Roles and Mechanisms of Herbal Medicine for Diabetic Cardiomyopathy: Current Status and Perspective

Abstract

Diabetic cardiomyopathy is one of the major complications among patients with diabetes mellitus. Diabetic cardiomyopathy (DCM) is featured by left ventricular hypertrophy, myocardial fibrosis, and damaged left ventricular systolic and diastolic functions. The pathophysiological mechanisms include metabolic-altered substrate metabolism, dysfunction of microvascular, renin-angiotensin-aldosterone system (RAAS) activation, oxidative stress, cardiomyocyte apoptosis, mitochondrial dysfunction, and impaired Ca2+ handling. An array of molecules and signaling pathways such as p38 mitogen-activated protein kinase (p38 MAPK), c-Jun N-terminal kinase (JNK), and extracellular-regulated protein kinases (ERK) take roles in the pathogenesis of DCM. Currently, there was no remarkable effect in the treatment of DCM with application of single Western medicine. The myocardial protection actions of herbs have been gearing much attention. We present a review of the progress research of herbal medicine as a potential therapy for diabetic cardiomyopathy and the underlying mechanisms.

Screening of herbal extracts for TLR2- and TLR4-dependent anti-inflammatory effects

“…This further complicates the identification of the responsible mechanism(s). Recently, numerous studies have focused on Chinese herbal medicines and their impact on several diseases [ 19 – 22 ], however, their anti-inflammatory effects remain largely unknown. Thus, in the current study we analyzed ethanolic extracts of medicinal plants, which may have anti-inflammatory properties (see S1 Table in the supplementary data).…”

<i>Astraglaus polysaccharide</i> protects diabetic cardiomyopathy by activating NRG1/ErbB pathway

“…Among these natural products, Astragalus polysaccharides (APS) is one of the main active extract from Astragalus membranaceus (20,(22)(23)(24)(25)(26)(27). Previous studies showed that, for diabetic cardiomyopathy in hamsters, APS can induce myocardial collagen deposition and improve cardiac function by activating ERK1/2 signal pathway (23,28). Besides, APS can improve cardiac glucose metabolism dysfunction by inducing expression of GLUT-4 and inhibiting PPAR expressing (20,24,29).…”

Anti-inflammatory effects of hederagenin on diabetic cardiomyopathy via inhibiting NF-κB and Smads signaling pathways in a type-2 diabetic mice model

“…25 However, many studies have found that some natural bioactive extracts have the pharmacological effect of treating diabetes-induced myocardial injury. 9 Our results showed that aer 6 weeks of gavage treatment with HED, there was no signicant difference in FPG levels between the db/db + HED mice and the db/db control mice. These results suggest that HED, which plays an anti-inammatory role, cannot be used alone as a hypoglycaemic drug.…”

“…8 However, studies have found that some bioactive natural compounds extracted from plants can directly inhibit inammation in diabetic hearts without lowering blood glucose levels. 9,10 Moreover, NF-kB, which plays a key role in the inammatory signalling pathway, is also involved in the diabetes-induced brosis of the heart, liver and kidney. 11,12 Diabetesinduced expression of TNF-a, IL-1b and IL-6 further promotes myocardial inammation, which leads to cardiac hypertrophy and brosis during the progression of cardiac remodelling.…”