Introduction/Objective:The incidence of metabolic-associated fatty liver disease
(MAFLD) increases annually. Modified Zexie Decoction (MZXD) can treat this disease; however,
their mechanisms of action are uncertain. This study evaluated the mechanisms of MZXD
against MAFLD based on network pharmacology, molecular docking, and in vivo experiments.Methods:The main active compounds, targets and signaling pathways of MZXD against
MAFLD were obtained using network pharmacological analysis. Underlying mechanisms were
validated by molecular docking and in vivo assays.Results:Forty-one active ingredients and 197 intersection targets were identified. The main active
ingredients include quercetin, luteolin, isorhamnetin, 3-methylhexane, and 3β-
acetoxyatractylone. The main targets were TP53, JUN, HSP90AA1, MAPK1, MAPK3, AKT1,
NF-κB p65, TNF, ESR1, FOS, and IL-6. The pathway enrichment analysis indicated that MZXD
was related to the IL-17, TNF, and PI3K-AKT signaling pathways. Molecular docking suggested
that these active ingredients bound strongly to TNF, IL-6, and NF-κB p65, which are integral
components of the TNF pathway. In the rat MAFLD model, MZXD attenuated high-fat diet(
HFD)-induced liver injury and lipid accumulation, decreased the serum levels of the inflammatory
mediators TNF-α, IL6, and IL-1β, and inhibited the protein expression of TNF-α, IL6, p-
IKB-α and p-NF-κB p65. Furthermore, immunohistochemistry results showed that MZXD attenuated
the F4/80 staining intensity of the liver compared with the model group.Conclusion:Collectively, our results suggested that MZXD could improve MAFLD by downregulating
TNF/NF-κB signaling mediated macrophage activation.