Advances in the Treatment of Myocardial Ischemia-Reperfusion Injury with Astragalus membranaceus and Salvia miltiorrhiza: A Mitochondrial Quality Control Perspective

Q: What is the clinical evidence from this study?

Study design: Review. Population: Myocardial ischemia-reperfusion injury (MIRI). Intervention: Astragalus membranaceus and Salvia miltiorrhiza herb pair and active ingredients (astragaloside IV, calycosin, Astragalus polysaccharides, formononetin, tanshinone IIA, salvianolic acid B, cryptotanshinone, danshensu). Primary outcome: Alleviation of myocardial ischemia-reperfusion injury via regulation of the mitochondrial quality control (MQC) network.

Q: What does this research mean for the field?

The herb pair Astragalus membranaceus and Salvia miltiorrhiza alleviates myocardial ischemia-reperfusion injury through multi-target regulation of the mitochondrial quality control network, including promoting biogenesis, balancing mitochondrial dynamics, modulating mitophagy, reducing oxidative stress, and inhibiting mPTP opening. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

日鑫 段

doi:10.12677/tcm.2026.1510610

January 1, 2026Traditional Chinese MedicineOpen Access

Advances in the Treatment of Myocardial Ischemia-Reperfusion Injury with Astragalus membranaceus and Salvia miltiorrhiza: A Mitochondrial Quality Control Perspective

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Key result

Astragalus and Salvia reduce myocardial ischemia-reperfusion injury by restoring mitochondrial quality control networks.

Why the study?

Myocardial ischemia-reperfusion injury paradoxically aggravates myocardial damage after blood flow restoration, and this review examines the molecular mechanisms by which active ingredients from Astragalus membranaceus and Salvia miltiorrhiza regulate mitochondrial quality control to provide theoretical references for clinical application and research.

Does the herb pair Astragalus membranaceus and Salvia miltiorrhiza and its active ingredients alleviate myocardial ischemia-reperfusion injury via multi-target regulation of the mitochondrial quality control network?

Key Points

To review the molecular mechanisms by which active ingredients from Astragalus membranaceus and Salvia miltiorrhiza alleviate myocardial ischemia-reperfusion injury by regulating mitochondrial quality control.
Systematically reviewed experimental and mechanistic studies on the classic herb pair Astragalus membranaceus and Salvia miltiorrhiza in myocardial ischemia-reperfusion injury models.
Analyzed active compounds—including astragaloside IV, tanshinone IIA, salvianolic acid B, and calycosin—across key mitochondrial regulatory pathways.
Active components restore mitochondrial biogenesis by activating the PGC-1α/NRF1/TFAM axis and remodel dynamic balance by inhibiting Ser616 phosphorylation of Drp1 while preserving Mfn1, Mfn2, and OPA1.
The herb pair bidirectionally modulates mitophagy through the PINK1/Parkin pathway, upregulates antioxidant enzymes including Mn-SOD and GPx, and suppresses opening of the mitochondrial permeability transition pore.

Structured PICO

Does the herb pair Astragalus membranaceus and Salvia miltiorrhiza and its active ingredients alleviate myocardial ischemia-reperfusion injury via multi-target regulation of the mitochondrial quality control network?

P

Population

Preclinical models (e.g., rats, mice, H9C2 cells) of myocardial ischemia-reperfusion injury (MIRI)

I

Intervention

Astragalus membranaceus and Salvia miltiorrhiza herb pair and their active ingredients (astragaloside IV, calycosin, astragalus polysaccharide, formononetin, tanshinone IIA, salvianolic acid B, cryptotanshinone, danshensu) as well as related traditional Chinese medicine formulas (e.g., Qishenyiqi dripping pill, Huangqi-Danshen decoction, Yiqi Huoxue prescription)

O

Outcome

Alleviation of myocardial ischemia-reperfusion injury via multi-target regulation of the mitochondrial quality control (MQC) network (including restoration of mitochondrial biogenesis, remodeling of mitochondrial dynamic balance, bidirectional modulation of mitophagy, anti-oxidative stress effects, and suppression of mPTP opening)surrogate

This narrative review synthesizes preclinical evidence demonstrating that active compounds from Astragalus membranaceus and Salvia miltiorrhiza attenuate myocardial ischemia-reperfusion injury by regulating multiple pathways within the mitochondrial quality control network, while highlighting pharmacokinetic and translational challenges that must be overcome for clinical application.

Limitations

Mechanistic analyses are fragmented and focus on single MQC pathways rather than dynamic temporal evolution across the full ischemia-reperfusion process.
Lack of rigorous controlled experiments distinguishing pharmacodynamic pathway synergy from pharmacokinetic synergy between Astragalus membranaceus and Salvia miltiorrhiza.
Translational bottlenecks due to low oral bioavailability of active ingredients and lack of myocardial mitochondria-targeted delivery technologies.
Preclinical models largely use young healthy animals without common clinical comorbidities such as aging, diabetes, or hyperlipidemia.
Molecular mechanism analysis is relatively one-sided, mostly focusing on a single MQC pathway, lacking research on the temporal evolution and dynamic linkage of multiple MQC modules throughout the ischemia-reperfusion process
Lack of rigorous controlled experiments to confirm the respective contributions of pharmacodynamic synergy (pathway complementarity) versus pharmacokinetic synergy (altered absorption, distribution, and metabolism)
Prominent translational bottlenecks due to generally low bioavailability of active ingredients and lack of myocardial mitochondria-targeted delivery technologies, leading to a disconnect between in vitro and in vivo efficacy
Disconnect between preclinical models and clinical reality, as studies mostly use young healthy animals for simple ischemia/reperfusion models while ignoring common clinical comorbidities such as aging, diabetes, and hyperlipidemia

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Implication

Preclinical mechanisms warrant no practice change; leaves open need for randomized trials to test translation in ischemia-reperfusion injury.

Abstract

Myocardial ischemia-reperfusion injury (MIRI) refers to a pathological condition where myocardial damage is aggravated paradoxically after blood flow is restored following myocardial ischemia.Astragalus membranaceus and Salvia miltiorrhiza, a classic herb pair for replenishing qi and activating blood circulation in clinical practice, can effectively alleviate MIRI via multi-target regulation of the mitochondrial quality control (MQC) network.This paper systematically reviews the molecular mechanisms of active ingredients derived from this herb pair against MIRI, covering restoration of mitochondrial biogenesis, remodeling of mitochondrial dynamic balance, bidirectional modulation of mitophagy, anti-oxidative stress effects and suppression of mPTP opening.It provides theoretical references for its clinical application and therapeutic research of MIRI.

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Cite This Study

日鑫段 (2026) conducted a review in Myocardial ischemia-reperfusion injury (MIRI). Astragalus membranaceus and Salvia miltiorrhiza herb pair and active ingredients (astragaloside IV, calycosin, Astragalus polysaccharides, formononetin, tanshinone IIA, salvianolic acid B, cryptotanshinone, danshensu) was evaluated on Alleviation of myocardial ischemia-reperfusion injury via regulation of the mitochondrial quality control (MQC) network. Astragalus membranaceus and Salvia miltiorrhiza alleviate myocardial ischemia-reperfusion injury by restoring mitochondrial biogenesis, dynamics, mitophagy, and redox balance.

synapsesocial.com/papers/6af0db863c845ca7837ceccb https://doi.org/10.12677/tcm.2026.1510610

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Advances in the Treatment of Myocardial Ischemia-Reperfusion Injury with Astragalus membranaceus and Salvia miltiorrhiza: A Mitochondrial Quality Control Perspective

Key Points

Structured PICO

Limitations

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Implication

Abstract

Discussion

Cite This Study

Advances in the Treatment of Myocardial Ischemia-Reperfusion Injury with Astragalus membranaceus and Salvia miltiorrhiza: A Mitochondrial Quality Control Perspective

Key Points

Structured PICO

Limitations

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Implication

Abstract

Discussion

Cite This Study

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