Research Progress on Traditional Chinese Medicine Targeting Pulmonary Vascular Remodeling via the "Lung-Gut Axis" in Chronic Obstructive Pulmonary Disease

Current clinical therapeutics, however, fail to adequately target the "lung-gut axis"—a critical biological hub in disease progression. From the perspective of Traditional Chinese Medicine (TCM), this review elucidates the multidimensional mechanisms by which lung-gut axis dysfunction drives vascular remodeling.

Gut-derived metabolites, including short-chain fatty acids (SCFAs), and amino acid derivatives, propagate endothelial injury, proliferation of pulmonary artery smooth muscle cells, and pathological extracellular matrix deposition through immune dysregulation and intertwined inflammatory-oxidative stress cascades. Furthermore, we synthesize TCM-based targeted intervention strategies aimed at restoring gut homeostasis, exploring TCM formulae and bioactive compounds through modulating gut microbiota composition, enriching beneficial bacterial abundance, restoring intestinal mucosal barrier integrity, and elevating SCFA levels, which have been shown to suppress vascular inflammation, mitigate oxidative stress, and rebalance the protease-antiprotease axis, thereby ameliorating vascular remodeling.