Drug Design, Development and Therapy (Aug 2025)
Kuoxin Decoction Alleviated Left Ventricular Remodeling by Inhibiting Cardiomyocyte Apoptosis Through ASK1/JNK/Cx43 Signaling Pathway in cTnTR141W Transgenic Mice and in vitro
Abstract
Mengjiao Ma,1,* Hua Fan,1,* Yidan Dong,1,2 Tianyi Feng,1 Longping Peng,1 Maolin Zhou,1 Feifei Liu,1 RueyJyh Lee,1 Rongxue Wu,3 Qiong Wu,1,3 Youhua Wang1 1Department of Cardiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3Department of Medicine/Cardiology, Biological Sciences Division, University of Chicago, Chicago, IL, USA*These authors contributed equally to this workCorrespondence: Youhua Wang, Department of Cardiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China, Email [email protected] Qiong Wu, Department of Cardiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China, Email [email protected]: Combined with RNA sequencing and experimental verification methods to investigate KXD’s potential role and underlying mechanisms in cTnTR141W transgenic mice and H9c2 cells.Methods: UPLC-Q-TOF-MS analysis was employed to identify the absorbed constituents from KXD in mice blood. cTnTR141W transgenic mice were given with KXD via gavage for 4 weeks. Cardiac remodeling was evaluated by echocardiography, heart weight index, H&E staining, Masson staining, and WGA staining. The potential therapeutic target of KXD was identified through RNA sequencing. H9c2 cells were stimulated with DOX and KXD in vitro. Tunel staining, Immunofluorescence, Transmission electron microscopy, qRT-PCR, and Western blot were used to evaluate cardiomyocyte apoptosis and gap junction remodeling.Results: 11 compounds from KXD were identified in the blood. KXD improved cardiac dysfunction and alleviated interstitial fibrosis and cardiomyocyte hypertrophy in cTnTR141W transgenic mice. The mechanistic investigations of RNA sequencing revealed that regulating apoptosis and gap junctions may be potential processes for KXD. KXD inhibited cardiomyocyte apoptosis, and promoted the expression of Connexin 43, a key protein of gap junctions, while also inhibiting the phosphorylation of ASK1 and JNK in cTnTR141W transgenic mice and H9c2 cells.Conclusion: KXD attenuated left ventricular remodeling and cardiomyocyte apoptosis in cTnTR141W transgenic mice and H9c2 cells, potentially through modulation of the ASK1/JNK/Cx43 signaling pathway. These findings provide valuable insights into the therapeutic potential of KXD in mitigating DCM. Keywords: Kuoxin Decoction, cardiomyocyte apoptosis, gap junctions, ASK1/JNK signaling pathway, dilated cardiomyopathy
