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Herbal Medicines fortheTreatment ofLiver Cirrhosis
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3.4.3 Vicenin-2
Vicenin-2 (VCN-2), a avonoid glycoside with the chemical name apigenin-6, is 8-di-C-D-glucopyranoside. The ethno­pharmacological sources include Cyclopia subternata and Perilla frutescens. Studies have demonstrated the antidia­betic, antioxidant, antiglycation, anti-inammatory, anti­thrombotic, and antiplatelet properties of VCN-2. VCN-2 post-treatment signicantly reduces the activation of MAPK, such as ERK, JNK, and p38, indicating that VCN-2 prevents sepsis by preventing MAPK signalling. VCN-2 represents a possible pharmaceutical strategy to prevent liver failure by attenuating liver damage by suppressing TLR signalling [118]. By suppressing the protein tyrosine kinase Src and activating the protein tyrosine phosphatase SHP-1, VCN-2 efciently reduced both constitutive and induced STAT3 phosphorylation. JAK protein, which controls STAT3 upstream activity, was suppressed by VCN-2 [119]. Pro­inammatory mediators, like IL-6 and TNF-α, are downreg­ulated by VCN-2, which directly responsible for pro-inammatory responses, such as leukocyte adherence, permeability, and migration towards endothelial cells. VCN-2 might prevent NF-κB activation [120].
3.4.4 Schaftoside
Schaftoside (SFS) is an active phytoconstituent of the Chinese herb Herba Desmodii Styracifolii. SFS exhibits many potent pharmacological activities, including inam­matory inhibition, anti-hepatitis, anticancer, etc. SFS also has a vital role in regulating liver cirrhosis and lipid homeo­stasis [121].SFS promoted lipolysisin Huh-7 cells, result­ing in the downregulation of TG and LDL-C, which eventuallydecreasedliver steatosis. In addition, SFS could inhibit SREBP-1c expression, reducing HFD-induced ele­vations in hepatic TG level, suppressing lipid droplet forma­tion, and ameliorating HFD-induced liver injury [122]. At both the mRNA and protein levels, SFS reduced the lipopolysaccharide- enhanced upregulation of ATF4 (acti­vating transcription factor 4), XBP-1 (X-box-binding pro­tein-1), and CHOP (C/EBP homologous protein) [123].
3.4.5 Geniposide
Geniposide (GPS) is the major active phytochemical of Gardenia jasminoides Ellis and having the molecular for­mula of C17H24O
GPS is an example of an iridoid glycoside
10.
[124]. Numerous pharmacologic actions of this active phyto­chemical include anti-inammatory analgesic, hepatoprotec­tive, and choleretic properties. CGA and GPS treat fatty liver disease by reducing the fat content upregulated by free fatty acids (FFAs) in HepG2 cells [125]. GPS-mediated preventa­tive action is maintained by downregulating TC, TG, and LDL-C levels and increasing HDL-C biosynthesis. GPS increased insulin levels and decreased FFA levels, suggest­ing that it may be a possible treatment for preventing high-
fat- diet-induced hepatic steatosis. GPS upregulates PPAR-α expression and downregulates TNF-α. This indicated that GPS modulation of lipid metabolism could be associated with PPAR-α expression and adipocytokine release. GPS signicantly decreased GSH-Px and SOD, reduced MDA, and lowered CYP2E1 activity. The antioxidant activity of GPS might be explained by its capacity to inhibit the produc­tion of free radicals or by its free radical scavenging activity [126].
3.4.6 Swertiamarin
Enicostemma littorale Blume, a member of the Gentianaceae family, is the major source of swertiamarin (SWT). SWT is a seco-iridoid glycoside type of phytochemical. SWT has been discovered to have benecial effects, including analgesic, hepatoprotective, antidiabetic, and gastroprotective effects [127]. Hepatic SOD, GPx, CAT, GST, and GSH activities were all signicantly reduced by CCl4 treatment. SWT sig­nicantly improved the levels of GSH and the activity of those antioxidant enzymes in the liver of CCl4-treated rats. It was proposed that SWT might reduce oxidative stress by restoring the activity of antioxidant enzymes and elevating the level of GSH in the liver, at least in part. In addition, SWT signicantly lowered levels of inammatory cytokines (IL-1β, IL-6, and TNF-α), which reduced inammatory response. In animals with acute cirrhosis, the concentrations of both total CYP and CYP isoenzymes were shown to be lower. Due to oxidative stress, the primary liver P450 isoen­zymes, CYP2C6, CYP1A2, CYP2E1, and CYP3A2, and their protein expression, drastically decreased in activity during acute liver damage brought on by CCl4 treatment [128]. Revealed SWT could accelerate the healing of CCl4­induced liver damage by recovering hepatic CYP3A and CYP2E1 expression. Treatment with SWT also restored NQO1 expression that CCl4 had downregulated. These nd­ings suggested that the upregulation of NQO1 and HO-1 and the Nrf2 pathway activation may be related to SWT hepato­protective properties [129]. SWT treatment successfully decreased the expression of SREBP-1, ACC, and FAS, sug­gesting that the drug suppressed DNL through its impact on these regulating elements. By controlling RAS, SWT has the potential to be an effective treatment for hepatic brosis [130].
3.4.7 Salidroside
Salidroside (SDS) is a phenolic glycoside having the chemi­cal name [2-(4-hydroxyphenyl) ethyl-beta-D-glucoside]. SDS is commonly present in Rhodiola sacinehalnsis. Ligustrum lucidum has recently been discovered to have a signicant level of SDS.SDS showed several pharmacologi­cal effects, including hepatoprotective, neuroprotection, free radical scavenging, immunological modulation, and kidney protection [131]. SDS might be used to treat NAFLD because
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it can inhibit the deposition of lipids in muscle and liver tis­sues by stimulating AMPK activity. SDS can treat NAFLD, which works by controlling the AMPK-dependent NLRP3/ TXNIP pathway and oxidative stress [132]. It was found that SDS effectively lowered ALT and AST levels in the serum in CCl4-induced hepatic brosis mice. Still, it was also found to prevent the liver tissue, demonstrating that SDS could lessen the damage caused by inammation in the progres­sion of liver brosis. Sphingosine kinase 1 (SphK1) suppres­sion signicantly lowered the degree of liver brosis, whereas high levels of SphK1 expression have also been seen to promote the advancement of liver brosis. Conversely, levels of SphK2 are lower in alcoholic-induced cirrhosis and hepatocellular carcinoma in livers. Research showed that SDS might reverse these modications, whether helpful or harmful [133]. Table4 includes biological role offew glyco­sides involved in recovering cirrhosis andvarious chronic liver ailments.
3.5 Terpenoids
The two most signicant categories of plant secondary metabolites are terpenes and terpenoids. They are hardly ever linked to hepatoprotective effects. Terpenoids exhibit hepatoprotection by suppressing apoptosis in liver cells by limiting the release of cytochrome c from the cytoplasm, lowering the Bax/Bcl-2 ratio, and blocking the phosphoryla­tion of JNK and ERK. Terpenoids comprise extracts with strong radical-scavenging properties that can boost the over­all antioxidant capability and lessen hepatitis-related inam­mation. By modifying the activity of cytochrome P450 enzymes, they play a signicant part in the biotransforma­tion of xenobiotics. In-depth explanations are provided for other effects, including regulating TGF-β stimulated colla­gen type I production linked to liver brosis and the specic actions of certain terpenoids [138]. Some potent terpenoids have been depicted in Fig. 6 and described below in detail(Table 5).
3.5.1 Betulinic Acid
Betulinic acid (BLA) is a cyclic triterpene in several plants, including Betula. By altering the AMPK-SREBP signalling pathway, BLA signicantly lowered hepatic fat buildup [139]. BLA activates calmodulin-dependent protein kinase to activate AMPK.Additionally, BLA inhibits the expression of S6 kinase-mediated SREBP1. Treatment with BLA blocks the effects of the HFD on the activation of nuclear SREBP1 and the subsequent buildup of TG in the liver [140].
3.5.2 Ursolic Acid
Ursolic acid (URA), a natural terpenoid, is the main active component of many traditional medicinal plants, including
Cornus ofcinalis. URA has been implicated in various bio­logical activities, such as lipid regulation, glucose metabo­lisms, and anti-atherosclerotic [141]. URA-fed mice had much smaller and lighter adipose tissues than the high-fat diet controls due to a decrease in lipid formation in adipose tissue. The main mechanisms by which URA exerts its hypo­lipidemic effects are the activation of PPAR and the manage­ment of its responsive genes involved in fatty acid and lipoprotein metabolism [142]. URA may have triggered endogenous ligand production or increased the availability of endogenous ligands through indirect methods to activate PPAR.After URA administration, the expression of PPAR and its responsive genes in lipid metabolism was dramati­cally altered in the liver by regulating the CPT1 and ACOX1 genes. In addition, SREBP1, FAS, and SCD1 gene expres­sion levels were suppressed by URA administration, which decreased the production of hepato-fatty acids and reduced TG levels in the blood [143].
3.5.3 Artemisinin
Artemisia annua L. is the source of numerous terpenoid­based bioactive phytochemicals. The antimalarial drug arte­misinin (ATM) is one of those. Hepatic ACC levels were signicantly greater in Artemisia annua L. extract-fed ani­mals. By administering artemisia extract, HFD-induced nuclear ChREBP and SREBP1 expression were consider­ably reduced. The extract dramatically reduced HMGB1 expression. RAGE expression was not signicantly reduced by ATM treatment in the HFD-fed mice, though. The use of ATM signicantly reduced COX-2 levels as well. The treat­ment of Artemisia annua extracts also reduced CTGF and TGF-β1 levels [144].
3.5.4 Oleanolic Acid
Oleanolic acid (OLA) is a triterpenoid isolated from Olea ferruginea, which grows in Kashmir, India. Numerous plant species worldwide also contain OLA, including Eugenia jambolana, Tiarella polyphylla, Clerodendrum spicatum, Olea europaea, etc. OLA is a very potent phytochemical that
exhibits a wide range of biological actions [145]. The admin­istration of OLA restored the levels of hepatotoxic blood marker enzymes and showed a substantial protective impact on ethanol-induced liver injury. The elevated level of CCL4­induced blood hepatic enzymes signicantly decreased OLA.OLA reversed the elevated levels of MDA and reduced the activity of SOD and GPx [146]. The liver lipid levels progressively recovered to normal after OLA administration, while ALT and AST levels were markedly lowered. OLA decreased the upregulation of IL-6, IL-1β, and TNF-α and the production of pro-inammatory factors in HFD mice. In liver tissues, OLA dramatically reduced the phosphorylation and degradation of IκB-α and p65-induced nuclear transloca­tion [147].
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[134]
[126]
[135]
[136]
[137]
Didymin decreased ERS, ROS, Bax, GRP78, XBP1 ATF6 cytochrome c, and
caspase-9 enhanced the expressions of CAT, GSH, and SOD, Bcl-2
GPS caused increased expression of PPAR-α, SOD, and GSH-Px, HDL-C
activity, and decreased MDA, CYP2E1, TG, TC, and LDL-C activity
Gentiopicroside inhibited protein and mRNA expression of α-SMA and
collagen I in TGF-β-activated LX-2 cells. Decreased SREBP1 and increased
AMPKα, PPAR-α and phosphorylated ACC
20±2g)
rats, 200±20g.
Animal experiment male
C57BL/6 mice (8–10weeks,
20–22g)
manshurica Kitagawa
Diosgenin Inhibits the expression of α-SMA and TGF-β. In addition, it
inhibited the TGF-β1-induced expression of collagen I and α-SMA in HSC-T6
cells
mRNAs encoding DGATs and GPAT, and increases serum and hepatic TG
levels. In addition, tectoridin signicantly elevated the content of GSH and the
activities of GSH-Px and SOD
In vitro, the human HSC cell
line, HSC-T6
In vitro male C57BL/6 mice Tectoridin causes a reduction of serum ALT and AST levels, expression of
species
lobata
Compound name Biological source Research model Biomarkers Refs.
Didymin Origanum vulgare L. Male C57BL/6J mice (SPF,
Table 4 Names, biological sources, experiment research models, and targeted biomarkers of glycosides
GPS Gardenia jasminoides In vitro male Sprague-Dawley
Gentiopicroside Roots of Gentiana
Diosgenin Solanum and Dioscorea
Tectoridin The ower of Pueraria
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Fig. 6 Terpenoids in the treatment of liver cirrhosis
3.5.5 Lycopene
Lycopene (LYP) is present in many natural plants and food sources. LYP is primarily found in red-coloured vegetables and fruits, including tomatoes, pink guavas, watermelons, and apricots [148]. Pretreatment with LYP revealed that LYP could prevent the changes in ALT and AST, lower TC, TG, LDL-C, and FFA levels, and raise HDL-C.In addi­tion, LYP elevated SOD and GSH and decreased MDA
activities against NAFLD, indicating that the activity of antioxidants may be involved in the mechanism of its hep­atoprotective effects. In contrast, animals on HFD had a substantial downregulation of CYP2E1 expression after receiving the LYP treatment [149]. LYP inhibited NF-κB activation and decreased interleukin IL-6, IL-1β, and TNF-α levels. The liver antioxidant enzymes GPx, SOD, and CAT were enhanced by LYP. LYP suppressed HSC
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[159]
[160]
the inammatory mediators like NF-κB, COX-2, iNOS and
B-cryptoxanthin restraining M1 or M2 activation of liver
pro-inammatory cytokines (TNF-α, IL-6, MCP-1, and IL-1β)
[161, 162]
macrophages/Kupffer cells. Reductions in serum levels of MDA,
hs-CRP, IL-6, and CK18-M65
Downregulation of CYP2C, TNF-α, SREBP-1c, IL-1β, FAS,
MCP1, SCD1, α-SMA, CD36, IRS1, FOXO1, AKT, and GSK3β
erythropoietin, ME1 and CCND1 and upregulating the expression
of IPP, HMGCS, FDPS, CXCL1, C4BP, CYP7A1, A2M, TFRC,
[163, 164]
FLT1, (PSMB 10, NQ01) and p53 signalling gene (TNFRSF6,
FAS)
Downregulated α-SMA, TGF-β1, NF-κB, IL-6, IL-1β, TXNIP,
GPx, while upregulated GSH, Nrf2, HO-1, and p53
) adults
2
Wistar rats weighing 150–200g Downregulated ALT, AST, LDH, and ALP in ALD, downregulating
In vitro human voluntary overweight/
obese (25BMI <40kg/m
(18age<60years)
In vitro HepG2 (p53 positive) human
such as kale and spinach
Green and yellow vegetables
and algae
liver cancer cells and female Sprague-
Dawley rats, 56-week old
Cimicifuga racemosa (L)
Nutt.
C57BL/6 mice and in vitro HepG2 cells
Compound name Biological source Research model Biomarkers Refs.
Lutein Dark green leafy vegetables,
Table 5 Names, biological sources, experiment research models, and targeted biomarkers of terpenoid
Β-cryptoxanthin
Actein Actaea racemosa L. syn. And
Andrographolide Andrographis paniculata In vitro CCl4-induced liver brosis male
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activation, and cellular lipid storage was altered. LYC treatment increased PPAR-α along with PPAR-β and PPAR-γ expressions of retinoid X receptor [150].
3.5.6 Fucoxanthin
A naturally occurring, low molecular weight, and chemically active carotenoid, fucoxanthin (FXN) is primarily generated from several marine algae. FXN concentration in seven microalgae isolates was measured, and the Synuroceae fam­ily had abundant FXN.The microalgae Tisochrysis lutea can also produce a high yield of FXN [151]. Dietary FXN sig­nicantly reduced the liver mRNA expression of brotic genes such as Timp1, collagen type I alpha 1 chain (Col1α1), and TGF-β1. As an indicator of activated HSCs, αSMA mRNA and protein expression were decreased by FXN.These ndings imply that dietary FXN inhibits the progression of brosis by controlling the expression of brogenic factors [152]. In LX-2 cells, FXN suppressed the basal and TGF-β1­induced mRNA and protein expression of pro-brogenic genes by dramatically inhibiting SMAD3 activation. The TGF-1 signalling pathway, which is implicated in the onset of liver brosis, must include SMAD3. FXN markedly decreased both baseline and TGF-β1-induced TIMP1 expres­sion. Its inhibitory effects on ROS buildup likely inuence the anti-brogenic actions of FXN through decreasing NOX4 expression and on TGF-triggered suppression of PPAR-γ [153]. FXN inhibited lipid accumulation by suppressing the expression of lipogenesis and β-oxidation, including adipose TG lipase, phosphorylated hormone-sensitive lipase, PPAR, CPT1, CPT2, and upregulating the expression of genes involved in lipolysis and β-oxidation [154].
3.5.7 Tanshinone IIA
One of the main lipophilic substances obtained from Salvia miltiorrhiza root and the extract is tanshinone IIA (TIIA)
[155].TIIA has a variety of biological actions, including the ability to protect against liver damage, hepatic steatosis, liver cirrhosis, hepatic brosis, and HCC [156]. The high levels of AST, ALT, ALP and TBIL in serum and of Hyp in hepatic tissue can be dramatically reduced by TIIA.TIIA can signi­cantly lessen liver brosis, collagen deposition in hepatic tis­sue, and liver damage. TIIA successfully reduced the two markers (α-SMA and COL1A2) in vivo. MMP9, c-Jun, PI3K, c-Myc, and P38 could target genes for TIIA, and all these proteins were increased in CCl4-induced liver brosis. In TGF-treated LX2 cells, TIIA signicantly reduced the expression of c-Jun, MMP9, c-Myc, CCND1, P-P65, PI3K, and P38. TIIA may reduce liver brosis through various tar­gets and signalling pathways, and it can shed light on the pharmacological processes by which it works to treat hepatic brosis [157]. It is commonly accepted that the excess depo­sition of ECM proteins is a key component of hepatic bro­sis. The extensive synthesis and secretion of ECM are
controlled by activated α-SMA and HSCs, and COL1A2 are molecular indicators of HSC activity. TIIA markedly down­regulated the protein expression of these genes’ products. TIIA therapy reduced ECM synthesis (COL1A2), HSC pro­liferation, and α-SMA expression, reducing the activation of HSC-LX2 cells [158].
3.6 Tannins
Tannins are sophisticated polyphenolic substances found in a wide variety of plants, particularly vascular plants. Tannin can capture free radicals. In addition, tannins have a hydroxyl group and a conjugated double bond (Fig.7) that allow the electron to delocalize, making them particularly efcient as an electron/hydrogen atom donor and chelating metal [165].
3.6.1 Tannic Acid
Tannic acid (TNA) is a hydrolysable tannin polyphenol pro­duced by plants. It is a gallic acid polymer glucoside that may be found in a variety of dietary plant products, including sorghum grain, coffee, tea, and cocoa [166]. NAFLD devel­opment is signicantly inuenced by ChREBP, the transcrip­tional activator of lipogenic genes. Through acetylation of Lys-672, p300 raises ChREBP transcriptional activity, which raises p300 occupancy on target gene promoters. Additionally, NAFLD is brought on by p300 overexpression. Histone acet­yltransferases and histon deacetylases (HDACs) control the typical epigenetic process known as histone acetylation. Cancer, inammation, and metabolic problems are linked to an imbalance between HAT and HDAC activity [167]. TNA­induced suppression of HAT activity reduces the develop­ment of NAFLD pathological characteristics. TNA prevented p300 from occupying the promoters of FAS and ATP-citrate lyase sterol regulatory element, ultimately leading to the hypoacetylation of H3K9 and H3K36. TNA also reduced the acetylation of total proteins and the histone H3 protein at lysine residues 9 and 36. Through these mechanisms, TNA suppressed the in vivo accumulation of fat by lowering the mRNA expression of genes essential for lipogenesis [168].
3.6.2 Dieckol
Dieckol (DCK) is a phlorotannin found in Ecklonia cava. Phlorotannin is a group of substances having polymerized phloroglucinol units. DCK from Laminaria japonica reduces hepatic steatosis by enhancing hepatic fatty acid β-oxidation [Liu Y etal., 2019]. The impacts of DCK on NAFLD might be made by reducing the development of the NLRP3 inam­mation and pyroptosis in aHFD-induced mice NAFLD model, HFD considerably enhanced food intake and weight changes, but DCK treatment markedly reduced them. HFD also raised the blood levels of LDL and total cholesterol, which were then decreased by DCK [169]. HFD enhanced
HO
HO
OH
Dieckol
OH
Punicalagin
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OH
O
HO
HO
HO
OH
O
O
OH
O
O
O
HO
OH
O
OO
O
OH
Tannic acid
O
O
OO
O
O
OH
OH
O
OH
OH
OH
OH
O
OH
HO
HO
HO
HO
HO
O
O
HO
O
Corilagin
HO
O
O
OH
O
O
O
OH
O
O
HO
OH
O
OH
OH
OH
OH
O
O
O
OH
OH
HO OH
OH
OH
OH
HO OH
O
O
HO OH
OH
Fig. 7 Terpenoids in the treatment of liver cirrhosis
OH
OHO
O
OO
OH
OH
M1 inltration but reduced M2 inltration in the lymphatic vasculature of the liver. DCK treatment resulted in a decrease in M1 inltration and an increase in M2 inltration. HFD induced an uptick in IL-6 and TNF-α expression in the liver, while DCK treatment had the opposite effect. HFD lowered the expression of VEGFC and VEGFR3, whereas DCK treat­ment increased it. When mice were given the HFD, the expression of the lymphangiogenesis-related PI3K, pAKT, and pERK signalling pathways dropped, while DCK increased it [170]. With the administration of DCK, high-fat died induced lipogenic genes (FASN, SREBP2, and FABP4) expressions were signicantly reduced. High-fat diet ele-
HO
O
O
O
O
OH
HO
O
O
OH
OH
OH
OH
O
O
HO
O
OHO
HO
OH
HO
HO
vated TLR4 and NF-κB expression in the liver. DCK down­regulates the overexpression. When DCK was administered, the NLRP3 inammasome’s elements, such as ASC and NLRP3, were reduced in the liver of HFD animals. In the liver, HFD raised the ratio of cleaved-caspase-1 to caspase-1, whereas DCK treatment lowered it [171].
3.6.3 Corilagin
Corilagin (CRL) is a gallotannin, one of the main active phy­tochemicals in various ethnopharmacological plants, includ­ing Phyllanthus emblica, Phyllanthus reticulatus, Dimocarpus longan, and Geranium wilfordii. According to
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reports, CRL exhibits many pharmacological properties, such as anti-tumour, antioxidant, hepatoprotective, and anti­inammatory properties [172]. CRL reduced the severity of GalN/LPS-induced liver damage by regulating oxidative stress and inhibiting apoptosis. CRL prevented the develop­ment of schistosomiasis-affected hepatic brosis by inhibit­ing the miR-21/SMAD7/ERK pathway [173]. The hepatitis C virus (HCV) NS3 serine protease, a well-known target for preventing HCV replication, was demonstrated to be inhib­ited by CRL.CRL therapy may signicantly alter the gene expression patterns in the liver brought on by a high-fat diet. High plasma ALT and AST values are two well-known bio­markers of hepatocellular damage. CRL effectively pre­vented the HFD-induced rise in ALT and AST levels in plasma, demonstrating its protective effects on liver function in developing NAFLD. CRL treatment in HFD-fed mice resulted in better plasma lipid proles caused by NAFLD.It lowers levels of TG, TC, and LDL-C as well as higher levels of HDL-C.CRL downregulated Hsd3b5 expression, which may have contributed to its inhibitory effect on the develop­ment of NAFLD [174].
3.6.4 Punicalagin
Punicalagin (PCG) is a well-known phytochemical in pome­granate (Punica granatum L.) peel. Being used primarily in Asian nations for traditional medicine, it is currently widely grown in Southwest America, California, Mexico, and Africa. It has a variety of pharmacological properties, such as antioxidant, anti-atherosclerotic, hepatoprotective, and hypolipidemic properties, that have been reported [175]. PCG enhanced the adipokine pathway and reduced oxidative stress in eWAT (epididymal white adipose tissue), which improved lipid homeostasis in the liver and adipose tissue. When mice were given a western diet, PCG reduced the number of hepatic lipids [176]. In addition, PCG could shield rats from cyclophosphamide-induced liver toxicity. PCG reduced the levels of TNF-α, NF-κB, p65, IL-1β, inducible nitric oxide synthase, and caspases 3 and 9 to prevent cyclophosphamide- induced liver inammation and death [177]. By decreasing the production of ROS and NO and raising the expression of SOD1, PCG prevented the oxida­tive stress caused by lipopolysaccharides (LPS) in macro­phages. PCG activated the Nrf2-signalling pathway to signicantly reduce the effects of FFA-induced lipotoxicity in HepG2 cells. PCG therapy decreased the MDA level and upregulated SOD and GPx activities against CCL4-induced liver injury [178].
4 Conclusion
Unhealthy dietand alcoholism are thetwo factorsprimarily bring on cirrhosis. DNL causes hindrance of lipid metabo­lism, which accelerates oxidative stress to promote lipid
accumulation and inammation in healthy hepato­cytes.Naturally obtained compounds work as boons in treat­ing these complicated diseases, while synthetic medications leave adverse imprints. Currently, herbal medicines are try­ing to be clinically reused like traditional medicines concom­itantly with synthetic ones. The search for suitable natural products for complicated diseases stands as a gold mine for medical research. SMR, hesperidin, CUR, etc., have already shown good hepatoprotective properties and are viable ther­apy alternatives on their own or as a supplement when taken with other medications. Undoubtedly, there is a great poten­tial for natural substances to be effective options for liver cirrhosis. Therefore, we expect that the study on the patho­physiology of hepatic injuries and progression to cirrhosis and future therapeutic medication development for cirrhosis and associated liver conditions may be theoretically sup­ported by the information in this chapter.
Funding None.
Conict of Interest The authors declare no conicts of
interest.
Acknowledgement All the authors acknowledge the Department of Pharmaceutical Technology, Jadavpur University, Kolkata, for provid­ing research amenities.
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