Recent Advances in the Study of Traditional Chinese Medicine in Reversing Hepatic Fibrosis Through the Regulation of Hepatic Stellate Cells Apoptosis Pathways

Hepatic fibrosis is a pathological manifestation in which hepatic stellate cells are activated by inflammatory stimuli and produce excessive extracellular matrix, leading to excessive intrahepatic collagen deposition. As the core effector cells of hepatic fibrosis, hepatic stellate cells have multiple cellular states, including quiescent, activated, and quiescence-like dysfunctional states. In hepatic fibrosis, they can exert functions such as pro-inflammatory effects, strong proliferation, maintenance of permanent activation state, and resistance to cell death by activating multiple relevant signaling pathways under their different states. Therefore, inducing multiple death pathways in hepatic stellate cells and restoring their dysfunctional, quiescent, and senescent states are crucial for inhibiting hepatic fibrosis. The active ingredients and compound formulations of traditional Chinese medicine have advantages such as multi-pathway effects and low metabolic burden in the treatment of hepatic fibrosis, and significant progress has been made in studies on regulating hepatic stellate cells death and reversing hepatic fibrosis, though challenges remain such as identifying specific active components, clarifying mechanisms, and improving experimental models to better simulate the liver’s multicellular environment.