Introduction
Dengue is a mosquito-borne viral disease attributed to dengue virus (DENV) infection. More than half of the world’s population is at risk of dengue, with approximately 100 million cases of symptomatic dengue coming into being annually [
1]. Central nervous system (CNS) disease is included in the definition of severe disease according to the World Health Organization’s ‘dengue guidelines’, such as dengue encephalitis [
2]. The clinical spectrum of dengue encephalitis has expanded, and 61% of patients with neurological features of dengue belong to patients with encephalitis [
3]. Patients with dengue encephalitis have a higher chance of developing dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF). DSS, dengue encephalitis and dengue encephalopathy are the most common triggers of increased morbidity and mortality [
4,
5]. Currently, no dengue vaccine can produce type-specific or cross-specific neutralizing antibodies against all DENV serotypes regardless of individual immune status and age at vaccination. [
6,
7]. Additionally, there are no effective antiviral drugs for symptomatic DENV infection, especially dengue encephalitis [
8,
9].
Inflammation plays a crucial role during the pathogenesis of dengue infection and has been described in both animal models and humans in several studies [
10]. DENV can facilitate the assembly of NLRP3 inflammasome during infection, which then regulates the cleavage of inactive pro-IL-1β (interleukin 1 beta, IL1B) via activating Caspase-1 (CASP1), a process that yields mature IL1B, thereby activating inflammation [
11].
Tanreqing injection (TRQ), consisting of
Scutellaria baicalensis Georgi (Lamiaceae),
Selenaretos thibetanus Cuvier (Ursidae),
Capra hircus Linnaeus (Bovidae),
Forsythia suspensa (Thunb.) Vahl (Oleaceae) and
Lonicera japonica Thunb (Caprifoliaceae), is a new type of Chinese medicine (TCM) with antipyretic, antiviral, antibacterial, and anti-convulsion effects [
12]. The multicomponent mixture in TRQ was screened and identified by HPLC–DAD-TOF/MS and 12 compounds were confirmed by online ESI-TOF/MS [
13,
14]. Among the chemical constituents of TRQ, chlorogenic acid, protocatechuic acid, caffeic acid, baicalin, ursodeoxycholic acid, chenodeoxycholic acid and forsythin was considered as the representative compounds due to their higher abundances. A previous study has confirmed the blood–brain barrier penetrance ability of chlorogenic acid, baicalin, ursodeoxycholic acid, and chenodeoxycholic acid [
1]. These compounds have been shown to display antiviral effects against a variety of viruses, including influenza virus, herpes simplex virus and immunodeficiency viruses [
15‐
23]. Moreover, these compounds have been demonstrated to exert anti-inflammatory effects to treat various inflammation-related diseases [
24‐
27]. Clinically, TRQ is mainly used for the treatment of infantile acute pneumonia, acute upper respiratory tract infection, acute cerebral ischemia and acute cholecystitis [
12,
28]. TRQ has been used in the treatment of brain-related diseases. It can also treat cerebral ischemia by regulating Ca
2+ transport and treat migraine by regulating inflammation [
29]. Therefore, we hypothesized that TRQ may alleviate dengue encephalitis. The efficacy and potential mechanisms of TRQ against DENV-induced encephalitis were explored both in vivo and in vitro in this research.
Materials and methods
Antibodies and reagents
TRQ is produced exclusively by Shanghai Kaibao Pharmaceutical Co., Ltd. (NO. 2003305, Shanghai, China). Antibodies against β-actin (ACTB), cleaved Caspase-1 (CASP1), pro-Caspase-1, NLRP3 and peroxidase-labeled anti-rabbit immunoglobulin were acquired from Cell Signaling Technology (Danvers, MA, USA). An Annexin V-FITC apoptosis detection kit and Hoechst 33258 were purchased from Thermo Fisher Scientific (Waltham, MA, USA). Interleukin-6 (IL6) and tumor necrosis factor-α (TNFα) enzyme-linked immunosorbent assay (ELISA) kits were acquired from Dakewei (Beijing, China). IL1B ELISA kits were purchased from Huamei (Wuhan, Hubei, China). NO kits were acquired from KeyGen BioTECH (Nanjing, Jiangshu, China). Other agents were acquired from Sigma-Aldrich (St. Louis, MO, USA). Ursodeoxycholic acid, protocatechuic acid, caffeic acid, forsythin, chenodeoxycholic acid, baicalin and chlorogenic acid were acquired from Shanghai Yuanye Bio-Technology Co., Ltd. (Shanghai, China), the lot numbers of which are M11GB140672, M27GB143417, A22GB158496, Y12S11W124066, H30N9Z76269, N15GB167969, and N05GB166572, respectively. The purities of seven standard compounds met the requirements of high-performance liquid chromatography (HPLC) analysis (≥ 98.0%). Ultrapure water was supplied by a Synergy UV-R water purification system (Millipore, Billerica, MA, USA). Formic acid was purchased from Sigma-Aldrich. HPLC grade methanol was acquired from Thermo Fisher Scientific.
Preparation of TRQ
The quality of TRQ was evaluated by UPLC-MS–MS [
13]. Chromatographic analysis was conducted on an Xevo TQ-XS Triple Quadrupole Mass Spectrometer (Waters, Milford, MA, USA) and an ACQUITY H-class plus UPLC System (Waters, Milford, MA, USA). Gradient elution was performed with 0.1% formic acid aqueous solution as solvent A and methanol as solvent B. The gradient elution was performed under the following conditions: 0–1 min, 5% B; 1–3 min, 5–95% B; 3–7 min, 95% B; 7–7.1 min, 95–5% B; 7.1–10 min, 5% B. The flow rate was set at 0.3 mL·min
−1. The samples were then separated with an ACQUITY UPLC HSS T3 column (2.1 mm × 100 mm, 1.7 μm) (Waters, Milford, MA, USA). The temperature of the column and the automatic sampler were set at 40 ℃ and 10 ℃, respectively. The injection volume was 1 µL. Negative ion ionization was selected for the detection of all compounds.
The ESI interface was linked to triple quadrupole tandem mass spectrometric detection. The capillary voltage was − 2500 V, and the pressure of the nebulizer was 7 bar. The nebulizing and dry gas was served by high-purity nitrogen. The desolvation temperature was 550 ℃, the collision gas flow rate was 0.15 mL·min
−1, and the desolvation gas flow rate was set at 1000 L·Hr
−1. Multiple reaction monitoring (MRM) conditions were optimized by infusion of the reference standard, as shown in Table
1.
Table 1
Optimized MRM parameters for the detection of analytes
Baicalin | 445.0 | 269.0 | 20 | Negative |
Protocatechuic acid | 153.0 | 108.9 | 15 | Negative |
Caffeic acid | 178.9 | 134.8 | 15 | Negative |
Chlorogenic acid | 353.1 | 191.0 | 15 | Negative |
Ursodeoxycholic acid | 437.1 | 391.0 | 15 | Negative |
Chenodeoxycholic acid | 437.1 | 391.0 | 15 | Negative |
Forsythin | 533.2 | 371.2 | 15 | Negative |
Each standard substance was dissolved or diluted individually to obtain a final concentration of 1 mmol/L as a stock solution. One hundred microliters of each stock solution was transferred to a 10 mL volumetric flask to form a mixed working standard solution. All standard solutions were stored at − 20 ℃. A series of calibration standard solutions were then prepared by stepwise dilution of this mixed standard solution. The sample was diluted four times with methanol, followed by incubation at − 20 ℃ for 1 h and centrifugation at 12 000 rpm and 4 ℃ for 15 min. The supernatant was diluted 1 time, 10 times, 100 times, or 1000 times for UPLC-MS/MS analysis.
Cell culture and virus
The mosquito larva C6/36 cells (American Type Culture Collection, ATCC, Rockville, MD, USA) were cultured in RPMI-1640 supplemented with 1% (
v/
v) penicillin/streptomycin (Gibco, the Netherlands) and 10% (
v/
v) fetal bovine serum (FBS, ExCell Bio, Shanghai, China) at 28 ℃. The baby hamster kidney fibroblast BHK-21 cells (ATCC) were cultured in RPMI-1640 supplemented with 10% (
v/
v) FBS [
30]. The mouse hippocampal neuronal cell line HT22 was generously provided by Professor Weidong Cheng (Southern Medical University). HT22 cells and the murine microglial cell line BV2 (BeNa Culture Collection, Beijing, China) were cultured in DMEM supplemented with 10% (
v/
v) FBS [
31,
32]. The DENV-2 New Guinea C strain was kept in our laboratory [
33] and propagated on C6/36 cells. DENV-2 was kept at − 80 ℃ until use.
Cell viability assay
A 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide (MTT, Sigma, St. Louis, MO, USA) assay was used to determine cell viability [
30]. BV2 cells (1 × 10
4 cells
per well) or BHK-21 cells (1 × 10
4 cells
per well) were seeded into 96-well plates and incubated at 37 ℃ for 24 h. Then, BV2 and BHK-21 cells were cultivated with various concentrations of TRQ for 24 h or 96 h and incubated by adding 10 μL of MTT solution (5 mg/mL)
per well for another 4 h at 37 ℃. After removal of the supernatant, 100 μL of DMSO was added to each well. Finally, a microplate reader was used to measure the absorbance at 490 nm (Thermo Fisher Scientific).
CCK-8 assay
BHK-21 cells were cultured for 24 h in 96-well plates. For virus binding and entry assay, BHK-21 cells were infected with DENV-2 and incubated with different concentrations of TRQ (1/800, 1/400, 1/200) at the same time. For viral intracellular replication assay, TRQ (1/800, 1/400, 1/200) was added after DENV-2 was completely absorbed into BHK-21 cells. After 4 days of incubation, the cell viability was assessed according to the method described for the CCK-8 solution (APE x BIO Technology LLC, Houston, TX, USA) [
34]. After incubation in the dark at 37 ℃ for 2 h, the viable cells were detected by using absorbance at a 450 nm wavelength.
Plaque assay
First, BHK-21 cells (1 × 10
5 cells
per well) were seeded in a 6-well plate and incubated for 24 h. Second, cells were infected with DENV-2 (10
2 TCID
50/mL) with or without TRQ for 1 h at 37 ℃. Two days later, new BHK-21 cells were infected with the supernatants containing progeny virus for 1 h at 37 ℃ followed by overlaying with RPMI-1640 media containing 1.2% methyl cellulose and 2% FBS. The cells were fixed with 4% formaldehyde for 15 min followed by careful removal of the solution. Finally, the plaques were developed by adding 2% crystal violet solution for 15 min [
30].
DENV infection of BV2 cells
BV2 cells were seeded in a 6-well plate at a concentration of 2 × 10
5 cells
per well and incubated overnight at 37 ℃. Next, cells were infected with DENV-2 (MOI = 0.5) in the presence or absence of TRQ for 1 h at 37 ℃ [
35]. After infection, BV2 cells were cultured in fresh DMEM with 2% FBS for 24 h. Finally, the cells or supernatants were used for subsequent experiments.
RNA extraction and quantitative real-time PCR (qRT‒PCR)
The sequences of the sense and antisense primers used in this study are shown in Table
2. Total RNA was extracted from RNAiso Plus (Takara, Shiga, Japan) according to the manufacturer’s instructions. The PrimeScript
™ RT Reagent Kit with gDNA Eraser was used immediately to synthesize cDNA. The reverse transcription parameters were set according to the previous conditions in our laboratory [
36]. Subsequently, qRT‒PCR analysis was accomplished on a LightCycler 96
® real-time PCR (Roche, Switzerland) with TB Green
™ Premix Ex Taq
M II. No-template controls were included on each plate. The mRNA expression level of each target gene was analyzed by the 2
−ΔΔCt method and normalized to the expression level of
β-actin (Actb).
Table 2
Primers used in the manuscript
Actb(β-actin) | GGCTGTATTCCCCTCCATCG | CCAGTTGGTAACAATGCCATGT |
Il6 | TAGTCCTTCCTACCCCAATTTCC | TTGGTCCTTAGCCACTCCTTC |
Tnfα | CAGGCGGTGCCTATGTCTC | CGATCACCCCGAAGTTCAGTAG |
Il1b (IL-1β) | GAAATGCCACCTTTTGACAGTG | TGGATGCTCTCATCAGGACAG |
Nlrp3 | ATTACCCGCCCGAGAAAGG | TCGCAGCAAAGATCCACACAG |
ELISA
The protein levels of IL1B, IL6 and TNFα in cell supernatants and tissues were determined by ELISA kits based on the manufacturer’s instructions [
37].
Western blotting
BV2 cells were homogenized in lysis buffer (150 mM sodium chloride, 50 mM Tris, pH 7.5, 1 mM phosphatase inhibitor, 1 mM dithiothreitol, 1 mM sodium orthovanadate, 1 mM EDTA, 1 mM PMSF and 1% Triton X-100). Then, samples were centrifuged at 15,000 ×
g for 20 min and the supernatants were harvested [
37]. A BCA kit was used to quantify the protein concentration of the supernatants. Subsequently, the proteins were separated by 10% SDS/PAGE and transferred to polyvinylidene fluoride (PVDF) membranes (Bio-Rad, Hercules, USA). After blocking with 5% (
w/v) skim milk for 1 h at room temperature (RT), immunoblotting was performed using appropriate primary antibodies against NLRP3 (1:1000), caspase-1 (1:1000), cleaved caspase-1 (1:1000), and β-actin (1:500). Next, the membranes were incubated at 4 ℃ overnight, washed with TBS-T and then incubated with appropriate horseradish peroxidase-conjugated secondary antibodies (1:1000) for 1 h at RT. Membranes were washed with TBS-T and then detected using enhanced chemiluminescence reagent (ECL) and visualized by a FluorChem E
™ system (ProteinSimple, San Francisco, CA, USA).
Apoptosis assay
Apoptosis was evaluated using the annexin V-FITC apoptosis detection kit. HT22 cells were seeded in 6-well plates (2 × 10
5 cells
per well) for 24 h and treated with supernatant of infected BV2 cells for 48 h. Then, cells were collected and washed with phosphate-buffered saline (PBS) twice before incubating with annexin V and PI dyes at RT for 15 min. Finally, stained cells were analyzed by flow cytometry (CytoFLEX, Beckman Coulter, Fullerton, CA, USA) [
38].
Hoechst 33,258 staining
Apoptosis was observed using Hoechst 33258 staining. The prepared paraffin sections were deparaffinized, hydrated and then washed with PBS twice. Finally, slices were stained with Hoechst 33258 (10 µg/mL in PBS) at 37 ℃ for 15 min in the dark. Then the slices were sealed, and observed under an IX 53 light microscope (Olympus, Tokyo, Japan) [
38].
Animals
Seven-day-old ICR suckling mice were purchased from SPF Biotechnology Co., Ltd. (Beijing, China) and kept in a biosafety level-2 facility of the Animal Experimental Center of Guangzhou University of Chinese Medicine. The 3 R’s of ethical principles of animal experimentation was respected and fully considered during the experiments. All animal studies were carried out in compliance with the rules of the Ethics Committee of Guangzhou University of Chinese Medicine (Permit number: 20211026004).
The mice were randomly divided into 6 groups: 1. Control group; 2. DENV-2 group; 3. DENV-2 + TRQ-L (low concentration, 1.25 mL/kg); 4. DENV-2 + TRQ-M (medium concentration, 2.5 mL/kg); 5. DENV-2 + TRQ-H (high concentration, 5 mL/kg); 6. DENV-2 + Dexamethasone (Dex, 4 mL/kg). Mice were inoculated with DENV-2 intracerebrally (4 × 10
5 plaque-forming units, PFU) [
39]. Furthermore, TRQ at different concentrations or an equal volume of saline solution was administered intraperitoneally from 0 days post infection (D.P.I). The clinical scores and body weights were recorded every day. The clinical score was divided into six grades: 0 for health, 1 for minor manifestations (reduced mobility and hunched posture), 2 for limbic seizure, 3 for dyspraxia (weakness in the front or hind limbs), 4 for paralysis and 5 for death. Finally, the mice were sacrificed to collect tissues for Western blotting, qRT‒PCR, histological and immunohistochemical analysis at 6 D.P.I. The survival rates of the mice were evaluated every day until 9 D.P.I.
Histopathological observation
The brain tissues were rinsed with cold PBS, and fixed in 4% (
v/
v) paraformaldehyde immediately. Twenty-four hours later, the brain tissues were dehydrated with graded ethanol and embedded in paraffin. Brain specimens were sliced into 4 μm sections. After deparaffinization and staining with hematoxylin and eosin (H&E, Yuanye Biotech, Shanghai, China), pathological changes in each tissue section were observed with an IX 53 light microscope (Olympus, Tokyo, Japan) [
40].
Immunohistochemistry and immunofluorescence
The slices were deparaffinized and dehydrated with ethanol. Then, slices were placed in boiling citrate buffer (pH = 6.0) for 10 min for antigen retrieval. Next, endogenous peroxidase was eliminated by the addition of 3% hydrogen peroxide. After blocking with 5% bovine serum albumin for 15 min, the sections were incubated with appropriate antibody overnight at 4 ℃. For immunohistochemistry, the sections were incubated with a horseradish peroxidase-labeled kit (GTVision
™ III Detection System/Mo&Rb, Dako, Denmark) according to the manufacturer’s instructions. Finally, the slices were stained with 3, 3ʹ-diaminobenzidine for 5 min [
39].
For immunofluorescence, the sections were incubated with anti-NLRP3 antibody. Bound antibodies were visualized with Alexa Fluor 568-conjugated goat anti-rabbit tyramide signal amplification (Thermo Fisher Scientific). 4ʹ, 6-Diamidino-2-phenylindole was (DAPI; Invitrogen, Grand Island, USA) used to label the nuclei. All images were observed under an IX 53 light microscope [
39,
41].
Statistical analysis
Data are presented as the mean ± standard deviation (SD) of at least three independent experiments and analyzed by one-way ANOVA with Tukey’s test. The data were analyzed with GraphPad Prism software (Version 8.0; San Diego, CA, USA). P < 0.05 was considered as statistically significant.
Discussion
Recent anti-DENV candidates with potential clinical application mainly include compounds inhibiting DENV entry and targeting viral NS proteins and host factors [
47]. However, no definitive and effective antiviral drugs are available for dengue infection treatment. TRQ was approved for use by the Chinese Food and Drug Administration in 2003. Because of its anti-inflammatory, antiviral, and antibacterial effects, TRQ has been used to treat acute cerebral ischemia, acute cholecystitis, and infantile acute pneumonia for many years. According to the Guidelines for the Diagnosis and Treatment of Dengue Fever (second edition, 2014), TRQ has been included in the treatment scheme of traditional Chinese medicine (TCM) based on syndrome differentiation. In the Guidelines for the Diagnosis and Treatment of Dengue Fever, dengue encephalitis is classified as severe dengue fever. Hence, this study was conducted to determine the inhibitory effects of TRQ on DENV encephalitis. We firstly present the quantification of 7 compounds in TRQ, including chlorogenic acid, protocatechuic acid, caffeic acid, baicalin, ursodeoxycholic acid, chenodeoxycholic acid and forsythin. These compounds all display anti-inflammatory effects to treat various inflammation-related diseases [
48‐
54].
DENV is transmitted principally by Aedes aegypti and Aedes albopictus. In addition, baby hamster kidney cells BHK-21 are extensively used to evaluate the antiviral activities of drugs. Therefore, C6/36 cells and BHK-21 cells were selected for virus propagation and antiviral efficacy evaluation, respectively. Rodent species are more susceptible to DENV NGC strain infection than human cells, as demonstrated by obvious cytopathic effect and high viral copy numbers. We next evaluated the protective effects of TRQ on BHK-21 cells after DENV infection by using MTT assay. However, our results showed no significant difference in absorbance values between the DENV infection and control groups, which may be due to the reaction between the DENV-2 strain used in this study and MTT solution. Therefore, we next used the CCK8 assay to measure the cell viability after DENV infection. Our results revealed that co-treatment with DENV and TRQ significantly elevated the survival rate of BHK-21 cells, while treatment post DENV infection had no significant effects. These results demonstrate that TRQ exerts anti-DENV effects at viral binding and entry stage rather than at post-entry stage. Plaque formation assays showed that TRQ inhibited DENV-2 binding to cells and alleviated the plaques formed by DENV-2 progeny virus. In addition, TRQ significantly reduced the viral load in brain tissue of DENV-2 infected mice at high dosages. However, all doses of TRQ show favourable therapeutic effects in vivo. This confirms the multi-component, multi-target and multi-pathway action characteristics of TCM. Considering the poor anti-DENV-2 activity and significant anti-inflammatory activity of TRQ, we explored whether inflammation is involved in the alleviating effect of TRQ on dengue encephalitis.
Viral encephalitis is an infectious disease of the CNS caused by a variety of viral infections. Viruses can directly damage glial and neuronal cells, while the immune inflammatory response during viral infection also plays a key role in neuronal damage. Inflammatory changes in the meninges and brain parenchyma are the main pathological features, including glial cell activations and neuronal necrosis. In addition to the destruction of nerve cells by the virus itself, immune-mediated inflammation in the acute phase of viral infection is an important way to cause brain tissue damage. Virus-induced secretion of cytokines, such as TNF and IL, contributes to innate immunity against viral infection. The pathogenesis of dengue fever is unclear, but the large amount of cytokine secretion (cytokine storm) is thought to be one of the main pathogenic factors [
55,
56]. According to our study, TRQ attenuated the expression of proinflammatory cytokines IL-6, TNF-α and NO both in vitro and in vivo relative to the DENV group, indicating that TRQ can remarkably restrain DENV-induced inflammation. Our study comprehensively evaluated the role of TRQ as an anti-inflammatory agent against DENV for the first time.
Inflammasomes, including NLRP3, are a group of multiprotein cytoplasmic receptors that sense pathogen-related and hazard-related molecular patterns in response to pathogen infection and cell injury. Then, the activation of caspase-1 is triggered and consequently leads to the maturation of inflammatory cytokines such as IL1B. The NLRP3 inflammasome is associated with a variety of human diseases, including Alzheimer’s disease, obesity, rheumatoid arthritis, asthma, nonalcoholic fatty liver disease, and autoimmune encephalitis [
57]. DENV induced IL1B activation in blood samples from infected patients and macrophages in mice [
11]. Although NLRP3 can be activated in the periphery of DENV-infected patients, the role of the NLRP3 inflammasome in DENV encephalitis has not been reported. Therefore, studying the relationship between the NLRP3 inflammasome and DENV encephalitis is of great significance for the biological basis of disease occurrence and development as well as drug development. We demonstrated that TRQ effectively inhibited DENV-induced injuries by suppressing NLRP3 and decreasing the release of IL1B in vitro and in vivo. Reports have demonstrated that IL1B disrupts the blood–brain barrier and peripheral immune cells infiltrate the CNS and aggravate inflammation of the nervous system. At the same time, IL1B activates microglia, which in turn induces IL6, TNFα and other inflammatory factors and further induces the synthesis of nitric oxide synthase and NO production [
58,
59]. It has been reported that DENV M protein triggers NLRP3 inflammasome activation and IL1B secretion due to the interaction of M protein with NLRP3 [
11]. However, whether TRQ could suppress the process warrants more investigation. TRQ also showed a dose-dependent inhibition effect on the release of CASP1 in vivo. CASP1 is a crucial indicator for detecting cell pyroptosis [
60]. The NLRP3 inflammasome activate by DENV can modify the CASP1 and the growth of cytokines. Therefore, tissue damage will be relieved in disease if these signals are blocked [
61]. TRQ may reduce brain damage by inhibiting CASP1 and NLRP3 inflammasome.
The immune inflammatory response of host cells caused by virus infection plays a key role in neuronal injury. The production of proinflammatory cytokines after microglial cell activation in DENV infection could trigger neuronal cell death [
62]. In this study, HT22 cells were not damaged by DENV-2 directly but injured by the supernatant of DENV-2 infected BV2 cells. However, this damage was decreased after TRQ treatment. Moreover, additional IL1B supplementation reversed the protective effect of TRQ. These results suggested that other factors, such as inflammatory molecules induced by DENV, alter the states of glial cells and stimulate the death of neurons.
DENV infection can result in neuronal loss and glial activation. Our results showed that both microglial activation and neuronal damage caused by DENV-2 were mitigated by TRQ in ICR suckling mice. Treatment with TRQ increased the average body weight of ICR suckling mice. The clinical score raised by DENV-2 was alleviated by TRQ. Patients with dengue encephalitis are at risk of death. Our results showed that TRQ delayed the death of DENV-2 infected ICR suckling mice. TRQ significantly reduced brain injury and alleviated the symptoms caused by DENV-2 in vivo. The data from in vivo experiments are of significance for supporting the clinical use of TRQ.
Altogether, this study provides a primary explanation for the hypothesis that TRQ could alleviate DENV-induced encephalitis. TRQ protects against brain tissue damage caused by DENV infection by reducing microglial activation, decreasing inflammatory responses, and protecting neuronal cells (Fig.
6H). Our findings are not only helpful for related drug discovery and clinical use of TRQ but also further prove that TCM used to treat infection-related diseases may be closely associated with its anti-inflammatory activities.
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