Recent Advances in the Investigation of the Role and Immunoregulatory Mechanisms of Polysaccharides From Traditional Chinese Medicine in the Intervention of Liver Cirrhosis

Cirrhosis is a severe chronic liver disease that typically develops as a result of prolonged hepatic injury and subsequent fibrosis, often driven by immune-mediated mechanisms, inflammatory responses, and oxidative stress. Polysaccharides derived from traditional Chinese medicine (TCM) are prominent constituents of herbal formulations widely employed in the management of cirrhosis and have demonstrated significant efficacy in alleviating clinical symptoms. This review aims to elucidate the potential roles and immunomodulatory mechanisms of TCM polysaccharides in the intervention of cirrhosis. A systematic search was conducted using PubMed and China National Knowledge Infrastructure (CNKI), with keywords including "Traditional Chinese medicine polysaccharides," "liver cirrhosis," and "liver fibrosis," focusing primarily on studies published within the last 5 years. A limited number of foundational older references were also included. After screening for relevance, language (English/Chinese), and full-text availability, 104 articles were analyzed. Signaling pathways such as transforming growth factor-beta1 (TGF-β1)/Smads, mitogen-activated protein kinase (MAPK), nuclear transcription factor-kappaB (NF-κB), interleukin-22 (IL-22)/signal transducer and activator of transcription 3 (STAT3), and wingless-related integration site (Wnt)/β-catenin, as well as various cytokines, have been identified as critical in the progression of cirrhosis. TCM polysaccharides exert their therapeutic effects on cirrhosis through the modulation of immune mechanisms within hepatocytes, thereby inhibiting liver fibrosis, alleviating oxidative stress, and suppressing inflammatory responses. TCM polysaccharides exhibit substantial therapeutic potential for treating cirrhosis through their immunomodulatory effects. These findings indicate that TCM polysaccharides warrant further investigation and clinical translation to fully realize their potential in managing cirrhosis.