AI Chat Paper
Note: Please note that the following content is generated by AMiner AI. SciOpen does not take any responsibility related to this content.
{{lang === 'zh_CN' ? '文章概述' : 'Summary'}}
{{lang === 'en_US' ? '中' : 'Eng'}}
Chat more with AI
Powered by AMiner. Clicking this button will take you away from SciOpen.
Home Journal of Traditional Chinese Medical Sciences Article
PDF (4.9 MB)
Cite
EndNote(RIS) BibTeX
Collect
AI Chat Paper
Show Outline
Outline
Show full outline
Hide outline
Outline
Show full outline
Hide outline
Original Article | Open Access

Protective effect and possible mechanisms of Salvia miltiorrhiza Bge. for the treatment of diabetic nephropathy: A systematic review and meta-analysis of animal studies

Tingting Jiaoa,1, Yunhua Liua,1, Mei Hanb, Sitong Wanga, Xinjiang Zhanga, Xinxue Zhanga, Zongjiang Zhaoa,*( )
School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China

Peer review under responsibility of Beijing University of Chinese Medicine.

Show Author Information

Abstract

Objective

To explore the protective effect and potential mechanisms of danshen root (Salvia miltiorrhiza Bge., S. miltiorrhiza) and its extracts for the treatment of diabetic nephropathy (DN).

Methods

Preclinical studies of S. miltiorrhiza and its extracts on DN were systematically searched in nine databases. The primary outcomes were blood glucose, kidney function, proteinuria, and renal histopathology. The secondary outcomes included the related mechanisms. The methodological quality of animal studies was assessed based on the risk of bias tool of the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) for animal studies. Meta-analysis was performed using R software (version 4.1.2).

Results

Twenty-nine animal experimental studies that met the eligibility criteria were included in this study. Compared to the control group, S. miltiorrhiza reduced the serum creatinine, blood urea nitrogen, 24-h urine protein, 24-h urine albumin, blood glucose, and kidney index (kidney weight/body weight), and alleviated renal pathological damage. In terms of the mechanism of action, compared to the control group, S. miltiorrhiza reduced the levels of transforming growth factor β1, collagen IV, malondialdehyde, tumor necrosis factor α, interleukin-6, and monocyte/macrophage (ED-1), and increased the levels of superoxide dismutase, glutathione peroxidase, nuclear factor E2–related factor 2, and heme oxygenase-1.

Conclusion

The existing evidence shows that S. miltiorrhiza has beneficial effects on the animal model of DN, and its mechanism is mainly related to improving kidney fibrosis, oxidative stress, and inflammatory response.

Keywords

Meta-analysisSystematic reviewAnimal modelsDiabetic nephropathySalvia miltiorrhiza Bge

References

1
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027):1513-1530.
2

Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119.
Crossref Google Scholar
3

Flyvbjerg A. The role of the complement system in diabetic nephropathy. Nat Rev Nephrol. 2017;13(5):311-318.
Crossref Google Scholar
4

Umanath K, Lewis JB. Update on diabetic nephropathy: core curriculum 2018. Am J Kidney Dis. 2018;71(6):884-895.
Crossref Google Scholar
5

Gembillo G, Cernaro V, Salvo A, et al. Role of vitamin D status in diabetic patients with renal disease. Medicina (Kaunas). 2019;55(6):273.
Crossref Google Scholar
6

Yu SM, Bonventre JV. Acute kidney injury and progression of diabetic kidney disease. Adv Chron Kidney Dis. 2018;25(2):166-180.
Crossref Google Scholar
7

Perez-Gomez MV, Sanchez-Niño MD, Sanz AB, et al. Horizon 2020 in diabetic kidney disease: the clinical trial pipeline for add-on therapies on top of renin angiotensin system blockade. J Clin Med. 2015;4(6):1325-1347.
Crossref Google Scholar
8

Fernandez-Fernandez B, Ortiz A, Gomez-Guerrero C, Egido J. Therapeutic approaches to diabetic nephropathy—beyond the RAS. Nat Rev Nephrol. 2014;10(6):325-346.
Crossref Google Scholar
9

Bandak G, Sang Y, Gasparini A, et al. Hyperkalemia after initiating renin-angiotensin system blockade: the Stockholm creatinine measurements (SCREAM) project. J Am Heart Assoc. 2017;6(7): e005428.
Crossref Google Scholar
10

Onuigbo MA. Can ACE inhibitors and angiotensin receptor blockers be detrimental in CKD patients?. Nephron Clin Pract. 2011;118(4): c407-c419.
Crossref Google Scholar
11

Lu Z, Zhong Y, Liu W, Xiang L, Deng Y. The efficacy and mechanism of Chinese herbal medicine on diabetic kidney disease. J Diabetes Res. 2019;2019:2697672.
Crossref Google Scholar
12

Guo XH, Fan J. Master Da'ning Zhang's experience in treatment for early stage of diabetic nephropathy. Tradit Chin Med J. 2018;17(6):14-16 [Chinese].
Crossref Google Scholar
13

Xiao Y, Zhao JX. Experience of Zhao Jin-xi in treating diabetic nephropathy. China J Tradit Chin Med Pharm. 2018;33(1):159-162 [Chinese].
Google Scholar
14

Zhao D, Yi TN, Zhang L. Summary of Zhang Lan's experience on treating early diabetic nephropathy. J Pract Tradit Chin Intern Med. 2022;36(8):49-51 [Chinese].
Google Scholar
15

Lin Y, Zhang F, Lei L, Wang P, Kang L, Ren J. Analysis on medication laws for TCM treatment of diabetic nephropathy based on data mining. Chin J Inf Tradit Chin Med. 2020;27(5):102-106 [Chinese].
Google Scholar
16

Li K. Effect of sodium tanshinone IIA sulfonate combined with alprostadil in patients with diabetic nephropathy and its influence on renal function. Clin Res Pract. 2018;3(18):121-122 [Chinese].
Google Scholar
17

Hong LJ. Effect of salvianolate in the treatment of diabetic nephropathy and the influence on renal function and inflammatory factors. Contemp Med. 2020;26(22):167-168 [Chinese].
Google Scholar
18

Zhou A, Zhou G, Li J. Effects of salvia injection and irbesartan on urine protein in patients with diabetic nephropathy. Clin Edu Gen Pract. 2009;7(6):595-596, 600 [Chinese].
Google Scholar
19

Yin D, Yin J, Yang Y, Chen S, Gao X. Renoprotection of Danshen Injection on streptozotocin-induced diabetic rats, associated with tubular function and structure. J Ethnopharmacol. 2014;151(1):667-674.
Crossref Google Scholar
20

Chen X, Wu R, Kong Y, et al. Tanshinone IIA attenuates renal damage in STZ-induced diabetic rats via inhibiting oxidative stress and inflammation. Oncotarget. 2017;8(19):31915-31922.
Crossref Google Scholar
21

Wu P, Yan Y, Ma LL, et al. Effects of the Nrf2 protein modulator salvianolic acid a alone or combined with metformin on diabetes-associated macrovascular and renal injury. J Biol Chem. 2016;291(42):22288-22301.
Crossref Google Scholar
22

Jin D, Yu M, Li X, Wang X. Efficacy of Tripterygium wilfordii Hook F on animal model of diabetic kidney diseases: a systematic review and meta-analysis. J Ethnopharmacol. 2021;281:114536.
Crossref Google Scholar
23

Hooijmans CR, IntHout J, Ritskes-Hoitinga M, Rovers MM. Meta-analyses of animal studies: an introduction of a valuable instrument to further improve healthcare. ILAR J. 2014;55(3):418-426.
Crossref Google Scholar
24

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.
Crossref Google Scholar
25

Feng H, Wu T, Zhou Q, et al. Protective effect and possible mechanisms of artemisinin and its derivatives for diabetic nephropathy: a systematic review and meta-analysis in animal models. Oxid Med Cell Longev. 2022;2022, 5401760.
Crossref Google Scholar
26

Feng X, Bu F, Huang L, Xu W, Wang W, Wu Q. Preclinical evidence of the effect of quercetin on diabetic nephropathy: a meta-analysis of animal studies. Eur J Pharmacol. 2022;921:174868.
Crossref Google Scholar
27

Hooijmans CR, Rovers MM, de Vries RB, Leenaars M, Ritskes-Hoitinga M, Langendam MW. SYRCLE's risk of bias tool for animal studies. BMC Med Res Methodol. 2014;14:43.
Crossref Google Scholar
28

Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10: ED000142.
Crossref Google Scholar
29

Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372: n160.
Crossref Google Scholar
30

Liu G, Guan G, Qi T, et al. Protective effects of Salvia miltiorrhiza on rats with streptozotocin diabetes and its mechanism. J Integr Med. 2005;3(6):44-47 [Chinese].
Crossref Google Scholar
31

Wang ZG, Yue H. Protection by root of red-rooted salvia against potential harms done to the kidneys of experimental white rats suffering type 2 diabetes. J Mudanjiang Med Coll. 2005;26(1):20-21 [Chinese].
Google Scholar
32

Hu B, Li F, Wang YW, Chen BX, Wang ZG, Li JY. Effect of Salvia miltiorrhiza on the expression of on MMP-2, TIMP-1, TGF-β1, and IV-C of rats with diabetic nephropathy. Lishizhen Med Mater Med Res. 2008;19(12):3020-3022 [Chinese].
Google Scholar
33

Zhou R, Liu M, He H. Protective effect of sulfotanshinone sodium injection on diabetic rat kidney. China Pharm. 2008;17(13):7-8 [Chinese].
Google Scholar
34

Kim SK, Jung KH, Lee BC. Protective effect of tanshinone IIA on the early stage of experimental diabetic nephropathy. Biol Pharm Bull. 2009;32(2):220-224.
Crossref Google Scholar
35

Huang X, Wang X. Influence of Salvia miltiorrhiza on expression of VEGF in kidney tissue in experimental diabetic nephropathy rats and its curative effects. J Taishan Med Coll. 2011;32(7):503-506 [Chinese].
Google Scholar
36

Lee SH, Kim YS, Lee SJ, Lee BC. The protective effect of Salvia miltiorrhiza in an animal model of early experimentally induced diabetic nephropathy. J Ethnopharmacol. 2011;137(3):1409-1414.
Crossref Google Scholar
37

Ye XL, Zhu XQ, Wang T, Tong Z, Chen YB. Effects of Danshen Injection on the expression of TSP-1 and TGF-β1 in diabetic rats. Chin J Tradit Med Sci Technol. 2011;18(6):492-493 [Chinese].
Google Scholar
38

Chen G, Tang S, Su B, et al. Effect of tanshinone IIA on renal tumor growth factor-beta 1 and nuclear factor-kappa B in diabetic nephropathy rats. J Guangzhou Univ Tradit Chin Med. 2015;32(5):891-895, 974 [Chinese].
Google Scholar
39

Chen Y, Li C, Cai F. Effect of sodium tanshione IIA sulfonic acid on SIRT1 and Fox01 in kidney of diabetic rats. Pharmacol Clin Chin Mater Med. 2015;31(1):47-50 [Chinese].
Crossref Google Scholar
40

Wang X, He X, Hua H, Wang Z. Protect effect of Salvia miltiorrhiza and APS on renal mitochondrial energy metabolism in rats with diabetic nephropathy. J Clin Pathol Res. 2015;35(2):243-247 [Chinese].
Crossref Google Scholar
41

Chen Y, Liu Z, Zhou F, et al. Evaluating pharmacological effects of two major components of Shuangdan oral liquid: role of Danshensu and paeonol in diabetic nephropathy rat. Biomol Ther (Seoul). . 2016;24(5):536-542.
Crossref Google Scholar
42

Xu L, Shen P, Bi Y, et al. Danshen injection ameliorates STZ-induced diabetic nephropathy in association with suppression of oxidative stress, pro-inflammatory factors and fibrosis. Int Immunopharm. 2016;38:385-394.
Crossref Google Scholar
43

An L, Zhou M, Marikar FMMT, et al. Salvia miltiorrhiza lipophilic fraction attenuates oxidative stress in diabetic nephropathy through activation of nuclear factor erythroid 2–related factor 2. Am J Chin Med. 2017;45(7):1441-1457.
Crossref Google Scholar
44

Hou B, Qiang G, Zhao Y, et al. Salvianolic acid A protects against diabetic nephropathy through ameliorating glomerular endothelial dysfunction via inhibiting AGE-RAGE signaling. Cell Physiol Biochem. 2017;44(6):2378-2394.
Crossref Google Scholar
45

Zhang XY, Zhang Z. Effects of Salvia miltiorrhiza on vascular endothelial cytokines and renal tissues in diabetic rats. World Latest Med Inf. 2017;17(4):71-72 [Chinese].
Google Scholar
46

Ming JS, Wang XX, Yuan YH. Effects of salvianolic acid B on Nrf-2 and HO-1 of renal tissue in rats with diabetic nephropathy. Tianjin Med J. 2018;46(12):1286-1290 [Chinese].
Google Scholar
47

Wang L, Wu Q. Effects of salvianolic acid on expression of extracellular regulatory protein kinase ERK1/2 in diabetic nephropathy rats. Chin J Tradit Med Sci Technol. 2018;25(2):197-201 [Chinese].
Crossref Google Scholar
48

Zhang X, Zhu YM, Tang BL, et al. Ameliorative effect and mechanism of salvianolic acid B on renal fibrosis in diabetic rats and potential mechanisms implicated. Chin Pharmacol Bull. 2019;35(1):51-55 [Chinese].
Google Scholar
49

Shao FP, Ruan X, Li MY, Zhang MM, Yang Y, Yin DK. Effects of Danshen Injection on AT1 expression in renal tubules under high glucose environment in vivo and in vitro. Chin Tradit Pat Med. 2020;42(5):1169-1173 [Chinese].
Google Scholar
50

Xu S, He L, Ding K, et al. Tanshinone IIA ameliorates streptozotocin-induced diabetic nephropathy, partly by attenuating PERK pathway-induced fibrosis. Drug Des Devel Ther. 2020;14:5773-5782.
Crossref Google Scholar
51

Yue WW, Akebaier W, Wang WQ. Ameliorative effect and mechanism of tanshinone IIA sodium sulfonate combined with dapagliflozin on diabetic rats with kidney injury. Cent South Pharm. 2020;18(12):1966-1971 [Chinese].
Google Scholar
52

Wu PY, Feng L. Effect of Danshensu on MEK/ERK/Nrf2 pathway and renal fibrosis in diabetic nephropathy rats. J Trop Med. 2021;21(10):1260-1264,376 [Chinese].
Google Scholar
53

Xu Z, Xiang X, Shang EX, et al. Regulatory effect of total phenolic acid from the stems and leaves of Salvia miltiorrhiza Bge. on intestinal microflora and short-chain fatty acids in type 2 diabetic nephropathy mice. Acta Pharm Sin. 2021;56(4):1035-1048 [Chinese].
Google Scholar
54

Yang B, Gao F, Liu LJ, et al. Mechanism of salvianolate for relieving renal fibrosis in diabetic nephropathy mice. J Guangzhou Univ Tradit Chin Med. 2021;38(5):1018-1024 [Chinese].
Google Scholar
55

Hu L, Ye QL, Zhuang HS, Jiang JP. Effect of salvianolic acid B on renal fibrosis and inflammation in diabetic nephropathy db/db mice. Chin Tradit Herb Drugs. 2022;53(4):1084-1092 [Chinese].
Google Scholar
56

Hu Y, Bao X, Wu Y, et al. Effect of salvianolic acid B–berberine compound on renal injury and SIRT1/PGC-1α signaling pathway in diabetic mice. J Emerg Tradit Chin Med. 2022;31(4):580-583 [Chinese].
Google Scholar
57

Zhao YM, Zheng DX, Huang YY, Lin WH, Wang Z. Normal reference range of blood routine test, blood biochemical indexes and visceral body ratio in SD rats. Chin J Health Lab Technol. 2002;12(2):165-167 [Chinese].
Google Scholar
58

Xi XX, Xi DB, Wu R, Wei HL, Cheng J, Zhang WH. Normal reference values of blood physiology and biochemistry of three SPF mice. Heilongjiang Anim Sci Vet Med. 2011;23:134-138 [Chinese].
Google Scholar
59

Wang SY, Yi XJ, Li JC, et al. Biological characteristics of spontaneous type 2 diabetes mellitus model db/db mice. J Basic Chin Med. 2019;25(7):909-912 [Chinese].
Google Scholar
60

Tang SC, Lai KN. The pathogenic role of the renal proximal tubular cell in diabetic nephropathy. Nephrol Dial Transplant. 2012;27(8):3049-3056.
Crossref Google Scholar
61

Kawanami D, Matoba K, Utsunomiya K. Signaling pathways in diabetic nephropathy. Histol Histopathol. 2016;1(10):1059-1067.
Crossref Google Scholar
62

Higgins SP, Tang Y, Higgins CE, et al. TGF-β1/p53 signaling in renal fibrogenesis. Cell Signal. 2018;43:1-10.
Crossref Google Scholar
63

Ibrahim S, Rashed L. Estimation of transforming growth factor-beta 1 as a marker of renal injury in type II diabetes mellitus. Saudi Med J. 2007;28(4):519-523.
Google Scholar
64

Wang L, Wang HL, Liu TT, Lan HY. TGF-beta as a master regulator of diabetic nephropathy. Int J Mol Sci. 2021;22(15):7881.
Crossref Google Scholar
65

Xiang E, Han B, Zhang Q, et al. Human umbilical cord-derived mesenchymal stem cells prevent the progression of early diabetic nephropathy through inhibiting inflammation and fibrosis. Stem Cell Res Ther. 2020;11(1):336.
Crossref Google Scholar
66

Wang X, Lin Z, Zhang B, Wang Y, Mao Q, Jiang Z. Early warning on safety risks of Danshen preparation in the treatment of breast cancer. J Beijing Univ Tradit Chin Med. 2020;43(5):414-422 [Chinese].
Google Scholar
Journal of Traditional Chinese Medical Sciences
Volume 9 Issue 4,
October 2022
Pages 351-364
DOI: 10.1016/j.jtcms.2022.09.007
Cite this article:
Jiao T, Liu Y, Han M, et al. Protective effect and possible mechanisms of Salvia miltiorrhiza Bge. for the treatment of diabetic nephropathy: A systematic review and meta-analysis of animal studies. Journal of Traditional Chinese Medical Sciences, 2022, 9(4): 351-364. https://doi.org/10.1016/j.jtcms.2022.09.007

432

Views

14

Downloads

0

Crossref

1

Scopus

Altmetrics
Received: 29 August 2022
Revised: 29 September 2022
Accepted: 29 September 2022
Published: 03 October 2022
© 2022 Beijing University of Chinese Medicine.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Return