Journal:  Front Pharmacol       Date:  2022-02-16       Impact factor: 5.810

Review 8.  Berberine in Non-Alcoholic Fatty Liver Disease-A Review.

Authors:  Anna Koperska; Agnieszka Wesołek; Małgorzata Moszak; Monika Szulińska
Journal:  Nutrients       Date:  2022-08-23       Impact factor: 6.706

9.  Dietary berberine alleviates high carbohydrate diet-induced intestinal damages and improves lipid metabolism in largemouth bass (Micropterus salmoides).

Authors:  Yulong Gong; Qisheng Lu; Yulong Liu; Longwei Xi; Zhimin Zhang; Haokun Liu; Junyan Jin; Yunxia Yang; Xiaoming Zhu; Shouqi Xie; Dong Han
Journal:  Front Nutr       Date:  2022-09-23

Review 10.  Promising Antioxidative Effect of Berberine in Cardiovascular Diseases.

Authors:  Na An; Guoxia Zhang; Yingjian Li; Chao Yuan; Fan Yang; Lijing Zhang; Yonghong Gao; Yanwei Xing
Journal:  Front Pharmacol       Date:  2022-03-07       Impact factor: 5.810

  10 in total

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