Synergistic Multi-Target Mechanisms of the Astragalus-Salvia Herb Pair in Chronic Kidney Disease
DOI:
https://doi.org/10.70088/kccb7j76Keywords:
chronic kidney disease, astragalus membranaceus, salvia miltiorrhiza, herb pair, network pharmacologyAbstract
Chronic kidney disease (CKD) is a progressive condition associated with persistent inflammation, oxidative stress, and renal fibrosis. This review aims to summarize the therapeutic potential and molecular mechanisms of the Astragalus membranaceus--Salvia miltiorrhiza herb pair in CKD. Relevant studies on astragaloside IV and salvianolic acid B were analyzed to explore their effects on renal protection and related signaling pathways. Current evidence indicates that these compounds can alleviate renal injury by regulating inflammatory responses through the NF-κB pathway, enhancing antioxidant defense via the Nrf2/HO-1 pathway, and suppressing fibrotic progression through the TGF-β/Smad pathway. The findings suggest that the Astragalus membranaceus--Salvia miltiorrhiza herb pair may delay CKD progression through coordinated regulation of multiple pathological processes. This review provides a theoretical basis for further investigation of TCM-based approaches in CKD prevention and treatment.References
V. Jha, G. Garcia-Garcia, K. Iseki et al., "Chronic kidney disease: global dimension and perspectives," The Lancet, vol. 382, no. 9888, pp. 260–272, 2013.
A. C. Webster, E. V. Nagler, R. L. Morton et al., "Chronic kidney disease," The Lancet, vol. 389, no. 10075, pp. 1238–1252, 2017.
M. Ruiz-Ortega, S. Rayego-Mateos, S. Lamas et al., "Targeting the progression of chronic kidney disease," Nature Reviews Nephrology, vol. 16, no. 5, pp. 269–288, 2020.
B. D. Humphreys, "Mechanisms of renal fibrosis," Annual Review of Physiology, vol. 80, pp. 309–326, 2018.
Y. Liu, "Renal fibrosis: new insights into the pathogenesis and therapeutics," Kidney International, vol. 69, no. 2, pp. 213–217, 2006.
S. Djudjaj and P. Boor, "Cellular and molecular mechanisms of kidney fibrosis," Molecular Aspects of Medicine, vol. 65, pp. 16–36, 2019.
X. M. Meng, D. J. Nikolic-Paterson, and H. Y. Lan, "TGF-β: the master regulator of fibrosis," Nature Reviews Nephrology, vol. 12, no. 6, pp. 325–338, 2016.
X. M. Meng, P. M. K. Tang, J. Li et al., "TGF-β/Smad signaling in renal fibrosis," Frontiers in Physiology, vol. 6, p. 82, 2015.
P. M. K. Tang, D. J. Nikolic-Paterson, and H. Y. Lan, "Macrophages: versatile players in renal inflammation and fibrosis," Nature Reviews Nephrology, vol. 15, no. 3, pp. 144–158, 2019.
B. C. Liu, H. Y. Lan, and L. L. Lv, Eds., Renal Fibrosis: Mechanisms and Therapies, vol. 1165. Singapore: Springer, 2019.
Y. Zhang, X. Liu, J. Wang et al., "Astragaloside IV attenuates renal fibrosis through repressing epithelial-to-mesenchymal transition by inhibiting microRNA-192 expression: in vivo and in vitro studies," Journal of Cellular and Molecular Medicine, vol. 23, no. 8, pp. 5666–5678, 2019.
H. W. Zhang, Z. X. Lin, C. Xu et al., "Astragalus (a traditional Chinese medicine) for treating chronic kidney disease," Cochrane Database of Systematic Reviews, no. 10, p. CD008369, 2014.
J. Zhang, C. Wu, L. Gao et al., "Astragaloside IV derived from Astragalus membranaceus: a research review on its pharmacological effects," Frontiers in Pharmacology, vol. 11, p. 349, 2020.
L. Zhou, Z. Zuo, and M. S. S. Chow, "Danshen: an overview of its chemistry, pharmacology, pharmacokinetics, and clinical use," Journal of Clinical Pharmacology, vol. 45, no. 12, pp. 1345–1359, 2005.
X. Wang, S. L. Morris-Natschke, and K. H. Lee, "New developments in the chemistry and biology of the bioactive constituents of Tanshen," Medicinal Research Reviews, vol. 27, no. 1, pp. 133–148, 2007.
J. Ren, L. Fu, S. H. Nile et al., "Salvia miltiorrhiza in treating cardiovascular diseases: a review on pharmacological and clinical applications," Frontiers in Pharmacology, vol. 10, p. 753, 2019.
H. J. Anders, V. Vielhauer, and D. Schlöndorff, "Chemokines and chemokine receptors are involved in the resolution or progression of renal disease," Kidney International, vol. 63, no. 2, pp. 401–415, 2003.
M. S. Hayden and S. Ghosh, "NF-κB in immunobiology," Cell Research, vol. 21, no. 2, pp. 223–244, 2011.
T. Lawrence, "The nuclear factor NF-κB pathway in inflammation," Cold Spring Harbor Perspectives in Biology, vol. 1, no. 6, p. a001651, 2009.
J. M. Forbes and D. R. Thorburn, "Mitochondrial dysfunction in diabetic kidney disease," Nature Reviews Nephrology, vol. 14, no. 5, pp. 291–312, 2018.
S. Ruiz, P. E. Pergola, R. A. Zager et al., "Targeting the transcription factor Nrf2 to ameliorate oxidative stress and inflammation in chronic kidney disease," Kidney International, vol. 83, no. 6, pp. 1029–1041, 2013.
D. D. Zhang, "Mechanistic studies of the Nrf2-Keap1 signaling pathway," Drug Metabolism Reviews, vol. 38, no. 4, pp. 769–789, 2006.
D. M. Small, J. S. Coombes, N. Bennett et al., "Oxidative stress, antioxidant therapies and chronic kidney disease," Nephrology, vol. 17, no. 4, pp. 311–321, 2012.
W. Xu, R. Guan, G. Zhang et al., "Astragaloside IV ameliorates renal fibrosis via the inhibition of mitogen-activated protein kinases and antiapoptosis in vivo and in vitro," Journal of Pharmacology and Experimental Therapeutics, vol. 350, no. 3, pp. 552–562, 2014.
L. Wang, Y. F. Chi, Z. T. Yuan et al., "Astragaloside IV inhibits renal tubulointerstitial fibrosis by blocking TGF-β/Smad signaling pathway in vivo and in vitro," Experimental Biology and Medicine, vol. 239, no. 10, pp. 1310–1324, 2014.
Y. Zhang, S. Wang, Y. Li et al., "Astragaloside IV improves renal function and fibrosis via inhibition of miR-21-induced podocyte dedifferentiation and mesangial cell activation in diabetic mice," Biomedicine & Pharmacotherapy, vol. 105, pp. 819–828, 2018.
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