Research Progresses in Traditional Chinese Medicine in Treating

Atherosclerosis

Jingyue Yu, Xueqin Chen, Huan Lei, Lei Li and Haihong Fang

School of Pharmacy, Jiangxi Science and Technology Normal University, Nanchang 330013, Jiangxi, China

Keywords:

Atherosclerosis, Traditional Chinese Medicine, Endothelial Cells, Immune Cells, Vascular Smooth Muscle

Cells.

Abstract: Atherosclerosis (AS) is the major cause of cardiovascular and cerebrovascular diseases, and its formation

process mainly involves several stages such as intimal injury, inflammation induction and plaque formation.

The cells to play crucial role in the occurrence of AS mainly include endothelial cells, immune cells and

vascular smooth muscle cells. Traditional Chinese medicine (TCM) is characterized by multi-components and

multi-targets and have significant advantages in the clinical treatment of AS. The paper reviews the regulatory

effects of TCM on major cells involved in AS, which provides a reference for future in-depth studies of

treating AS by TCM.

1 INTRODUCTION

Atherosclerosis, a chronic vascular inflammatory

disease, is the main cause of cardiovascular and

cerebrovascular disorders such as coronary heart

disease, myocardial infarction and cerebral infarction.

Its pathological mechanism is mainly characterized

by lipid metabolism, local arterial blood flow

disorder, damage to the vascular intima,

inflammation induced by lipid deposition, and

ischemia or necrosis of arterial blood supply tissue

caused by atherosclerotic plaque formation, vascular

sclerosis, or lumen narrowing (Ma, 2021). Traditional

Chinese medicine (TCM) is characterized by multi-

components and multi-targets and has unique

advantages in treating AS and relieving various states

in the progress of AS. Cells such as endothelial cells,

lymphocytes, macrophages and vascular smooth

muscle cells are mainly involved in the occurrence of

AS (Zhang, 2021). The paper reviews the regulatory

effects of TCM on various types of cells in the

different stages of AS, providing a reference for the

future in-depth study of treating AS by TCM.

2 PROTECTING ENDOTHELIAL

CELLS AND REDUCING

INTIMAL DAMAGE

In the lipid plaque stage of AS, endothelial cells are

damaged, monocytes aggregate and differentiate, and

lipid metabolism occurs, while in the fibrous plaque

stage, arteries respond to endothelial injury with

inflammation-fibroproliferative, and vascular smooth

muscle cells (VSMCs) proliferate and migrate. Lots

of TCM can prevent and treat AS by protecting

endothelial cells and reducing endometrial damage

(Fatkhullina, 2016).

Table 1: Therapeutic effects of traditional Chinese medicine in endothelial cells.

Mechanism Chinese medicine References

Affecting nitric oxide

synthase activity, regulating

the expression of nitric oxide

and endothelin, improving

EC function

Astragalus Polysaccharide; B-Elemene Saikosaponin;

Baicalin Puerarin; Tanshinone IIA;

Ligusticum Jeholense; PinelliaGinger

Jiawei Alisma Decoction; Toona Sinensis Extract Musk

Xintongning; Angelica Peony Powder

Compound Sanqi Granules;

Kangxin Capsules

Compound Danshen Dropping Pills;

(Zhu, 2008; Ren, 2017)

178

Yu, J., Chen, X., Lei, H., Li, L. and Fang, H.

Research Progresses in Traditional Chinese Medicine in Treating Atherosclerosis.

DOI: 10.5220/0012015900003633

In Proceedings of the 4th International Conference on Biotechnology and Biomedicine (ICBB 2022), pages 178-182

ISBN: 978-989-758-637-8

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

3 IMMUNE SYSTEM AND

ATHEROSCLEROSIS

3.1 Regulating Immune Cells to Realize

Anti-Inflammatory Effects

3.1.1 Monocytes

In the early stage of AS, the inflammatory process

accompanying the formation of AS plaque is mainly

related to the recruited monocytes and monocyte-

derived macrophages (Liang, 2022). During the

formation stage, monocytes are negatively correlated

with the thickness of the fibrous cap of AS plaque.

Monocytes thereby play a crucial role in the

formation and development of AS plaque (Wang,

2022).

Table 2: Therapeutic effects of traditional Chinese medicine on monocytes.

Immune

Cells

Mechanism Chinese medicine References

Monocyt

Preventing monocyte from adhesion,

aggregation, infiltration, and

differentiation

Burdock Root Extract

Ginsenoside F1; Breviscapine

Naringin Scrophoside B; Scrotaloside

Salvianolic Acid B; Puerarin

Tanshinone IIA; Catalpol

Paeonol; Ligustrazine

Musk Ketone; Musk Baoxin Pills

(Zhang, 2021;

Ye, 2018; Liu,

2011

)

Inhibit inflammatory factors and

adhesion molecules release, improving

the inflammatory response

(Zhang, 2021;

Ye, 2018; Liu,

2011; Li, 2019;

Zhou, 2017)

3.1.2 Lymphocytes

Lymphocytes are derived from bone marrow

hematopoietic stem cells. The deficiency of total

lymphocytes attenuates the occurrence and

development of AS. In the pathological process of

AS, T and (or) B lymphocytes can identify the

presented antigens and then release antibodies,

leading to the occurrence of adaptive immune

responses.

Table 3: Therapeutic effects of traditional Chinese medicine on lymphocytes.

Immune

Cells

Induction

factors

Secreted factors

and antibodies

Mechanism Chinese medicine References

T cell

Th1

IL-12 IL-6, IFN-γ,

IL-1β, and

TNF-α

reducing the expression of

adhesion molecules, activating

related immune cells, and

preventing the polarization of

M1 macro

Shikonin

Sinomenine

Huanglian Jiedu

Decoction

Ton

xinluo

(Zhang, 2021;

Li, 2019; Ye,

2018; Liu,

2015)

Th17

IL-6 IL-21

TGFβ

IL-17 Mediating immune responses

and suppressing inflammatory

responses

Total Flavonoids

Glycyrrhizinate

Angong Bezoar Pills

Qishen Yi

i Pills

(Zhang, 2021;

Ji, 2019)

Th2

IL-4, IL-5,

and IL-13

IL-4, IL-5, IL-

10, and TGF-β

activating B cells, and

preventing M2 macrophage

olarization

Curcumin

Huanglian Jiedu

Decoction

(Li, 2019; Liu,

2015)

B cell

Endogenous

substances

alarmin

IgM

Secretion of

natural

antibody IgM

Adjusting the proportion of

lymphocytes, increasing the

proportion of Treg cells and B1

cells, restoring immune

balance, identifying antigens,

and slowing down the

formation of foam cells

Amygdalin

Triterpenoid Saponins

Huanglian Jiedu

Decoction

Buyang Huanwu Soup

Si Miao Yong An

Sou

(Zhang, 2021,

Ji, 2019; Tin,

2020)

Endogenous

substances

alarmin

oxLDL

specificity

IgG;HSP60

specificity

G;I

Activating macrophages, mast

cells, and macrophages, and

identifying stressed ECs

Triptolide

Dihydroartemisinin

Phenethylchromone

Derivatives

(Zhang, 2021,

Liu, 2015, Tin,

2020, Sage,

2019)

Research Progresses in Traditional Chinese Medicine in Treating Atherosclerosis

179

3.1.3 Macrophages and AS

In the early stage of AS, if macrophages take up

excessive oxLDL, their ability to reverse cholesterol

transport in plaques would be weakened after the

activation of cell surface scavenger receptors,

resulting in ‘fatty streaks’ formed by the

accumulation of a large number of intracellular lipids,

which finally becomes the pathological basis for the

occurrence and development of AS (Hansson, 2011).

In addition, monocytes also differentiate into various

macrophages in the development of AS (Li, 2019).

Macrophages are characterized by huge numbers.

Besides, their traits such as plasticity and

heterogeneity make them play an important role in the

physiology and pathology of AS (Zhang, 2021).

Table 4: Therapeutic effects of traditional Chinese medicine on macrophages.

Immune cells Mechanism Chinese medicine References

Macrophages Activate PPARγ, inducing M2-type

differentiation of macrophages

Emodin; Huperzine A

Curcumin; Magnolol

Ginsenoside Rb1

(Zhang,

2021; Liu,

2011; Zhou,

2017)

Regulating lipid metabolism and

reducing oxidative factors

Soybean Extract; Quercetin

Licorice Flavonoids; Astragalus

Polysaccharides

Ginkgolide B; Ferulic AcidSoy;

(Zhang,

2021; Liu,

2015; Meng,

2017; Guo,

2021)

Activating the

LXRαABCA1/ABCG1 pathway,

promoting cholesterol efflux, and

inhibiting the formation of

macrophage cells

Phellinone G; Salvianol C

Saponin a; Ligustrazine

Arctigenin; Quercetin

Ginsenoside Rd; Salvia

North Bupleurum; Chuanxiong

Burdock; Bupleurum Ginseng;

(Li, 2019;

Liu, 2015;

Meng, 2017)

Mediating the expression of CD36

and ABCA1 and reducing the

volume of oxLDL-induced lipid

deposition in cells

Danshensu

Salidroside; Turmeric Butter

Icariin; Puerarin

Salvia

(Zhang,

2021; Liu,

2015)

Enhancing macrophage autophagy

and inhibiting macrophage

apoptosis to resist AS

Green Glucoside;

Olean Nuts

Araya; Calamus; Sanqi

(Liu, 2015)

Reducing the expression of SRA1,

and inhibiting the uptake of oxLDL

by macrophages to treat AS

Dihydrotanshinone I

Formononetin

Astragaloside IV

Luteolin

(Liu, 2015)

4 INHIBITING PROLIFERATION

AND MIGRATION OF

VASCULAR SMOOTH

MUSCLE CELLS

Activation, proliferation and migration of vascular

smooth muscle cells (VSMCs) are essential for the

development of atherosclerotic lesions. In the early

stage of AS, the damaged vascular endothelium

would cause abnormal proliferation of VSMCs, and

migration from the medial to the intima would

promote the formation of atherosclerotic plaques.

Whereas, in the advanced stage of AS, VSMCs would

further proliferate and aggregate, forming fibrous

caps to stabilize fragile plaques (Chen, 2018).

Therefore, inhibiting the proliferation and migration

of VSMCs or promoting VSMCs proliferation in

different stages has dual actions in the prevention and

treatment of AS (Zhao, 2019).

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Table 5: Therapeutic effects of traditional Chinese medicine on vascular smooth muscle cells.

Mechanis

Chinese medicine References

Inhibiting VSMCs proliferation and migration, yet

not inducing VSMCs apoptosis

Triptolide; Baicalin Luteolin;

Resveratrol Hyperoside;

Yew Panax;

(Zhou, 2017;

Zhao, 2019; Liu,

2021; Wei, 2019

)

Inhibiting VSMCs migration, yet not affecting cell

roliferation and FAK

hos

hor

lation

Geranin

Geraniu

(Zhao, 2019; Liu,

2021

)

Inhibiting oxidative stress and apoptosis in VSMCs Dihydromyricetin

Bayberry

(Zhou, 2017;

Zhao, 2019; Liu,

2021; Wei, 2019

)

Significantly inhibiting VEGF-induced

phosphorylation of VEGFR2

Resveratrol Glycosides

Knotweed

(Zhou, 2017;

Zhao, 2019; Liu,

2021; Wei, 2019

)

Inhibiting VSMCs proliferation and antigen

expression by regulating the ERS pathway to

increase SMC apoptosis

Emodin; Crocoside; Curcumin

Icariin; Tanshinone IIA; Thapsigargin

Rhubarb; Safflower; Ginger

imedium; Radish

(Zhou, 2017;

Zhao, 2019; Liu,

2021; Wei, 2019

)

5 CONCLUSION

The drugs currently treated AS such as statins,

aspirin, nitroglycerin which have effective in

lowering cholesterol and preventing and treating AS,

but it often cause adverse reactions such as liver

damage and myalgia

[6]

. Besides, there is a higher

residual risk after intensive lipid-lowering therapy,

without significant improvement in stabilizing

advanced plaques. To get rid of this dilemma, more

and more people are pinning their hopes on the

research of TCM to treat AS. Clearing away heat and

detoxification, promoting blood circulation and

removing blood stasis are the theoretical basis of

TCM for treating AS

[23]

. We need to conduct more

detailed research on various Chinese medicines and

their components, so that TCM can become the

gospel of AS patients in the near future.

ACKNOWLEDGMENT

This work was supported by the 2021 Graduate

Innovation Special Fund Project (No. YC2021-X21)

and Education Reform Project of Jiangxi Science

&Technology Normal University (JGYB-20-61-24).

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