Zhongguo Zhong Yao Za Zhi. 2026 Jul;51(13):3657-3665. doi: 10.19540/j.cnki.cjcmm.20260305.702.
ABSTRACT
Diabetic macroangiopathy, a major chronic complication of diabetes, is characterized by atherosclerosis. Its pathological core involves the phenotype transformation of vascular smooth muscle cells(VSMCs) towards synthesis, aging, calcification, macrophage-like and fibroblast-like phenotypes. These phenotypic transformations jointly drive atherosclerotic plaque formation, vascular remodeling and calcification, leading to high-risk events such as myocardial infarction and stroke, which are important causes of disability and mortality in diabetic patients. Current conventional treatment provides insufficient long-term protection against macroangiopathy. In contrast, traditional Chinese medicine(TCM), through its holistic regulation via multi-component and multi-target mechanisms, has shown unique advantages in regulating VSMCs phenotype transformation. The progression of diabetic macroangiopathy mediated by VSMCs phenotypic transformation is characterized by deficiency in origin and excess in superficiality in TCM theory. Conceptualizing this phenotypic switching as "phlegm turbidity and blood stasis obstructing the collaterals", therapeutic strategies should focus on resolving phlegm and turbidity, transforming stasis and unblocking collaterals, while simultaneously reinforcing healthy Qi and tonifying deficiencies. A growing body of research indicates that monomers such as matrine, baicalein, and tanshinone Ⅱ_A, as well as sour Chinese herbal medicines and compound formulas such as Huoluo Xiaoling Dan, can inhibit pathological VSMCs phenotype transformations, including abnormal proliferation, migration, aging, and calcification. These interventions align with the pathogenesis and therapeutic principles, thereby delaying the progression of vascular lesions. This review briefly outlined the pathological progression of diabetic macroangiopathy, elaborated on how VSMCs phenotype transformation mediated diabetic macroangiopathy, and summarized key studies on the intervention of TCM active compounds, monomers and formulas in diabetic macroangiopathy by regulating VSMCs phenotype transformation. It aims to provide new strategies for the prevention and treatment of diabetic macroangiopathy and ultimately enhance clinical diagnosis and treatment.
PMID:42543355 | DOI:10.19540/j.cnki.cjcmm.20260305.702