Review of Herbal Traditional Chinese Medicine for the Treatment of Diabetic Nephropathy

Hindawi Publishing Corporation Journal of Diabetes Research Volume 2016, Article ID 5749857, 18 pages http://dx.doi.org/10.1155/2016/5749857 Review Article Review of Herbal Traditional Chinese Medicine for the Treatment of Diabetic Nephropathy Guang-dong Sun, Chao-yuan Li, Wen-peng Cui, Qiao-yan Guo, Chang-qing Dong, Hong-bin Zou, Shu-jun Liu, Wen-peng Dong, and Li-ning Miao Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China Correspondence should be addressed to Guang-dong Sun; and Li-ning Miao; Received 28 May 2015; Accepted 22 July 2015 Academic Editor: David W. Powell Copyright © 2016 Guang-dong Sun et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Diabetic nephropathy (DN) is the most serious chronic complications of diabetes; 20–40% of diabetic patients develop into end stage renal disease (ESRD). However, exact pathogenesis of DN is not fully clear and we have great difficulties in curing DN; poor treatment of DN led to high chances of mortality worldwide. A lot of western medicines such as ACEI and ARB have been demonstrated to protect renal function of DN but are not enough to delay or retard the progression of DN; therefore, exploring exact and feasible drug is current research hotspot in medicine. Traditional Chinese medicine (TCM) has been widely used to treat and control diabetes and its complications such as DN in a lot of scientific researches, which will give insights into the mechanism of DN, but they are not enough to reveal all the details. In this paper, we summarize the applications of herbal TCM preparations, single herbal TCM, and/or monomers from herbal TCM in the treatment of DN in the recent 10 years, depicting the renal protective effects and the corresponding mechanism, through which we shed light on the renal protective roles of TCM in DN with a particular focus on the molecular basis of the effect and provide a beneficial supplement to the drug therapy for DN. 1. Introduction Diabetic nephropathy (DN) is a widely recognized microvascular complication of diabetes and almost the leading cause of end-stage kidney failure worldwide responsible for morbidity and mortality [1]. Clinical manifestations of DN include initial increase in glomerular filtration (GFR), proteinuria, increased creatinine levels, and eventually decreased GFR [2– 4]. Major pathological changes of DN are virtually indistinguishable in both type 1 and type 2 diabetes, including mesangial expansion, extracellular matrix (ECM) accumulations, tubulointerstitial fibrosis, and glomerular sclerosis. Hyaline arteriolosclerosis is often prominent in the established DN pathological features caused by endothelial dysfunction and inflammation [5–7]. Multiple factors have been implicated in the pathogenesis of DN including hyperglycemia induced activation of advanced glycation end products (AGEs) and reactive oxygen species (ROS); JAK-STAT pathways and G protein signaling; activation of the PKC, renin-angiotensin aldosterone system (RAAS), transforming growth factor 𝛽-Smad-mitogenactivated protein kinase (TGF-𝛽-Smad-MAPK), deregulated expression of cyclin dependent kinases (CDK), and their inhibitors; and aberrant expression of ECM proteins, ECMdegrading enzymes, metalloproteinases, and their inhibitors [8]. The abovementioned factors can induce aberrant expression of profibrotic and proinflammatory cytokines, cell-cycle genes, and ECM genes involved in DN [9]. A large number of novel treatment options has arisen from experimental studies based on the pathogenic factors of DN, including intensive glycemic control, precise blood pressure control, optimal RAAS blockade with ACEI/ARB, life style modifications such as exercise and dietary restrictions, and a lot of novel agents [10], but the portion of ESRD due to DN still remains high in spite of the widespread application of numerous therapeutic approaches focusing on the management of factors mentioned above [11–13]. Therefore, interventions that could effectively delay the progression of DN are greatly required. In China, traditional Chinese medicine (TCM) has been widely used in the treatment of diabetes and its complications 2 for a long time [14]; TCM has lots of advantages over the conventional medical approaches in the prevention of diabetic complications because of less toxicity and/or side effects [15– 17]. In this review, we will explore the advance of herbal TCM treatment on DN in recent 10 years, based on the experimental and clinical studies to note the scientific basis for the therapeutic effects of TCM on DN. 2. Applications of TCM in DN Plants have been widely used for medical purposes long before recorded history [18]. In China, TCM emerged and influenced the surrounding countries such as Japan and South Korea; increasing popularity of TCM caused great interests in laboratory and clinical investigations in lots of diseases on its efficiency and action mechanism. TCM manifests as herbal medicine, acupuncture, moxibustion, massage, dietary therapy, and physical exercise including shadow boxing and Qigong, and herbal remedies are the focus of TCM in mainland China [19] and acupuncture is prevalent in the United States [18]. Under the urgent need for the treatment of DN, we focus on the update of the efficient herbal TCM preparations, single herbal TCM, and/or monomers from herbal TCM in DN related clinical and experimental trials, through which we explore the effective herbal TCM for DN and clearly put forward underlying mechanism in the treatment of DN. 2.1. TCM Preparations in DN. TCM preparations are applied as decoction, pill, and capsule in the treatment of DN. We will introduce the TCM preparations in alphabetical order about components of TCM preparations, therapeutic effects in clinical or experimental studies, and relevant mechanism. All the mentioned TCM preparations in this review are listed in Table 1. 2.1.1. Chaihuang Yishen Granule (CHYS). Chaihuang Yishen granule (CHYS, also called Qilong-Lishui granule) is composed of radix astragali, Dioscorea nipponica, radix bupleuri, Angelica sinensis, Pyrrosia petiolosa, Polyporus umbellatus, and Hirudo nipponica. A recent study in STZ plus uninephrectomized induced rats showed that CHYS could be a therapeutic agent for DN by blocking TGF-𝛽/Smad3-mediated renal fibrosis [20]. 2.1.2. Compound Rhizoma Coptidis Capsule (CRCC). Compound rhizoma coptidis capsule (CRCC) is composed of rhizoma coptidis, Kudzu root, dwarf lilyturf,and Loquat leaf. CRCC has been shown to protect renal function and slow down the progression of DN by the suppression of TGF-𝛽1 and type IV collagen expression in STZ induced diabetic rats [21]. 2.1.3. Compound Shenhua Tablet (CST). Compound Shenhua Tablet (CST), is composed of radix astragali, fructus ligustri lucidi, rhizoma zedoaria, an (...truncated)