Mechanisms of Traditional Chinese Medicine in the Treatment of Ischemic Stroke Based on Nrf2 Signaling Pathway

Abstract

Nuclear factor erythroid 2-related factor 2 (Nrf2) is a core transcription factor regulating cellular oxidative stress (OS). In the pathological cascade of ischemic stroke (IS), Nrf2 exerts pleiotropic effects, including modulating programmed cell death, counteracting OS, alleviating neuroinflammation, maintaining blood–brain barrier homeostasis, facilitating angiogenesis, and stimulating neurogenesis. Terpenoids, glycosides, alkaloids, and other herbal monomers, as well as compound prescriptions such as Buyang Huanwu Decoction, Huangqi Guizhi Wuwu Decoction, Huazhuo Jiedu Huoxue Tongluo Formula, and Yinao Fujian Formula, can intervene in IS via modulating Nrf2-related signaling pathways. Current studies still have several limitations: limited research focusing on Chinese herbal-mediated angiogenesis and neurogenesis; dominant mechanistic investigations on herbal monomers with insufficient evidence for compound formulas; insufficient exploration of safe dosage and optimal therapeutic dosage of herbal agents; imperfect experimental design in partial studies; unclear synergistic regulatory mechanisms of Nrf2 across multiple pathways. Accordingly, future research should strengthen studies on traditional Chinese medicine (TCM) compound formulas and elucidate the multipathway synergistic regulatory network of Nrf2, so as to provide novel strategies and theoretical references for TCM management of IS.