Therapeutic potential of traditional Chinese medicine for the treatment of NAFLD: A promising drug Potentilla discolor Bunge

Abstract

Nonalcoholic fatty liver disease (NAFLD) is characterized by excessive accumulation of hepatic lipids and metabolic stress-induced liver injury. There are currently no approved effective pharmacological treatments for NAFLD. Traditional Chinese medicine (TCM) has been used for centuries to treat patients with chronic liver diseases without clear disease types and mechanisms. More recently, TCM has been shown to have unique advantages in the treatment of NAFLD. We performed a systematic review of the medical literature published over the last two decades and found that many TCM formulas have been reported to be beneficial for the treatment of metabolic dysfunctions, including Potentilla discolor Bunge (PDB). PDB has a variety of active compounds, including flavonoids, terpenoids, organic acids, steroids and tannins. Many compounds have been shown to exhibit a series of beneficial effects for the treatment of NAFLD, including anti-oxidative and anti-inflammatory functions, improvement of lipid metabolism and reversal of insulin resistance. In this review, we summarize potential therapeutic effects of TCM formulas for the treatment of NAFLD, focusing on the medicinal properties of natural active compounds from PDB and their underlying mechanisms. We point out that PDB can be classified as a novel candidate for the treatment and prevention of NAFLD.

Keywords: Acupuncture; Anti-inflammatory; Anti-oxidative; Endoplasmic reticulum stress; Insulin resistance; Intestinal microflora; Lipid metabolism; Natural active compounds; Nonalcoholic fatty liver disease (NAFLD); Potentilla discolor Bunge (PDB); Traditional Chinese medicine.

Graphical abstract

Figure 1

Pathogenesis of NAFLD: inter-tissue crosstalk between the liver, the intestine, and adipose tissue. (i) Gut barrier dysfunction and disruption of barrier integrity cause translocation of bacteria or bacterial products into the blood circulation, resulting in liver inflammation and the progression towards NASH. (ii) The intricate crosstalk between adipose tissue and the liver contributes to the progression of NAFLD. (iii) KCs produce TNF, TRAIL and FAS ligands through phagocytosis of apoptotic bodies, which subsequently promotes hepatocyte apoptosis, causing hepatitis and fibrosis. EVs released from hepatocytes contribute to hepatic recruitment of monocyte-derived macrophages. (iv) The up-regulation of hepatic chemokines CXCL1 and IL-8 and resulting infiltration of neutrophils are hallmarks of NASH.

Figure 2

Mechanisms of the classical TCM formulas for the treatment of NAFLD. The classical formulas of TCM exhibit a series of beneficial effects for the treatment of NAFLD, including improvement of lipid metabolism and IR, regulation of cytokines, anti-inflammatory responses, inhibition of apoptosis, and regulation of intestinal microflora.

Figure 3

Structure backbones of the main components of PDB.

Figure 4

Functions of the main natural active compounds of PDB. Flavonoids improve lipid metabolism and IR, reduce oxidative stress and ER stress, and regulate the intestinal microflora. Organic acids regulate the intestinal microflora. The terpenoids improve lipid metabolism and inhibit endoplasmic reticulum stress. The steroids improve IR.