The Potentiality of Herbal Remedies in Primary Sclerosing Cholangitis: From In Vitro to Clinical Studies

Abstract

Primary sclerosing cholangitis is a complex pathological condition, characterized by chronic inflammation and fibrosis of the biliary epithelium. Without proper clinical management, progressive bile ducts and liver damage lead to cirrhosis and, ultimately, to liver failure. The known limited role of current drugs for treating this cholangiopathy has driven researchers to assess alternative therapeutic options. Some herbal remedies and their phytochemicals have shown anti-fibrotic properties in different experimental models of hepatic diseases and, occasionally, in clinical trials in primary sclerosing cholangitis patients; however their mechanism of action is not completely understood. This review briefly examines relevant studies focusing on the potential anti-fibrotic properties of Silybum marianum, Curcuma longa, Salvia miltiorrhiza, and quercetin. Each natural product is individually reviewed and the possible mechanisms of action discussed.

Keywords: bioflavonoids; cholangiocytes; hepatic stellate cells; herbal; phytochemicals; primary sclerosing cholangitis.

Figure 1

Potential anti-fibrotic properties of natural remedies in cholangiopathies. (A) By activation of PPARγ, curcumin might block reactive cholangiocytes and their inflammatory activation through the reduction of VCAM-1 expression, resulting in decreased attraction of immune cells. Silymarin, Salvia miltiorrhiza, and quercetin might exert its antifibrotic properties acting directly on HSCs activation. (B) In addition, acting as PPARγ activator and by inhibiting the ERK signaling curcumin might block HSCs activation. This dual role of curcumin could explain the antifibrotic properties exerted in experimental models and clinical trials. PPARγ, peroxisome proliferator-activated receptor gamma; VCAM-1, vascular cell adhesion molecule 1; ERK, extracellular signal–regulated kinases; HSCs, hepatic stellate cells.