Xiaoyao San's dual efficacy in NAFLD and depression: Unraveling the mechanisms via network pharmacology and multi-omics

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) and depression represent two highly prevalent medical conditions often presenting concurrently. However, currently available pharmacological treatments rarely target both disorders simultaneously. Xiaoyao San (XYS), a traditional herbal formulation from Chinese medicine, has been clinically effective in addressing NAFLD and depressive symptoms, although its precise therapeutic mechanisms remain poorly understood. OBJECTIVE: This study aimed to investigate the underlying mechanisms of XYS in managing comorbid NAFLD and depression by employing network pharmacology (NP) and multi-omics methodologies. METHODS: A chronic restraint stress (CRS)-induced NAFLD rat model was constructed to simulate the disease conditions. The efficacy of XYS treatment was evaluated through behavioral assessments, histopathological liver examination, biochemical analyses, and measurements of inflammatory and oxidative stress (OS) biomarkers. Further, NP combined with metabolomic and proteomic techniques was applied to uncover pivotal targets and pathways, with subsequent validation via Western blotting (WB). RESULTS: XYS improved depression-like behaviors, reduced hepatic lipid deposition, and lowered levels of hepatic enzymes, blood lipids, and blood glucose. It also attenuated inflammatory and OS responses. Multi-omics analysis identified the PPARα/HMOX1/GPX4 axis as a key target. XYS modulated this pathway to inhibit ferroptosis and reduce hepatic iron accumulation. Specifically, XYS upregulated PPARα and GPX4 expression, downregulated HMOX1 expression, and decreased hepatic iron levels, alleviating both NAFLD and depression. CONCLUSION: XYS exerts therapeutic effects on NAFLD and depression through multi-target regulation, primarily by modulating the PPARα/HMOX1/GPX4 axis to inhibit ferroptosis. This study provides a novel mechanistic basis for the dual therapeutic efficacy of XYS.