1. Introduction
Cardiometabolic multimorbidity (CMM) is one of the most common patterns of multimorbidity among the elderly population, encompassing the co-occurrence of two or more cardiovascular and metabolic conditions such as ischemic stroke (IS), coronary heart disease (CHD), and diabetes mellitus (DM) [
1]. Currently, the prevalence of chronic diseases among the elderly population in China is reported to be 42.4%, with CMM affecting approximately 11.61% [
2]. CMM significantly impacts life expectancy, reducing it by 12 years in 60-year-olds with two diseases and by 15 years in those with three diseases compared to individuals without any cardiometabolic conditions [
2]. Given the global demographic shift towards an aging population, CMM has become a significant global health concern [
3]. This underscores the importance of intervention research and metabolism exploration in CMM in the elderly population.
Recent studies have demonstrated the potential benefits of dietary interventions and nutritional supplements in reducing cardiovascular morbidity and mortality. Additionally, there is growing interest in the therapeutic use of natural products and active ingredients found in Chinese herbs, such as ginseng, ginkgo biloba, and Ganoderma lucidum, for the treatment of CMM [
4,
5]. However, multi-target natural products with significant pharmacological activity offer a greater advantage [
6].
Resveratrol (3,5,4′-trihydroxytrans-stilbene) is a member of the stilbene group within the polyphenol family, naturally occurring in various plants such as nuts, berries, and grapes. The compound exhibits antioxidant properties [
7], anti-inflammatory effects [
8], enhancement of mitochondrial function [
9], neuroprotective capabilities, and potentially possesses anti-aging and immune-modulating effects [
10]. Resveratrol has garnered considerable attention for its efficacy in treating cardiovascular diseases. A randomized double-blind clinical trial (RCT) has demonstrated that resveratrol offers benefits for heart failure [
11] and exhibits a protective effect against atherosclerosis among individuals at low cardiovascular risk [
12]. Moreover, resveratrol is widely utilized in diabetes treatment, primarily for its roles in reducing blood sugar levels, enhancing insulin sensitivity, and preserving pancreatic beta cells [
13]. Clinical trials have highlighted that resveratrol supplementation can effectively improve blood glucose control and insulin sensitivity, making it a potential adjunct in diabetes management [
7]. Nonetheless, the precise mechanism underlying the therapeutic effects of resveratrol on CMM remains elusive.
Network pharmacology is an innovative approach in pharmacological research rooted in systems biology, transcending the constraints of traditional single-target drug studies. It elucidates that drugs typically act on multiple targets and that these targets often intersect with various diseases. This methodology has been instrumental in predicting protein targets of active plant ingredients and their associated pathological pathways [
8]. Currently, there are limited studies on resveratrol for the treatment of CMM using network pharmacology.
The main objectives of this study are as follows:
Utilize the OMIM, GeneCards, and DisGeNET databases to identify targets associated with CMM.
Incorporate the DSigDB drug characterization database into enrichment analyses to predict drug candidates for addressing CMM.
Identify active compounds and their corresponding targets in resveratrol using the TCMSP, SymMap, DrugBank, Swiss Target Prediction, CTD, and UniProt databases.
Validate drug similarities and toxic properties using the SwissADME and ADMETlab 2.0 web tools.
Explore interactions among common targets of resveratrol and CMM using PPI databases, and construct a PPI network using Cytoscape 3.9.1 software.
Conduct enrichment analysis to assess the distribution of resveratrol’s targets in diseases, cellular components (CCs), biological processes (BPs), molecular functions (MFs), and signaling pathways.
Develop a target-pathway topological network model to elucidate the mechanisms of resveratrol against CMM.
Evaluate interactions between resveratrol and core targets through molecular docking and molecular dynamics simulations.
Perform differential analysis of GEO datasets to identify potential core targets of resveratrol in addressing CMM.
In this study, we explored the mechanism of resveratrol in modulating CMM through network pharmacology. We employed molecular docking and molecular dynamics simulations to assess the interaction properties between resveratrol and its key targets, validating these insights through GEO datasets. These findings offer novel insights into the therapeutic potential of phytochemicals in managing CMM. They also provide theoretical guidance and a scientific foundation for future experimental investigations and clinical applications. The flow chart of this study is shown in
Figure 1.
4. Discussion
CMM represents a prevalent chronic condition worldwide, significantly contributing to mortality and disability rates across populations. Individuals with CMM face heightened risks of complications from various cardiovascular and metabolic diseases [
14]. Hence, identifying effective pharmacological treatments and elucidating underlying pathogenic mechanisms are crucial clinical imperatives. Natural products possessing pharmacological activities offer distinct advantages in alleviating clinical symptoms and in the prevention and treatment of CMM [
15,
16].
Resveratrol exhibits antioxidant and anti-inflammatory properties, contributing to improved glucose and lipid metabolism, enhanced cardiovascular function, and delayed aging processes [
17]. Research indicates that resveratrol reduces oxidative stress, modulates the renin–angiotensin system via AMPK activation, enhances endothelial function through the Nrf2-II enzyme pathway [
18], and lowers blood pressure [
19]. Furthermore, it demonstrates efficacy in mitigating ischemia–reperfusion injury in ischemic heart disease [
20]. Resveratrol also regulates lipid metabolism, suppresses inflammation, and diminishes oxidative stress, thereby beneficially influencing various stages of atherogenesis and the progression of atherosclerosis [
21].
In this study, we employed network pharmacology to construct drug–target pathway topological networks, facilitating the prediction of drug targets and mechanisms of action. By identifying shared targets between resveratrol and CMM, we revealed potential therapeutic effects of resveratrol on this condition by targeting key nodes in the protein–protein interaction network of common targets. Additionally, we conducted GO and KEGG analyses, uncovering several biological processes associated with resveratrol in CMM, such as positive regulation of cell proliferation [
22], gene expression [
23], response to estradiol [
24], positive transcriptional regulation of the RNA polymerase II promoter [
25], and positive regulation of protein phosphorylation [
22]. These processes predominantly occur in extracellular matrix, cell surface, myofibrillar membrane, and platelet α-granule lumen locations. Molecular functions identified include protein binding, growth factor activity, RNA polymerase II transcription factor activity, and ligand-activated sequence-specific DNA binding.
Furthermore, KEGG analysis highlighted enriched pathways including the MAPK signaling pathway [
26], PI3K-Akt signaling pathway [
27], calcium signaling pathway [
28], Rap1 signaling pathway [
25], Ras signaling pathway, and JAK-STAT signaling pathway [
29]. Importantly, targets of resveratrol and CMM play pivotal roles in inflammatory responses, such as inhibiting pro-inflammatory cytokine production via the JAK-STAT signaling pathway, mitigating maladaptive hypertrophy in cardiac remodeling through the MAPK signaling pathway, and exerting anti-apoptotic effects via the PI3K-Akt signaling pathway [
30,
31].
The cardiovascular protective effect of resveratrol is primarily attributed to its ability to reduce oxidative stress, regulate inflammation, and improve cardiovascular risk factors [
32]. Oxidative stress plays a crucial role in the pathogenesis of various cardiovascular diseases [
33,
34]. Resveratrol exerts a protective effect by scavenging free radicals, thereby safeguarding cells from oxidative damage [
35]. The mitogen-activated protein kinase (MAPK) cascade is a critical signaling pathway that regulates numerous cellular processes, including proliferation, cell survival, and apoptosis, under both normal and pathological conditions such as oxidative stress [
36]. Excessive activation of the MAPK signaling pathway due to oxidative stress is associated with pathological cardiac hypertrophy; however, resveratrol can inhibit ROS-mediated activation of MAPK/ERK1/2 [
37]. Furthermore, resveratrol is known to inhibit the production of pro-inflammatory cytokines, highlighting its anti-inflammatory properties. Studies have shown that resveratrol down-regulates the expression of NF-κB p65 and p38 MAPK, while up-regulating the expression of SIRT1, thereby reducing vascular inflammatory damage and atherosclerosis [
38]. Yang et al. found that resveratrol inhibits the production of COX-2/PGE2 induced by slow hormones by activating SIRT1, which can inhibit AP-1 (MAPK activation) and NF-κB transcription factor (acetylation) [
39]. Gao et al. discovered that resveratrol can reduce cardiac dysfunction and fibrosis induced by diabetes, an effect associated with a reduction in the inflammatory response and the down-regulation of the AT1R-ERK/p38 MAPK signaling pathway [
40].
To identify pivotal proteins and compounds, we constructed a compound–target pathway network. By intersecting this network with a protein–protein interaction (PPI) network focused on common targets, we identified six core targets: EGFR, STAT3, MAPK3, FGF2, STAT5B, and FGFR1. Subsequent molecular docking validated these targets, revealing binding energies consistently below −4 kcal/mol, indicating high affinity. Among these, MAPK3 and EGFR exhibited the strongest affinity. EGFR, known for its widespread presence in fibroblasts, notably interacts with STAT3, presenting a promising therapeutic avenue to mitigate CMM [
41].
In this study, we employed molecular dynamics simulations to investigate the binding interactions of resveratrol with EGFR, STAT3, MAPK3, FGF2, STAT5B, and FGFR1 in depth. Our findings indicate that resveratrol exhibits strong binding affinity with MAPK3, suggesting its potential to modulate MAPK3 activity. Notably, MAPK3 forms stable hydrogen bonds with nearly all small-molecule docking ligands studied. Further exploration of these interactions could pave the way for targeted therapeutic strategies in CMM.
Our study also revealed an intersection between CMM datasets from the GEO database and resveratrol targets, highlighting FGF2 as a common target. This underscores the pivotal role of FGF2 in the pathogenesis of CMM. FGF2, a member of the fibroblast growth factor family [
42], is widely expressed in cardiovascular tissues and plays critical roles in cardiomyocyte cell cycle regulation, cardiac development, disease pathogenesis, and repair mechanisms. Additionally, FGF2 is involved in various metabolic processes, including bile acid metabolism, fatty acid metabolism, and glucose metabolism [
43]. Research has demonstrated FGF2’s significant involvement in atherosclerotic plaque formation [
42] and its influence on vascular smooth muscle cell behavior [
44]. Notably, FGF2 is recognized as a potent regulator of inflammation, capable of inducing pro-inflammatory cytokine expression in human aortic smooth muscle cells and promoting a shift from a contractile to a secretory phenotype [
45]. Our findings suggest that targeting FGF2 through resveratrol may offer therapeutic potential in managing the inflammatory response associated with CMM.
SwissADME is a web-based tool used to calculate essential physicochemical, pharmacokinetic, and drug-related parameters of molecules, crucial for predicting their medicinal potential [
46]. Pharmacokinetic and drug-like activity simulations performed by SwissADME aid in discovering active compounds with novel structures, thereby enhancing the likelihood of successful clinical drug development [
47]. According to SwissADME simulations, resveratrol demonstrates favorable intestinal solubility and blood–brain barrier permeability, is metabolizable by the liver, and exhibits promising drug-like properties. Additionally, ADMETlab analysis indicates minimal toxicity associated with resveratrol.
Resveratrol is a compound found in various plants and exists in both cis- and trans-isomers, with trans-resveratrol being more biologically active and stable than the cis-isomer. Most of the reported health benefits are attributed to the trans form [
48]. Due to its structure and interaction with biological pathways, trans-resveratrol is believed to cross cell membranes more efficiently and exert antioxidant and anti-inflammatory effects [
49]. A growing number of studies have shown that trans-resveratrol has higher bioavailability compared to regular resveratrol, particularly in cardiovascular health [
50]. For instance, Sung et al. found that resveratrol can effectively treat myocardial infarction induced by pressure overload by improving diastolic function, cardiac remodeling, myocardial energy, vascular function, and reducing cardiac fibrosis [
51]. Additionally, Guo et al. discovered that resveratrol can treat atherosclerosis by inhibiting the TGF/ERK signaling pathway [
52].
Due to the promising preclinical effects of resveratrol, many randomized clinical trials (RCTs) have reported similar findings [
32,
53,
54]. However, the appropriate dose of resveratrol remains uncertain. Studies indicate that resveratrol provides health benefits in a dose-dependent manner, with low doses appearing to prevent various diseases [
55]. Rapid metabolism in the intestine and liver results in low bioavailability and limited effectiveness, encouraging the exploration of methods to improve its bioavailability [
56]. One approach is to combine resveratrol with other phytochemicals to protect it from rapid metabolism [
57]. Alternatively, using resveratrol in different forms may enhance its efficacy [
58]. Techniques such as derivatization, microencapsulation, nanomaterials, and bioenhancers have also been reported to be effective [
59,
60,
61].
However, this study has some limitations. The reliability and accuracy of our compound and target predictions depend on the quality of the database data. While data mining methods provided valuable insights, validating these predictions through clinical trials and animal experiments would be of greater significance. Network pharmacology is primarily a data-driven and web-based research methodology; therefore, these findings should be further validated through clinical trials and animal experiments.