Jiani Zhang

Diabetic kidney disease (DKD) represents a diabetes-driven microvascular complication characterized by renal physiological and metabolic disorders and is considered a top-ranking trigger of progression to end-stage renal disease and death in diabetic patients. Although the drugs commonly used in clinical practice for DKD provide some renal protection, their toxic side effects and limited ability to halt further progression of the disease remain unsatisfactory. Traditional Chinese medicine (TCM) brings centuries of accumulated practice and distinct therapeutic strengths to the management of chronic diseases with complex pathogenesis such as DKD. Its characteristics of multi-target and multi-pathway intervention establish a solid material basis for DKD therapy, while its low toxicity profile aligns well with the chronic nature of DKD. This review elaborates on the therapeutic potential of examining TCM’s impact on DKD through the prism of cellular signaling pathways and reveals that the Nrf2, TGF-β/Smad, NF-κB/NLRP3, MAPK, and PI3K/AKT signaling pathways warrant particular attention in the TCM treatment of DKD. The TCM agents involved include astragaloside IV, Shengqing Jiangzhuo formula, Huangkui capsule, Fuxin granules, Liuwei Dihuang pill, Taxus chinensis , Burdock fructooligosaccharide, baicalin, hirudin, rutin, and fermented seaweed extracts. This review aims to refresh and consolidate the signaling pathways engaged by TCM in DKD, sift for promising targets and drugs, and supply both conceptual and experimental scaffolding for future anti-DKD therapeutics.

Diabetic cardiomyopathy (DCM) is a common cardiovascular complication that could lead to changes in cardiac structure and function. It is one of the leading causes of death in diabetic patients. Due to the complex pathogenesis of DCM, there is currently no specific drug or prophylactic agent to treat DCM, so there is an urgent need to identify new therapeutic agents or complementary and alternative therapies for DCM. Although Traditional Chinese medicine (TCM) has some limitations, it has the unique advantages of multi-level, multi-target and few side effects, which could effectively deal with the complex pathological mechanism of DCM. Growing evidence suggests that inflammation, oxidative stress, myocardial fibrosis and autophagy are the main pathological mechanisms of DCM. This study will shed light on the prospects of TCM treatment of DCM from the above perspective in order to provide more ideas and evidence for the clinical use of TCM for the prevention and treatment of DCM.

Diabetic cardiomyopathy (DCM) is a myocardial-specific microvascular disease caused by diabetes that affects the structure and function of the heart and is considered to be the leading cause of morbidity and death in patients with diabetes. Currently, there is no specific treatment or preventive drug for DCM, and there is an urgent need to develop new drugs to treat DCM. Traditional Chinese medicine (TCM) has rich experience in the treatment of DCM, and its characteristics of multi-target, multi-pathway, multi-component, and few side effects can effectively deal with the complexity and long-term nature of DCM. Growing evidence suggests that myocardial fibrosis, inflammation, oxidative stress, apoptosis, cardiac hypertrophy, and advanced glycation end product deposition were the main pathologic mechanisms of DCM. According to the pathological mechanism of DCM, this study revealed the potential of metabolites and prescriptions in TCM against DCM from the perspective of signaling pathways. The results showed that TGF-β/Smad, NF-κB, PI3K/AKT, Nrf2, AMPK, NLRP3, and Wnt/β-catenin signaling pathways were the key signaling pathways for TCM treatment of DCM. The aim of this study was to summarize and update the signaling pathways for TCM treatment of DCM, to screen potential targets for drug candidates against DCM, and to provide new ideas and more experimental evidence for the clinical use of TCM treatment of DCM.

Diabetic retinopathy (DR) is one of the common diabetic microvascular complications that occurs in the eyes and is closely associated with vision loss in working adults. However, the clinical treatment of DR is limited or accompanied by a large number of complications. Therefore, the development of new drugs for the treatment of DR is urgently needed. Traditional Chinese medicine (TCM) is widely used to treat DR in China, and its multi-pathway and multi-level characteristics can effectively address the complex pathogenesis of DR. Growing evidence suggests that inflammation, angiogenesis, and oxidative stress are the core pathological mechanisms in the development of DR. This study innovatively considers the aforementioned processes as the fundamental unit and sheds light on the molecular mechanisms and potential of TCM against DR in terms of signaling pathways. The results showed that NF-κB, MAPK/NF-κB, TLR4/NF-κB, VEGF/VEGFR2, HIF-1α/VEGF, STAT3, and Nrf2/HO-1 are the key signaling pathways for the treatment of DR by TCMs, which involved curcumolide, erianin, quercetin, blueberry anthocyanins, puerarin, arjunolic acid, ethanol extract of Scutellaria barbata D. Don, Celosia argentea L. extract, ethanol extract of Dendrobium chrysotoxum Lindl., Shengpuhuang-tang, and LuoTong formula. The purpose of this review is to update and summarize the signaling pathways of TCM in the treatment of DR and provide ideas for the development of new drugs against DR in the future.