Mechanisms of traditional Chinese medicine in modulating cardiac microvascular endothelial cells in various injury models: A comprehensive systematic review

Abstract Background The structural and functional failure of cardiac microvascular endothelial cells (CMECs) is a primary contributor to coronary microvascular dysfunction (CMD). Traditional Chinese medicine (TCM) has been identified as a potential therapeutic approach for preserving CMECs and mitigating CMD. Objective This systematic review aims to present the latest evidence on TCM intervention mechanisms in CMECs under diverse injury models. Methods This systematic review was performed following the parameters of the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). A comprehensive literature search was conducted using PubMed, Embase, Web of Science, Scopus, China National Knowledge Infrastructure and China Biology Medicine disc. Reference lists of selected articles were reviewed to identify relevant studies. The search was not limited by year and was conducted solely in English. Eligible studies comprised publications describing in vitro studies that presented the latest evidence on TCM intervention mechanisms in CMECs under diverse injury models. Results A total of 63 papers were included in this study. According to the cell processing approach, 19 studies on ischemia or hypoxic injury models, 16 studies on Ischemia/reperfusion (I/R) or hypoxia/reoxygenation (H/R) injury models, 10 studies on inflammatory injury models, 5 studies on metabolic injury models, 3 studies on angiotensin II injury models, and 10 studies on other models. TCM exhibits structural and functional intervention capabilities in diverse damage conditions of CMECs. Its mechanism of action involves antioxidant, anti-apoptotic, anti-inflammatory effects, as well as regulation of energy metabolism through signaling pathways such as HIF-1α/VEGF, PI3K/AKT, MAPK, and NF-κB. Conclusions The CCM and its constituents modulate CMECs through multiple signaling pathways in response to various injury models, thereby conferring protection on the coronary microcirculation. Graphical Abstract