Potential Effects of Traditional Chinese Medicine on COVID-19 and Cardiac Injury: Mechanisms and Clinical Evidence

Figures & data

Figure 1 Etiology and Symptoms of Acute Effects of Viral Infection on the Cardiovascular System.

Abbreviation: ACE2, angiotensin converting enzyme 2.

Table 1 Mechanism of TCM Treatment of Cardiovascular Disease

Type of Disease	TCM Formulae	Method	Possible Efficacy	Possible Mechanism
Chronic heart failure	Ginseng^Citation39	Vivo model	Enhance cardiac contractility	Increase peroxisome proliferator-activated receptors expression
	Scleroderma of Poria cocos((Hoelen)^Citation40	Mice model	Exert diuretic effect and improves cardiac function	Suppress renal aquaporin-2 expression
	Shengmai San-derived^Citation41	Mice model	Prevent the myocardial infarction induced vulnerable substrate for atrial fibrillation	Inhibit left atrial fibrosis and increase the expression of connexin
	Qi-shen-yi-qi^Citation42	Mice model	Ligation-induced left ventricular remodeling	Attenuate inflammation and fibrosis via STAT3 and NF-κB signaling pathway
	Qili qiangxin^Citation43	Mice model	Inhibit cardiomyocyte apoptosis	Reduce reactive oxygen species and depress the expression of Fas and caspase 3.
	Notoginseng and safflowe^Citation44	Metabolomics and pharmacodynamics	Anti-myocardial Ischemia	Attenuate the NF-κB signaling pathway, depress the expressions of TNF-α, IL-6, IL-1β, and PLA2.
Arrhythmia	Que^Citation45,Citation46	Mice model	Inhibit atrial tissue fibrosis	Inhibit the TGF-β/Smads pathway, decrease TLR4 and NF-κB expression
	Pueraria lobata^Citation47	Mice model	Maintain the electrical balance on both sides of myocardial cell membrane.	Improve Na+-K+-ATPase activity, reduce the damage of oxygen free radicals
	Zhigancao Dection^Citation48	Mice and rabbit model	Reverse the atrial electrical remodeling, lowering the degree of myocardial fibrosis.	Reduce the maximum ascent rate (Max dV/dt) and plateau potential, shorten the action potential duration, reduced COL1A1, COL1A2, COL3A1, and TGF-β1 in myocardial fibrotic tissue and interfere with the expression of COL1A1, COL1A2, COL3A1, and TGF- β1
	Wenxin Keli^Citation49	Systems Pharmacology and in vivo	Reduce arrhythmias and shortened RR, PR, and the QT interval	Inhibit p-CaMKII and intracellular Ca^2+ transients and overexpressing CNCA1C
	Anlv capsule^Citation50	Mice model	Reduce arrhythmias and blocking effect on ion channels in ventricular myocytes	Block effect of L-type calcium channel current
Coronary heart disease	Xuefu Zhuyu Decoction^Citation51	Metabolomics, network pharmacology and mice model	Reduce the level of autophagy, improving energy metabolism, and maintaining mitochondrial homeostasis	Regulate the expression levels of autophagy-related proteins LC3-B and P62/SQSTM1
	Zhishi Xiebai Guizhi Decoction^Citation52	Network pharmacology and clinical trials.	Anti-inflammatory and treat cardiovascular diseases	Activate PPARγ, regulate TNF, AMPK, PI3K-Akt signaling pathway
	Si-miao-yong-an Decoction^Citation53,Citation54	Network pharmacology, vitro study and mice model	Reduce inflammation, protect the cell injury	Regulate AKT/VEGFA pathway, inhibit TLR4/NF-κB signaling pathway
	Tongmai Yangxin Pill^Citation55	Clinical trial, microarray study, bioinformatics analysis and the vitro assays.	Anti-inflammatory, attenuate macrophage foam cell formation	Regulate NF-κB signaling pathway activity

Abbreviations: TCM, traditional Chinese medicine; STAT3, signal transducer and activator of transcription 3; NF-κB, nuclear factor kappa-Bl; Fas, factor-related apoptosis; TNF, tumor necrosis factor; IL, Interleukin; PLA2, phospholipase A2; TGF-β, transforming growth factor-β; TLR4, Toll like receptor r; Na, sodium; Ka, kalium; ATPase, adenosine triphosphatase; TGF-β1, transforming growth factor-β1; PPARγ, peroxisome proliferator activated receptor γ; AMPK, adenosine-monophosphate activated protein kinase; PI3K, phosphatidylinositol 3-kinase.

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