Herbal Medicine in the Treatment of Non-Alcoholic Fatty Liver Diseases-Efficacy, Action Mechanism, and Clinical Application

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease with high prevalence in the developed countries. NAFLD has been considered as one of the leading causes of cryptogenic cirrhosis and chronic liver disease. The individuals with obesity, insulin resistance and diabetes mellitus, hyperlipidaemia, and hypertension cardiovascular disease have a high risk to develop NAFLD. The related critical pathological events are associated with the development of NAFLD including insulin resistance, lipid metabolism dysfunction, oxidative stress, inflammation, apoptosis, and fibrosis. The development of NAFLD range from simple steatosis to non-alcoholic steatohepatitis (NASH). Hepatic steatosis is characterized by fat accumulation, which represents the early stage of NAFLD. Then, inflammation triggered by steatosis drives early NAFLD progression into NASH. Therefore, the amelioration of steatosis and inflammation is essential for NAFLD therapy. The herbal medicine have taken great effects on the improvement of steatosis and inflammation for treating NAFLD. It has been found out that these effects involved the multiple mechanisms underlying lipid metabolism and inflammation. In this review, we pay particular attention on herbal medicine treatment and make summary about the research of herbal medicine, including herb formula, herb extract and naturals compound on NAFLD. We make details about their protective effects, the mechanism of action involved in the amelioration steatosis and inflammation for NAFLD therapy as well as the clinical application.

Tri-Herbal Medicine Divya Sarva-Kalp-Kwath (Livogrit) Regulates Fatty Acid-Induced Steatosis in Human HepG2 Cells through Inhibition of Intracellular Triglycerides and Extracellular Glycerol Levels

“…In parallel, SKK also increased the presence of extracellular free glycerol molecules. These observations suggest that SKK modulated the process of triglyceride synthesis [ 43 ]. Polyphenol extracts obtained from S. nigrum and P. niruri has shown a protective effect against high fat diet-induced NAFLD in mice [ 21 , 22 , 28 ].…”

“…Prophylactic treatment of HepG2 cells with SKK downregulated these overexpressed genes. This observed downregulation of SREBP1c and C/EBPα by SKK might be directly related to the regulation of the AMPK protein phosphorylation, protecting against the progression of steatosis [ 43 , 48 , 49 , 50 ]. Kaempferol, a plant metabolite belonging to B. diffusa has been found to modulate the AMPK/mTOR pathway, an upstream regulator of SREPB-1c cleavage and activation in RIN-5F cells and murine pancreatic islets cells [ 51 ].…”

Efficacy and safety of traditional Chinese medicines for non-alcoholic fatty liver disease: a systematic literature review of randomized controlled trials

“…This progression may be slowed or even reversed with proper management. However, at present, the optimal pharmacotherapy for NAFLD remains uncertain as no pharmacological agent has been officially approved for treating NAFLD [ 4 ]. The best recommendations for NAFLD patients were lifestyle improvement and physical exercise [ 5 , 6 ].…”

“…Therefore, TCMs are used mainly to channel Gan-qi, promote blood circulation, reduce phlegm and cleanse unclean elements. In modern science, preclinical and clinical studies suggested that TCMs may be an effective measure for NAFLD due to the beneficial effects on fatty acid metabolism that improves lipid metabolic parameters such as decreased levels of triglycerides, total cholesterol and low-density lipoprotein, alanine aminotransferase, aspartate aminotransferase and increased production of high-density lipoprotein [ 4 ]. Such TCMs often contain complex constituents with multiple pharmacological activities at various targets.…”

“…A systematic review conducted in 2013 assessed the benefits and risks of herbal medicines (including TCMs) for people with NAFLD and reported that some of the herbal preparations investigated seemed to have positive efforts on selected clinical indicators without inducing increased risks of adverse effects compared to the control groups [ 12 ]. Subsequent studies further suggested various underlying mechanisms through which herbal medicines might prevent NAFLD [ 4 , 13 ]. The evidence from RCTs or other studies about TCMs for NAFLD is mounting but, nevertheless, inconclusive if not conflicting.…”