Targeting the Lung-Gut Axis: Mechanisms of Traditional Chinese Medicine in Modulating Pulmonary Vascular Remodeling to Ameliorate COPD

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), secondary bile acids, and amino acid derivatives, propagate endothelial injury, phenotypic switching 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 microbial composition, elevating SCFA levels, and curtailing the translocation of trimethylamine N-oxide and lipopolysaccharides, which have been shown to suppress vascular inflammation, mitigate oxidative stress, and rebalance the protease-antiprotease axis, thereby ameliorating vascular remodeling.