State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Innovation Team of Research on Compound Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
Biomed Pharmacother. 2021 Oct;142:111979. doi: 10.1016/j.biopha.2021.111979. Epub 2021 Aug 4.
Cardiovascular diseases are one of the leading causes of death worldwide and cardiac fibrosis is a common pathological process for cardiac remodeling in cardiovascular diseases. Cardiac fibrosis not only accelerates the deterioration progress of diseases but also becomes a pivotal contributor for futile treatment in clinical cardiovascular trials. Although cardiac fibrosis is common and prevalent, effective medicines to provide sufficient clinical intervention for cardiac fibrosis are still unavailable. Traditional Chinese medicine (TCM) is the natural essence experienced boiling, fry, and other processing methods, including active ingredients, extracts, and herbal formulas, which have been applied to treat human diseases for a long history. Recently, research has increasingly focused on the great potential of TCM for the prevention and treatment of cardiac fibrosis. Here, we aim to clarify the identified pro-fibrotic mechanisms and intensively summarize the application of TCM in improving cardiac fibrosis by working on these mechanisms. Through comprehensively analyzing, TCM mainly regulates the following pathways during ameliorating cardiac fibrosis: attenuation of inflammation and oxidative stress, inhibition of cardiac fibroblasts activation, reduction of extracellular matrix accumulation, modulation of the renin-angiotensin-aldosterone system, modulation of autophagy, regulation of metabolic-dependent mechanisms, and targeting microRNAs. We also discussed the deficiencies and the development direction of anti-fibrotic therapies on cardiac fibrosis. The data reviewed here demonstrates that TCM shows a robust effect on alleviating cardiac fibrosis, which provides us a rich source of new drugs or drug candidates. Besides, we also hope this review may give some enlightenment for treating cardiac fibrosis in clinical practice.
心血管疾病是全球主要死亡原因之一，心肌纤维化是心血管疾病中心脏重构的常见病理过程。心肌纤维化不仅加速了疾病的恶化进程，而且成为临床心血管试验中无效治疗的关键因素。尽管心肌纤维化很常见，但仍缺乏有效的药物来为心肌纤维化提供充分的临床干预。中药是经过煮沸、油炸等加工方法提取的天然精华，包括活性成分、提取物和草药配方，长期以来一直用于治疗人类疾病。最近，研究越来越关注中药在预防和治疗心肌纤维化方面的巨大潜力。在这里，我们旨在阐明已确定的促纤维化机制，并通过研究这些机制，深入总结中药在改善心肌纤维化方面的应用。通过综合分析，中药在改善心肌纤维化过程中主要调节以下途径：减轻炎症和氧化应激、抑制心肌成纤维细胞激活、减少细胞外基质积累、调节肾素-血管紧张素-醛固酮系统、调节自噬、调节代谢依赖机制和靶向 microRNAs。我们还讨论了抗纤维化疗法在心肌纤维化治疗中的不足和发展方向。这里综述的数据表明，中药在缓解心肌纤维化方面具有强大的作用，为我们提供了丰富的新药或药物候选物来源。此外，我们还希望这篇综述能为临床实践中治疗心肌纤维化提供一些启示。
