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<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Mol. Biosci.</journal-id>
<journal-title-group>
<journal-title>Frontiers in Molecular Biosciences</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Mol. Biosci.</abbrev-journal-title>
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<issn pub-type="epub">2296-889X</issn>
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<publisher-name>Frontiers Media S.A.</publisher-name>
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<article-meta>
<article-id pub-id-type="publisher-id">1665650</article-id>
<article-id pub-id-type="doi">10.3389/fmolb.2025.1665650</article-id>
<article-version article-version-type="Version of Record" vocab="NISO-RP-8-2008"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Research</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Forsythiaside a facilitates autophagy to ameliorate chronic nonbacterial prostatitis in rats by blocking the PKC&#x3b1;/NF-&#x3ba;B pathway</article-title>
<alt-title alt-title-type="left-running-head">Yu et al.</alt-title>
<alt-title alt-title-type="right-running-head">
<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fmolb.2025.1665650">10.3389/fmolb.2025.1665650</ext-link>
</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Yu</surname>
<given-names>Xingwei</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Tan</surname>
<given-names>Hongao</given-names>
</name>
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<sup>1</sup>
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<contrib contrib-type="author">
<name>
<surname>Gao</surname>
<given-names>Yunqiu</given-names>
</name>
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<sup>1</sup>
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<contrib contrib-type="author">
<name>
<surname>Qiu</surname>
<given-names>Dandan</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
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<contrib contrib-type="author">
<name>
<surname>Zhu</surname>
<given-names>Yan</given-names>
</name>
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<sup>1</sup>
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<contrib contrib-type="author" corresp="yes">
<name>
<surname>Qi</surname>
<given-names>Haixin</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
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<xref ref-type="corresp" rid="c001">&#x2a;</xref>
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<aff id="aff1">
<label>1</label>
<institution>Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)</institution>, <city>Hangzhou</city>, <state>Zhejiang</state>, <country country="CN">China</country>
</aff>
<aff id="aff2">
<label>2</label>
<institution>Department of Proctology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)</institution>, <city>Hangzhou</city>, <state>Zhejiang</state>, <country country="CN">China</country>
</aff>
<author-notes>
<corresp id="c001">
<label>&#x2a;</label>Correspondence: Haixin Qi, <email xlink:href="mailto:haixq123123@163.com">haixq123123@163.com</email>
</corresp>
</author-notes>
<pub-date publication-format="electronic" date-type="pub" iso-8601-date="2026-01-07">
<day>07</day>
<month>01</month>
<year>2026</year>
</pub-date>
<pub-date publication-format="electronic" date-type="collection">
<year>2025</year>
</pub-date>
<volume>12</volume>
<elocation-id>1665650</elocation-id>
<history>
<date date-type="received">
<day>14</day>
<month>07</month>
<year>2025</year>
</date>
<date date-type="rev-recd">
<day>15</day>
<month>12</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>15</day>
<month>12</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2026 Yu, Tan, Gao, Qiu, Zhu and Qi.</copyright-statement>
<copyright-year>2026</copyright-year>
<copyright-holder>Yu, Tan, Gao, Qiu, Zhu and Qi</copyright-holder>
<license>
<ali:license_ref start_date="2026-01-07">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
<license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p>
</license>
</permissions>
<abstract>
<sec>
<title>Background</title>
<p>Given the lack of effective treatment for chronic nonbacterial prostatitis (CNP) and the anti-inflammatory property of natural bioactive compound forsythiaside A (FTA), the therapeutic potential of FTA on CNP is worthy of investigation.</p>
</sec>
<sec>
<title>Methods</title>
<p>CNP rat models were established using complete Freund&#x2bc;s adjuvant, followed by a 4-week administration of FTA at different concentrations (40 and 80 mg/kg/d). The body and prostate of rats were weighed to calculate the prostatic index. Prostate damage and inflammatory infiltration were assessed using histological analysis and immunohistochemistry staining. Levels of inflammation-related cytokines, autophagic markers as well as the protein kinase C alpha (PKC&#x3b1;)/NF-&#x3ba;B pathway in prostate tissues were detected using enzyme-linked immunosorbent assay and western blot.</p>
</sec>
<sec>
<title>Results</title>
<p>No significant change was observed in the body weight of CNP rat models administered with or without FTA. FTA treatment reduced the prostatic index and mitigated prostate damage and inflammatory infiltration of CNP rat models. FTA treatment decreased the number of CD3-positive cells and CD45-positive cells, while downregulating interleukin 1 beta (IL-1&#x3b2;), IL-2, IL-6, IL-17A, monocyte chemoattractant protein-1, and tumor necrosis factor alpha in prostate tissues of CNP rat models. FTA treatment promoted Beclin-1 and LC3B II/LC3B I expressions, and inhibited PKC&#x3b1; and p-p65/p65 expressions in prostate tissues of CNP rat models.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>FTA alleviates inflammation and facilitates autophagy in CNP rat models by blocking the PKC&#x3b1;/NF-&#x3ba;B pathway.</p>
</sec>
</abstract>
<kwd-group>
<kwd>autophagy</kwd>
<kwd>chronic nonbacterial prostatitis</kwd>
<kwd>forsythiaside A</kwd>
<kwd>NF-&#x3ba;B pathway</kwd>
<kwd>protein kinase C alpha</kwd>
</kwd-group>
<funding-group>
<funding-statement>The author(s) declared that financial support was received for this work and/or its publication. This work was supported by the Zhejiang Traditional Chinese Medicine Science and Technology Plan Project [2025ZL280].</funding-statement>
</funding-group>
<counts>
<fig-count count="4"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="49"/>
<page-count count="00"/>
</counts>
<custom-meta-group>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Cellular Biochemistry</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="s1">
<label>1</label>
<title>Introduction</title>
<p>Chronic nonbacterial prostatitis (CNP), belonging to category III prostatitis (chronic prostatitis/chronic pelvic pain syndrome), is a highly prevalent urological disease in men (<xref ref-type="bibr" rid="B33">Polackwich and Shoskes, 2016</xref>), constituting over 90% of prostatitis cases in clinical practice (<xref ref-type="bibr" rid="B13">Holt et al., 2016</xref>), with profound impacts on quality of life and mental health. Despite undefined etiology and pathogenesis of CNP, inflammation in response to autoimmunity has been confirmed to play a pivotal role in development of CNP and consequently affect prostate function (<xref ref-type="bibr" rid="B25">Motrich et al., 2018</xref>). Currently, pharmacotherapies (such as alpha-blockers and anti-inflammatory agents) remain the mainstay of clinical management for CNP (<xref ref-type="bibr" rid="B7">Datta, 2002</xref>; <xref ref-type="bibr" rid="B4">Chen et al., 2025</xref>). However, these strategies have limited and unsatisfactory therapeutic efficacy, underscoring the importance of developing new effective therapies.</p>
<p>Autophagy is a fundamental cellular process involving quality control, metabolism, and immunity (<xref ref-type="bibr" rid="B30">Parzych and Klionsky, 2014</xref>), playing a complex and context-dependent role in diseases. Autophagy dysregulation is implicated in various pathologies; for instance, excessive autophagy promotes apoptosis to aggravate non-small cell lung cancer, making it vital to precisely control autophagy (<xref ref-type="bibr" rid="B42">Wu et al., 2023</xref>). As a cellular degradative pathway, autophagy can protect cells from exogenous hazards and endogenous sources of inflammation (<xref ref-type="bibr" rid="B8">Deretic, 2021</xref>). Under normal physiological conditions, autophagy remains at a low level, and its dysfunction is often associated with dysregulated inflammation in human diseases (<xref ref-type="bibr" rid="B9">Deretic and Levine, 2018</xref>). In prostate pathology research, the focus has expanded from cancer to mechanisms such as cellular senescence (<xref ref-type="bibr" rid="B19">Li et al., 2023</xref>), yet the regulatory mechanism of autophagy in inflammatory conditions such as CNP remains unclear. Given the accumulating evidence underscoring the important role of autophagy in CNP, it is speculated that pharmacological modulation of autophagic activity could offer a compelling therapeutic candidate to halt the advancement of the condition (<xref ref-type="bibr" rid="B47">Zang et al., 2021</xref>). This discovery is particularly crucial, especially in the current era of research precisely targeting key signaling pathways (<xref ref-type="bibr" rid="B41">Wei et al., 2024</xref>).</p>
<p>Clinically, antibiotics, &#x3b1;-receptor blockers, non-steroidal anti-inflammatory drugs and phytotherapeutic agents are commonly used to treat CNP, but their effectiveness is variable (<xref ref-type="bibr" rid="B37">Tsunemori and Sugimoto, 2021</xref>). In recent years, traditional Chinese medicine has been reported to offer effective treatment for CNP with minimal side effects (<xref ref-type="bibr" rid="B10">Dong et al., 2021</xref>; <xref ref-type="bibr" rid="B47">Zang et al., 2021</xref>; <xref ref-type="bibr" rid="B29">Park et al., 2019</xref>). A representative example is Jiedu Huoxue decoction, a classical herbal formula composed of ten distinct Chinese medicinal herbs (<xref ref-type="bibr" rid="B45">Yan et al., 2020</xref>), exerting a strong anti-inflammatory effect on rats with CNP (<xref ref-type="bibr" rid="B44">Yan et al., 2019</xref>); however, its specific active component of the medicinal herb remains to be elucidated. Forsythiaside A (FTA) is a major bioactive component isolated from <italic>Forsythia suspensa</italic>, a medicinal herb that has long been used to treat various inflammatory conditions in China (<xref ref-type="bibr" rid="B16">Lee et al., 2018</xref>). FTA possesses a wide range of pharmacological activities including anti-inflammation, antivirus, anti-oxidative stress and neuroprotection (<xref ref-type="bibr" rid="B11">Gong et al., 2021</xref>). At present, although whether FTA exerts a therapeutic effect on CNP has rarely been reported, a growing number of studies have demonstrated that FTA can suppress the nuclear factor kappa B (NF-&#x3ba;B) pathway in several inflammatory diseases (<xref ref-type="bibr" rid="B36">Tong et al., 2021</xref>; <xref ref-type="bibr" rid="B5">Cheng et al., 2015</xref>; <xref ref-type="bibr" rid="B27">Pan et al., 2015</xref>). According to analysis of Swisstargetprodiction (<ext-link ext-link-type="uri" xlink:href="http://swisstargetprediction.ch/">http://swisstargetprediction.ch/</ext-link>), protein kinase C alpha (PKC&#x3b1;) is predicted to be the most probable target of FTA. PKC&#x3b1; is a member of the PKC family, which acts as cellular signal transducers and is involved in the modulation of inflammation (<xref ref-type="bibr" rid="B17">Lepp&#xe4;nen et al., 2014</xref>). It has been reported that PKC&#x3b1; can activate multiple signaling pathways, including the NF-&#x3ba;B pathway, and plays a critical role in a variety of cellular physiological processes (<xref ref-type="bibr" rid="B18">Li and Luan, 2018</xref>).</p>
<p>This study was designed to explore the potential therapeutic effect of FTA on CNP using complete Freund&#x2bc;s adjuvant (CFA)-induced animal models and to investigate whether FTA regulates autophagy to attenuate CNP via the PKC&#x3b1;/NF-&#x3ba;B pathway.</p>
</sec>
<sec sec-type="methods" id="s2">
<label>2</label>
<title>Methods</title>
<sec id="s2-1">
<label>2.1</label>
<title>Animals and ethics statement</title>
<p>Six-week-old Sprague-Dawley rats (male, 240&#x2013;260 g) were housed in a specific pathogen-free laboratory (12/12-h light-dark cycles) with free access to food and drinking water. All experimental procedures involving animals in this study were approved by the Institutional Animal Care and Use Committee of Zhejiang Baiyue Biology Technology Co., Ltd for Experimental Animals Welfare (NO. ZJBYLA-IACUC-20221202) and conducted based on the guidelines of the China Council on Animal Care and Use.</p>
</sec>
<sec id="s2-2">
<label>2.2</label>
<title>Drug preparation</title>
<p>FTA (C<sub>29</sub>H<sub>36</sub>O<sub>15</sub>, purity &#x2265;99%, HY-N0028) and G&#xf6; 6983 (specific protein kinase C (PKC) inhibitor; purity: 99.32%, HY-13689) were purchased from MedChemExpress (Monmouth Junction, NJ, USA). Ten percent dimethyl sulfoxide (20-139, Sigma-Aldrich, St. Louis, MO, USA) was utilized to dissolve FTA and G&#xf6; 6983 to prepare stock solution. Chloroquine (CQ, autophagy pathway inhibitor; 60 mg/kg) was also procured from Sigma-Aldrich and diluted in sterile saline.</p>
</sec>
<sec id="s2-3">
<label>2.3</label>
<title>Animal experiments and administration</title>
<p>CNP rat models were constructed through an intraprostatic injection with CFA (YZ-642852, Acmec Biochemical Co., Ltd, Shnaghai, China), as described previously (<xref ref-type="bibr" rid="B46">Yang et al., 2019</xref>). In brief, rats were randomly assigned to eight groups: normal group, model group, model &#x2b; FTA-L group, model &#x2b; FTA-H group, model &#x2b; CQ group, model &#x2b; FTA-H &#x2b; CQ group, model &#x2b; G&#xf6; 6983 group, and model &#x2b; G&#xf6; 6983 &#x2b; FTA-H group. After being anesthetizing with 3% isoflurane (792632, Sigma-Aldrich, United States) in an anesthesia system (RWD Life Science, Shenzhen, China), rats from the last three groups were subjected to a lower abdominal incision to expose the prostate ventral lobes beneath the bladder. Subsequently, 100 &#x3bc;L CFA was injected into the exposed prostate, followed by wound suture. Meanwhile, rats from the normal group underwent sham surgeries without CFA injection. Next, rats from the model &#x2b; FTA-L group and model &#x2b; FTA-H group were administered with 40 mg/kg and 80 mg/kg corn oil-diluted FTA, respectively, through oral gavage on the second day after surgery (<xref ref-type="bibr" rid="B15">Lang et al., 2022</xref>). Concurrently, rats in the model &#x2b; CQ and model &#x2b; FTA-H &#x2b; CQ groups received an intraperitoneal injection of CQ (<xref ref-type="bibr" rid="B21">Liu et al., 2024</xref>), while rats in the model &#x2b; G&#xf6; 6983 and model &#x2b; G&#xf6; 6983 &#x2b; FTA-H groups received G&#xf6; 6983 (10 &#x3bc;g/kg) (<xref ref-type="bibr" rid="B43">Xu et al., 2018</xref>) via the same route. Gavage of high-dose FTA (80 mg/kg) in combination with the respective inhibitor was performed in the model &#x2b; FTA-H &#x2b; CQ and model &#x2b; G&#xf6; 6983 &#x2b; FTA-H groups. FTA administration was consecutively conducted for 4 weeks (<xref ref-type="bibr" rid="B38">Wang et al., 2017</xref>). The administration with the same volume of corn oil (vehicle) was conducted on rats from the model group in the same way. After that, all rats were weighed and then sacrificed under anesthesia (45 mg/kg pentobarbital sodium, P-010, Sigma-Aldrich, United States).</p>
</sec>
<sec id="s2-4">
<label>2.4</label>
<title>Calculation of the prostatic index</title>
<p>Prostate samples were excised from the sacrificed rats and weighed for calculating the prostatic index, as follows: prostatic index &#x3d; prostate weight/body weight &#xd7; 10000. After that, rat prostates were stored in liquid nitrogen until use.</p>
</sec>
<sec id="s2-5">
<label>2.5</label>
<title>Histological analysis</title>
<p>Rat prostates were fixed with 4% paraformaldehyde (PFD; abs9179, Absin, Shanghai, China), followed by dehydration. Then, the paraffin-embedded samples were sectioned into 5-&#xb5;m thick sections. After deparaffinization and rehydration, the sections were stained with hematoxylin (abs9214, Absin, China) and eosin (AG1100, Acmec Biochemical Co., Ltd, China) at room temperature (RT) in sequence. A light microscope (Eclipse 80i, Nikon, Tokyo, Japan) was employed to observe prostatic morphology at &#xd7; 40 magnification in five random fields. The degree of prostate injury was assessed using an inflammation score (0&#x2013;4) scale, as per the guidance (<xref ref-type="bibr" rid="B46">Yang et al., 2019</xref>).</p>
</sec>
<sec id="s2-6">
<label>2.6</label>
<title>Immunohistochemistry (IHC) staining</title>
<p>To examine the presence of CD3<sup>&#x2b;</sup>T cells and CD45<sup>&#x2b;</sup> leukocytes in rat prostate after CNP modeling, prostate sections were treated with citric acid (AC10801, Acmec Biochemical Co., Ltd, China) for antigen retrieval. Afterwards, the sections were exposed to 3% hydrogen peroxide (H299581, Aladdin, Shanghai, China), washed with phosphate-buffered saline (PBS; C0221A, Beyotime, Shanghai, China) and blocked with goat serum (abs933, Absin, China) at RT. Then, CD3 antibody (14-0030-82, Thermo Fisher, Waltham, MA, USA) and CD45 antibody (MA1-70000, Thermo Fisher, USA) were utilized to incubate the sections at 4 &#xb0;C overnight. A hybridization with horseradish peroxidase (HRP)-conjugated secondary antibody (31430, Thermo Fisher, USA) was carried out at RT for 1 h. Immunoreactivity was detected by light microscopy (&#xd7;40 magnification) after development with 3,3&#x2032;-diaminobenzidine (AC11043, Acmec Biochemical Co., Ltd, China) and counterstaining with hematoxylin.</p>
</sec>
<sec id="s2-7">
<label>2.7</label>
<title>Enzyme-linked immunosorbent assay (ELISA)</title>
<p>To measure levels of inflammation-related cytokines including interleukin 1 beta (IL-1&#x3b2;), IL-2, IL-6, tumor necrosis factor alpha (TNF-&#x3b1;), IL-17A and monocyte chemoattractant protein-1 (MCP-1) in prostate of CNP rats, ELISA was performed using commercial rat ELISA kits (RLB00/R2000/R6000B/RTA00) from Novus Biologicals (Littleton, CO, USA) as well as commercial rat ELISA kits (D731078/D731095) from Sangon Biotech (Shanghai, China). Briefly, fresh prostate tissues were homogenized in pre-cooled PBS supplemented with protease inhibitor (G2008, Servicebio, Wuhan, China) and centrifuged at 5,000 &#xd7; g for 10 min to obtain supernatant. Next, 100 &#x3bc;L diluted samples were cultured in each well of pre-coated ELISA plates at 37 &#xb0;C for 90 min, and cultivated with 100 &#x3bc;L Biotinylated Detection Antibody for 1 h. After washing, the incubation with HRP Conjugate Diluent was carried out at 37 &#xb0;C for 30 min, followed by a chromogenic treatment with Substrate Reagent without light. The absorbance in each well was measured at 450 nm with a microplate reader (Infinite 200, Tecan, M&#xe4;nnedorf, Switzerland).</p>
</sec>
<sec id="s2-8">
<label>2.8</label>
<title>Western blot</title>
<p>Prostate homogenate was prepared with RIPA Lysis Buffer (89901, Thermo Fisher, USA) containing protease and phosphatase cocktail (P1045, Beyotime, China). Protein concentration in the collected supernatant was quantified using BCA Protein Assay Kit (71285-3, Sigma-Aldrich, United States). Protein extract was denatured and separated by 10% SDS-PAGE. Equal amounts of protein on the gel were transferred to polyvinylidene fluoride membranes (G6015, Servicebio, China) and blocked with 5% bovine serum albumin (A1933, Sigma-Aldrich, United States) at RT for 1 h. Next, membranes were incubated with primary antibodies against Beclin-1 (ab207612, 52 kDa, Abcam, Cambridge, UK), LC3B (ab192890, 16/14 kDa, Abcam, UK), protein kinase C alpha (PKC&#x3b1;; ab32376, 75 kDa, Abcam, UK), p-p65 (ab76302, 65 kDa, Abcam, UK), p65 (&#x23;8242, 65 kDa, Cell Signaling Technology, Danvers, MA, USA) and loading control GAPDH (ab181602, 36 kDa, Abcam, UK) at 4 &#xb0;C overnight. The next day, the membranes were probed with HRP-conjugated mouse anti-rabbit IgG (D110065, Sangon Biotech, China) at RT for 2 h. The immunoblots were visualized with Enhanced Chemiluminescent Substrate (32106, Thermo Fisher, United States). Protein signals were densitometrically analyzed using Image Quant LAS 4000 system (GE Healthcare, Marlborough, MA, United States).</p>
</sec>
<sec id="s2-9">
<label>2.9</label>
<title>Statistical analysis</title>
<p>Data in this study are expressed as mean &#xb1; standard error of the mean from at least three independent experiments. Graphpad Prism 8.0 (GraphPad Software Inc., San Diego, CA, United States) was employed for all statistical analysis. Comparisons among multiple groups were analyzed using one-way analysis of variance. Difference with a <italic>P</italic>-value of &#x3c;0.05 suggested a statistical significance.</p>
</sec>
</sec>
<sec sec-type="results" id="s3">
<label>3</label>
<title>Results</title>
<sec id="s3-1">
<label>3.1</label>
<title>FTA treatment reduced the prostatic index of CNP rat models</title>
<p>To investigate the effects of FTA on CNP, we first established CFA-induced CNP rat models. The body weight was barely changed between the normal group and the model group (<xref ref-type="fig" rid="F1">Figure 1A</xref>). After 4 weeks of FTA administration, FTA at 40 mg/kg or 80 mg/kg had no significant effect on the body weight of CNP rat models (<xref ref-type="fig" rid="F1">Figure 1A</xref>). The prostatic index of rats was elevated after CNP modeling (<xref ref-type="fig" rid="F1">Figure 1B</xref>, <italic>P</italic> &#x3c; 0.001), which was evidently diminished after 40 mg/kg or 80 mg/kg FTA treatment (<xref ref-type="fig" rid="F1">Figure 1B</xref>, <italic>P</italic> &#x3c; 0.01).</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>The attenuating effect of FTA on prostate damage and inflammation in CNP rat models. <bold>(A)</bold> CNP rat models were constructed by intraprostatic injection of complete Freund&#x2bc;s adjuvant, followed by a 4-week oral administration with or without FTA (40 and 80 mg/kg/d). Weight changes in rats. <bold>(B)</bold> Prostatitis index changes in rats. <bold>(C,E)</bold> Representative images of prostatic morphology in rats after histological analysis (magnification: &#xd7;40, scale bar &#x3d; 100 &#xb5;m), and assessments of inflammation score. <bold>(D,F,G)</bold> Immunohistochemistry staining was used to detect CD3 and CD45 signals in prostate tissues of rats (magnification: &#xd7;40, scale bar &#x3d; 100 &#xb5;m). Data are shown as mean &#xb1; standard deviation. n &#x3d; 6 for <bold>(A,B)</bold>; n &#x3d; 3 for <bold>(C&#x2013;F)</bold>. <sup>&#x2a;&#x2a;&#x2a;</sup>
<italic>P</italic> &#x3c; 0.001, vs. normal; <sup>&#x23;</sup>
<italic>P</italic> &#x3c; 0.05, <sup>&#x23;&#x23;</sup>
<italic>P</italic> &#x3c; 0.01, <sup>&#x23;&#x23;&#x23;</sup>
<italic>P</italic> &#x3c; 0.001, vs. model. Abbreviation: CNP, chronic nonbacterial prostatitis; FTA, forsythiaside A; L, low; H, high.</p>
</caption>
<graphic xlink:href="fmolb-12-1665650-g001.tif">
<alt-text content-type="machine-generated">Bar graphs and histological images showing experimental results with different treatments. Graphs A and B display weight and prostatitis index for normal, model, and treatment groups (FTA-L and FTA-H). Image C shows histological sections of prostate tissues under different conditions. Image D displays immunohistochemical staining for CD3 and CD45 markers across treatment groups. Graphs E, F, and G illustrate inflammation scores and percentages of CD3 and CD45 positive areas, indicating treatment effects.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s3-2">
<label>3.2</label>
<title>FTA treatment attenuated prostate damage and inflammatory infiltration in CNP rat models</title>
<p>In comparison with normal rats, significant inflammatory infiltration, edema and rough acinar shape were observed in the prostate of CNP rat models (<xref ref-type="fig" rid="F1">Figure 1C</xref>), which were alleviated following 40 mg/kg or 80 mg/kg FTA treatment (<xref ref-type="fig" rid="F1">Figure 1C</xref>). As shown in <xref ref-type="fig" rid="F1">Figure 1E</xref>, the inflammation score was greatly increased in rats after CNP modeling (<italic>P</italic> &#x3c; 0.001), but was decreased in the model &#x2b; FTA-L and model &#x2b; FTA-H groups (<xref ref-type="fig" rid="F1">Figure 1E</xref>, <italic>P</italic> &#x3c; 0.05). Next, we applied IHC assay to quantify expressions of CD3 and CD45 in prostate tissues to analyze lymphocyte infiltration. The results demonstrated that the number of CD3-positive cells and CD45-positive cells was increased in CNP rat models (<xref ref-type="fig" rid="F1">Figures 1D, F, G</xref>, <italic>P</italic> &#x3c; 0.001). Different concentrations (40 mg/kg and 80 mg/kg) of FTA treatment reduced the number of CD3-positive cells and CD45-positive cells in CNP rat models (<xref ref-type="fig" rid="F1">Figures 1D, F, G</xref>, <italic>P</italic> &#x3c; 0.05).</p>
</sec>
<sec id="s3-3">
<label>3.3</label>
<title>FTA treatment suppressed the release of inflammation-related cytokines in prostate tissues of CNP rat models</title>
<p>The release of inflammation-related cytokines in rat prostate tissues was assessed using ELISA. As demonstrated in <xref ref-type="fig" rid="F2">Figures 2A&#x2013;F</xref>, the expression levels of IL-1&#x3b2;, IL-2, IL-6, IL-17A, MCP-1, and TNF-&#x3b1; were significantly higher in the model group compared to the normal group (<italic>P</italic> &#x3c; 0.001). Notably, treatment with FTA at doses of either 40 mg/kg or 80 mg/kg reduced the expression of these cytokines in the prostate tissues of CNP rat models. (<xref ref-type="fig" rid="F2">Figures 2A-F</xref>, <italic>P</italic> &#x3c; 0.001).</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>The suppressing effect of FTA on inflammatory-related cytokines in prostate tissues of CNP rat models. <bold>(A&#x2013;F)</bold> CNP rat models were constructed by intraprostatic injection of complete Freund&#x2bc;s adjuvant, followed by a 4-week oral administration with or without FTA (40 and 80 mg/kg/d). Enzyme-linked immunosorbent assay was performed to detect levels of IL-1&#x3b2;, IL-2, IL-6, IL-17A, MCP-1 and TNF-&#x3b1; in rat prostates. Data are shown as mean &#xb1; standard deviation. n &#x3d; 6 in each group. <sup>&#x2a;&#x2a;&#x2a;</sup>
<italic>P</italic> &#x3c; 0.001, vs. normal; <sup>&#x23;&#x23;&#x23;</sup>
<italic>P</italic> &#x3c; 0.001, vs. model. Abbreviation: IL-1&#x3b2;, interleukin 1 beta; IL-2, interleukin 2; IL-6, interleukin 6; IL-17A, interleukin 17A; MCP-1, monocyte chemoattractant protein-1; TNF-&#x3b1;, tumor necrosis factor alpha.</p>
</caption>
<graphic xlink:href="fmolb-12-1665650-g002.tif">
<alt-text content-type="machine-generated">Bar graphs labeled A to F show cytokine levels: IL-1&#x3B2;, IL-2, IL-6, IL-17A, MCP-1, and TNF-&#x3B1;. Each graph compares Normal, Model, Model plus FTA-L, and Model plus FTA-H groups. Cytokine levels are highest in Model, reduced in FTA-L and FTA-H groups, shown with significance markers.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s3-4">
<label>3.4</label>
<title>FTA treatment facilitated autophagy and blocked the PKC&#x3b1;/NF-&#x3ba;B pathway in prostate tissues of CNP rat models</title>
<p>It is established that autophagy plays a critical role in regulating intercellular inflammatory response (<xref ref-type="bibr" rid="B24">Matsuzawa-Ishimoto et al., 2018</xref>). We subsequently detected autophagic markers including Beclin-1 and LC3B in rat prostate tissues using Western blot, and the results showed that CNP modeling downregulated Beclin-1 and LC3B II/LC3B I (<xref ref-type="fig" rid="F3">Figures 3A-C</xref>, <italic>P</italic> &#x3c; 0.001), but the expressions were increased due to FTA (80 mg/kg) treatment in prostate tissues of CNP rats (<xref ref-type="fig" rid="F3">Figures 3A-C</xref>, <italic>P</italic> &#x3c; 0.001). CQ inhibited the expressions of Beclin-1 and LC3B II/LC3B I, which was offset by FTA (<xref ref-type="fig" rid="F3">Figures 3A-C</xref>, <italic>P</italic> &#x3c; 0.05). ELISA results demonstrated that CQ promoted inflammation, but FTA attenuated its effect (<xref ref-type="fig" rid="F3">Figures 3D-I</xref>, <italic>P</italic> &#x3c; 0.05). G&#xf6; 6983 further blocked the PKC&#x3b1;/NF-&#x3ba;B signaling pathway (<xref ref-type="fig" rid="F4">Figures 4A-C</xref>, <italic>P</italic> &#x3c; 0.05). ELISA results showed that FTA reduced inflammatory factors in rats prostate tissues, while G&#xf6; 6983 further suppressed inflammation (<xref ref-type="fig" rid="F4">Figures 4D-I</xref>, <italic>P</italic> &#x3c; 0.05).</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption>
<p>The regulatory role of FTA in autophagy in CNP rat models. <bold>(A&#x2013;C)</bold> CNP rat models were constructed by intraprostatic injection of complete Freund&#x2bc;s adjuvant, followed by a 4-week oral administration regimen with groups designated as normal, model, model &#x2b; FTA-H, model &#x2b; CQ, and model &#x2b; FTA-H &#x2b; CQ. Western blot was performed to measure protein expressions of Beclin-1, LC3B II/LC3B I, PKC&#x3b1; and p-p65/p-65 in rat prostates. GAPDH was used as a loading control. <bold>(D&#x2013;I)</bold> Enzyme-linked immunosorbent assay was performed to detect levels of IL-1&#x3b2;, IL-2, IL-6, IL-17A, MCP-1 and TNF-&#x3b1; in rat prostates. Data are shown as mean &#xb1; standard deviation. n &#x3d; 3 in each group. <sup>&#x2a;&#x2a;&#x2a;</sup>
<italic>P</italic> &#x3c; 0.001, vs. normal; <sup>&#x23;</sup>
<italic>P</italic> &#x3c; 0.05, <sup>&#x23;&#x23;</sup>
<italic>P</italic> &#x3c; 0.01, <sup>&#x23;&#x23;&#x23;</sup>
<italic>P</italic> &#x3c; 0.001, vs. model. <sup>&#x2b;</sup>
<italic>P</italic> &#x3c; 0.05, <sup>&#x2b;&#x2b;&#x2b;</sup>
<italic>P</italic> &#x3c; 0.001, vs. model &#x2b; FTA-H; &#x5e;&#x5e;&#x5e;<italic>P</italic> &#x3c; 0.001 vs. model &#x2b; CQ. Abbreviation: CQ, Chloroquine.</p>
</caption>
<graphic xlink:href="fmolb-12-1665650-g003.tif">
<alt-text content-type="machine-generated">A series of charts display results from a protein expression study. Panel A shows Western blot bands for Beclin-1, LC3B I and II, and GAPDH across different models, with corresponding molecular weights. Panels B and C graph relative protein expressions of Beclin-1 and LC3B, respectively. Panels D to I illustrate cytokine levels: IL-1 beta, IL-2, IL-6, IL-17A, MCP-1, and TNF-alpha, measured in picograms per milliliter, for normal and various models, each with significance levels marked.</alt-text>
</graphic>
</fig>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption>
<p>The regulatory role of FTA in the PKC&#x3b1;/NF-&#x3ba;B pathway in CNP rat models. <bold>(A&#x2013;F)</bold> CNP rat models were constructed by intraprostatic injection of complete Freund&#x2bc;s adjuvant, followed by a 4-week oral administration regimen with groups designated as normal, model, model &#x2b; FTA-H, model &#x2b; G&#xf6; 6983, and model &#x2b; FTA-H &#x2b; G&#xf6; 6983. Western blot was performed to measure protein expressions of PKC&#x3b1; and p-p65/p-65 in rat prostates. <bold>(D&#x2013;I)</bold> Enzyme-linked immunosorbent assay was performed to detect levels of IL-1&#x3b2;, IL-2, IL-6, IL-17A, MCP-1 and TNF-&#x3b1; in rat prostates. GAPDH was used as a loading control. Data are shown as mean &#xb1; standard deviation. n &#x3d; 3 in each group. <sup>&#x2a;&#x2a;&#x2a;</sup>
<italic>P</italic> &#x3c; 0.001, vs. normal; <sup>&#x23;&#x23;&#x23;</sup>
<italic>P</italic> &#x3c; 0.001, vs. model. <sup>&#x2b;</sup>
<italic>P</italic> &#x3c; 0.05, <sup>&#x2b;&#x2b;</sup>
<italic>P</italic> &#x3c; 0.01, vs. model &#x2b; FTA-H; <sup>&#x26;</sup>
<italic>P</italic> &#x3c; 0.05 vs. model &#x2b; G&#xf6; 6983. Abbreviation: PKC&#x3b1;, protein kinase C alpha.</p>
</caption>
<graphic xlink:href="fmolb-12-1665650-g004.tif">
<alt-text content-type="machine-generated">Western blot results and quantification grouped into panels A to I, showing protein expressions and cytokine levels across different experimental groups. Panel A displays protein bands for PKC&#x3B1;, phosphorylated p65, p65, and GAPDH. Panels B to I present bar graphs comparing groups labeled as Normal, Model, Model&#x2b;FTA-H, Model&#x2b;G&#xF6;6983, and Model&#x2b;G&#xF6;6983&#x2b;FTA-H. These graphs reveal changes in expressions or levels of PKC&#x3B1;, p-p65/p65, IL-1&#x3B2;, IL-2, IL-6, IL-17A, MCP-1, and TNF-&#x3B1;, with statistical indicators for significance differences among groups.</alt-text>
</graphic>
</fig>
</sec>
</sec>
<sec sec-type="discussion" id="s4">
<label>4</label>
<title>Discussion</title>
<p>In the present study, we firstly confirmed that FTA exhibited a therapeutic effect against CNP in rat by decreasing the prostatic index, attenuating prostate damage and reducing inflammatory response. Further, this study demonstrated that FTA promoted the activation of autophagy and inhibited the PKC&#x3b1;/NF-&#x3ba;B pathway in CNP rat-derived prostate tissues.</p>
<p>CNP is characterized by urogenital symptoms, such as urgency, frequent urination, pain and sexual dysfunction, in the absence of urinary tract infection or other identifiable pathogenic factors (<xref ref-type="bibr" rid="B26">Nickel et al., 2017</xref>). Existing evidence has verified inflammatory dysregulation in autoimmunity against prostate antigens as one of the contributors to CNP (<xref ref-type="bibr" rid="B25">Motrich et al., 2018</xref>). Therefore, animals injected with CFA intraprostatically, which induces inflammation and immune cell infiltration in the prostate gland due to T cell activation, are commonly used as experimental models of autoimmune prostatitis in CNP research (<xref ref-type="bibr" rid="B14">Kurita et al., 2018</xref>; <xref ref-type="bibr" rid="B20">Lin et al., 2017</xref>). In this study, rats injected with CFA exhibited significant prostate tissue damage, inflammatory response and increased numbers of CD3<sup>&#x2b;</sup>T cells and CD45<sup>&#x2b;</sup> leukocytes, consistent with the findings of Yang et al. (<xref ref-type="bibr" rid="B46">Yang et al., 2019</xref>). However, these changes were reversed after FTA administration. As an active compound, FTA has been rarely studied in terms of its anti-inflammatory effect on chronic prostatitis. Intriguingly, recent evidence has shown that forsythoside B can significantly suppress inflammation to attenuate CFA-induced chronic inflammatory pain in mice by decreasing proinflammatory cytokines (IL-6 and TNF-&#x3b1;) (<xref ref-type="bibr" rid="B40">Wang et al., 2023</xref>). In ovalbumin-induced asthma, FTA has been found to reduce airway inflammation in mice (<xref ref-type="bibr" rid="B34">Qian et al., 2017</xref>). Additionally, FTA can decrease rat serum levels of proinflammatory cytokines (IL-6, IL-1&#x3b2; and TNF-&#x3b1;) to alleviate renal damage in adriamycin-induced nephropathy (<xref ref-type="bibr" rid="B23">Lu et al., 2020</xref>). In patients with CNP, immunoinflammatory cell-secreted proinflammatory cytokines, including IL-1&#x3b2;, IL-2, IL-6, MCP-1 and TNF-&#x3b1;, are upregulated in seminal plasma, prostatic secretions and urine (<xref ref-type="bibr" rid="B2">Breser et al., 2017</xref>). To our knowledge, MCP-1 acts as a critical mediator during the development of CNP through recruitment of T cells, monocytes and macrophages (<xref ref-type="bibr" rid="B35">Quick et al., 2012</xref>). IL-17A, produced by Th17 cells, is increased in CNP rat models, and the upregulation of IL-17A is associated with autoimmunity and inflammatory response (<xref ref-type="bibr" rid="B32">Peng et al., 2021</xref>). According to the results of ELISA, we found increased levels of IL-1&#x3b2;, IL-2, IL-6, MCP-1, TNF-&#x3b1; and IL-17A in prostate tissues of CNP rat models, but these tendencies were reversed by FTA treatment. Collectively, FTA could be used as a potential anti-inflammatory agent for treating CNP.</p>
<p>Subsequently, this study further investigated the underlying molecular mechanism of FTA on CNP. Intriguingly, the anti-inflammatory activity of FTA in many inflammatory disorders is associated with the regulation of the NF-&#x3ba;B pathway (<xref ref-type="bibr" rid="B36">Tong et al., 2021</xref>; <xref ref-type="bibr" rid="B39">Wang et al., 2022</xref>). NF-&#x3ba;B is a critical transcription factor that can be activated through various pathways to mediate transcription of key genes involved in inflammation, apoptosis or autophagy (<xref ref-type="bibr" rid="B16">Lee et al., 2018</xref>; <xref ref-type="bibr" rid="B28">Park and Koh, 2019</xref>). Activation of NF-&#x3ba;B in prostatitis has been demonstrated to be associated with chronic inflammation and disease severity (<xref ref-type="bibr" rid="B31">Paulis, 2018</xref>). Recently, it has been reported that inhibition of NF-&#x3ba;B by Qianliexin capsule can ameliorate 17 &#x3b2;-oestradiol-induced CNP by suppressing NLRP3 inflammasome (<xref ref-type="bibr" rid="B47">Zang et al., 2021</xref>). As a cytosolic multi-protein complex, NLRP3 inflammasome plays a regulatory role in autophagic process to balance host defense inflammation and prevent excessive inflammation (<xref ref-type="bibr" rid="B1">Biasizzo and Kopitar-Jerala, 2020</xref>). Lang et al. found that FTA can suppress the activation of NLRP3 inflammasome to attenuate methotrexate-induced intestinal mucositis in rats (<xref ref-type="bibr" rid="B15">Lang et al., 2022</xref>). In this study, the results of western blot revealed that expressions of Beclin-1 and LC3B II/LC3B I were decreased in prostate tissues of CNP rat models, confirming suppressed autophagy in CNP (<xref ref-type="bibr" rid="B22">Lu et al., 2019</xref>). It is well accepted that p65 activation is a central event in the NF-&#x3ba;B signaling pathway (<xref ref-type="bibr" rid="B6">Cui et al., 2014</xref>). In prostate tissues, we found that CNP modeling-induced downregulation of Beclin-1 and LC3B II/LC3B I as well as upregulation of p65 phosphorylation were reversed after FTA treatment. As a putative target of FTA, PKC&#x3b1; has been reported to play a regulatory role in inflammation (<xref ref-type="bibr" rid="B12">Guo et al., 2017</xref>), but its effect on chronic prostatitis is unknown. Chen et al. have suggested that PKC&#x3b1; inhibition protects the lung of mice against sepsis-induced hyperinflammatory response and oxidative stress, which could be accomplished by blocking the NF-&#x3ba;B pathway (<xref ref-type="bibr" rid="B3">Chen et al., 2022</xref>). PKC&#x3b1; also can stimulate the activation of NF-&#x3ba;B pathway through p65 nuclear translocation to regulate apoptotic resistance and thereby contribute to urothelial cell carcinoma (<xref ref-type="bibr" rid="B48">Zheng et al., 2017</xref>). In this study, we observed that the expression of PKC&#x3b1; was increased in prostate tissues of CNP rat models, which was reversed by FTA. The above findings implied that the inhibiting effect of FTA on NF-&#x3ba;B activation in CNP rat models could be mediated by targeting PKC&#x3b1;. Notably, this study has some limitations, as it did not provide direct visual evidence of nuclear translocation through immunofluorescence microscopy. Future studies could incorporate immunofluorescence techniques to more clearly elucidate the spatial and temporal resolution of this critical cellular process.</p>
<p>In summary, this study provides new evidence that FTA alleviates inflammation and facilitates autophagy in CNP rat models by blocking the PKC&#x3b1;/NF-&#x3ba;B pathway. On the basis of our current findings, we propose that FTA holds promise as a potential therapeutic agent for CNP.</p>
</sec>
</body>
<back>
<sec sec-type="data-availability" id="s5">
<title>Data availability statement</title>
<p>The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.</p>
</sec>
<sec sec-type="ethics-statement" id="s6">
<title>Ethics statement</title>
<p>The animal study was approved by the Institutional Animal Care and Use Committee of Zhejiang Baiyue Biology Technology Co., Ltd. The study was conducted in accordance with the local legislation and institutional requirements.</p>
</sec>
<sec sec-type="author-contributions" id="s7">
<title>Author contributions</title>
<p>XY: Conceptualization, Project administration, Writing &#x2013; original draft, Writing &#x2013; review and editing. HT: Data curation, Formal Analysis, Writing &#x2013; original draft, Writing &#x2013; review and editing. YG: Validation, Writing &#x2013; original draft, Writing &#x2013; review and editing. DQ: Methodology, Writing &#x2013; original draft, Writing &#x2013; review and editing. YZ: Resources, Software, Visualization, Writing &#x2013; original draft, Writing &#x2013; review and editing. HQ: Supervision, Writing &#x2013; original draft, Writing &#x2013; review and editing.</p>
</sec>
<sec sec-type="COI-statement" id="s9">
<title>Conflict of interest</title>
<p>The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="ai-statement" id="s10">
<title>Generative AI statement</title>
<p>The author(s) declared that generative AI was not used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p>
</sec>
<sec sec-type="disclaimer" id="s11">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<fn-group>
<fn fn-type="custom" custom-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/59155/overview">Venkaiah Betapudi</ext-link>, United States Department of Health and Human Services, United States</p>
</fn>
<fn fn-type="custom" custom-type="reviewed-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1997690/overview">Kefeng Lu</ext-link>, Sichuan University, China</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3208039/overview">Song Jin</ext-link>, Capital Medical University, China</p>
</fn>
</fn-group>
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