Metabolomics and Network Pharmacology-Based Screening of Candidate Hepatoprotective Metabolites in Fermented Dendrobium officinale Against Acetaminophen-Induced Liver Injury

<i>Dendrobium officinale</i> exhibits hepatoprotective potential against acetaminophen-induced liver injury (AILI). Fermentation has been proposed as a strategy to enhance the utilization and efficacy of herbal medicines. However, whether yeast fermentation improves the hepatoprotective effects of <i>D. officinale</i> remains unclear. This study investigated whether fermentation of <i>D. officinale</i> flower extract with <i>Saccharomyces cerevisiae</i> (1002S) enhances its protective effects against AILI, compared with a nonfermented extract (DOFE). Hepatoprotective efficacy was evaluated in male C57BL/6 mice, which received 1002S or DOFE (500 mg/kg, oral gavage) for 7 days before an acute acetaminophen challenge. Untargeted metabolomics and network pharmacology analyses were used to characterize fermentation-associated metabolic alterations and to explore potential pathways related to the observed effects. Metabolomic profiling revealed distinct metabolic differences between 1002S and DOFE. Network pharmacology analysis indicated predicted targets of fermentation-associated metabolites were associated with the phosphoinositide 3-kinase (PI3K)/ protein kinase B (Akt) and Janus kinase (JAK)/signal transducer and activator of transcription proteins (STAT) signaling pathways. In vivo, 1002S more effectively alleviated hepatocellular necrosis and significantly reduced serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Increased expression of nuclear factor erythroid 2-related factor 2 (Nrf2), superoxide dismutase 2 (SOD2), solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) was observed in liver tissues. Molecular docking suggested hemsleyanoside may contribute to these effects. Collectively, <i>S. cerevisiae</i> fermentation enhanced the antioxidant and hepatoprotective efficacy of <i>D. officinale</i> flower extract, supporting its potential development for AILI prevention.