Multi-Target Mechanisms of the Naofucong in Ameliorating Diabetes-Associated Cognitive Dysfunction via cAMP/PKA/CREB-Mediated Synaptic and Inflammatory Regulation.

OBJECTIVE: Diabetes-associated cognitive dysfunction (DACD) is a prevalent and debilitating complication of diabetes, yet effective therapies remain limited. The traditional Chinese medicine compound Naofucong (NFC) has shown neuroprotective potential, but its underlying mechanisms are not fully understood. This study investigated the therapeutic efficacy and molecular mechanisms of NFC against DACD using an integrated multi-omics approach combined with experimental validation. METHODS: Streptozotocin-induced DACD rats received NFC (22.5 g/kg/day) for 12 weeks. Cognitive performance was assessed by the Morris water maze. Transcriptomics and untargeted metabolomics were integrated to identify key regulatory pathways, which were further validated using immunofluorescence, Golgi staining, cytokine profiling, qPCR, and western blotting. RESULTS: NFC significantly improved spatial learning and memory, attenuated neuronal damage in the hippocampus and cortex, and reduced pathological protein accumulation (APP, phosphorylated Tau). By integrating transcriptomics and metabolomics, we elucidated that NFC primarily acts via activation of the cAMP/PKA/CREB signaling pathway, leading to synaptic repair and neuroinflammatory modulation. Mechanistically, NFC restored synaptic ultrastructure, enhanced dendritic complexity and spine maturation, and upregulated neurotrophic factors (BDNF, NGF) and synaptic proteins (PSD-95, SYN). Furthermore, NFC inhibited glial overactivation, decreased pro-inflammatory cytokines (IL-1β, TNF-α, IFN-γ, IL-6, KC/GRO), and increased anti-inflammatory cytokines (IL-10, IL-13, IL-4), thereby re-establishing neuroimmune balance. CONCLUSION: NFC exerts multi-target neuroprotective effects by activating the cAMP/PKA/CREB pathway and coordinately regulating synaptic plasticity and neuroinflammation. These findings highlight NFC as a promising candidate for DACD treatment.