Integrative multi-omics analysis prioritizes ALDH2 as a candidate Puerarin-associated target linked to macrophage infiltration in lung adenocarcinoma.

Background: Puerarin is a bioactive isoflavone with reported anti-tumor and immunomodulatory activities; however, its candidate molecular targets and associations with the immune microenvironment in lung adenocarcinoma(LUAD) remain incompletely defined. This study integrated computational analyses with a murine LUAD model to prioritize candidate puerarin-associated targets and evaluate their relationships with immune-cell changes. Methods: We first identified puerarin targets, non-small cell lung cancer (NSCLC)-associated genes, and differentially expressed genes (DEGs). An integrative strategy combining network pharmacology, multi-omics, and machine learning algorithms (Least Absolute Shrinkage and Selection Operator, Support Vector Machine-Recursive Feature Elimination, and Random Forest) was employed to screen feature genes. Feature genes were further evaluated by molecular docking, molecular dynamics simulations, Mendelian randomization(MR), cellular origins and immune infiltration analyses, and Results: A comprehensive analysis identified 130 targets associated with puerarin, 10,871 genes related to NSCLC, and 4,690 DEGs, resulting in an intersection comprising 39 candidate genes. Five feature genes (ABCG2, ALDH2, MIF, PTGS1, and SELP) were retained by three machine-learning approaches and ABCG2, ALDH2, MIF, and SELP showed consistent diagnostic performance in the training and validation cohorts. Docking and molecular dynamics simulations predicted favorable and stable modeled interactions of puerarin with ABCG2 and ALDH2, but did not establish direct target engagement. MR using a LUAD outcome dataset suggested an inverse association between genetically predicted ALDH2 expression and LUAD risk. Single-cell analysis indicated relative enrichment of ALDH2 transcripts in macrophages. Conclusion: Puerarin suppressed tumor growth in a murine LUAD model and was associated with ALDH2 upregulation and increased macrophage infiltration. Integrated analyses prioritize ALDH2 as a candidate molecule potentially linking puerarin treatment to changes in the tumor immune microenvironment. Direct puerarin-ALDH2 binding, macrophage-specific ALDH2 regulation, and the functional consequences for macrophage polarization require further experimental validation.