Decoding protein signaling networks in microvascular angina: the multi-target biochemical actions of traditional Chinese medicine
4 affiliations
- 1First Clinical College, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, China
- 2The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, China
- 3Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, China
- 4Shenyang Health and Wellness Service Center, Shenyang, Liaoning, China
Abstract
Although angina pectoris is among the most common conditions in cardiology, a substantial proportion of symptomatic patients exhibit persistent ischemia without flow-limiting epicardial coronary artery disease—termed ANOCA (angina with nonobstructive coronary arteries). Accumulating evidence underscores coronary microvascular dysfunction as central to ANOCA’s pathophysiology, involving molecular mechanisms such as endothelial dysfunction, oxidative stress, vascular inflammation, impaired vasodilation, microvascular remodeling, metabolic disturbance, and reduced coronary flow reserve. These interconnected pathways challenge the efficacy of single-target therapies. Traditional Chinese medicine (TCM), with its multi-target systems-based approach, offers a promising therapeutic model. Preclinical and clinical studies reveal that representative TCM formulas and bioactive compounds preserve endothelial integrity, suppress pro-inflammatory cytokines, attenuate oxidative injury, restore mitochondrial and metabolic homeostasis, stimulate angiogenesis, and improve myocardial perfusion. Such effects align with the molecular complexity of ANOCA, suggesting TCM could complement conventional cardiovascular treatments. This review synthesizes current understanding of coronary microvascular pathobiology, traces the evolution of microvascular-protective therapeutic concepts, and evaluates TCM’s mechanistic and clinical evidence base. While findings highlight TCM’s therapeutic potential, translational limitations persist—including heterogeneity in diagnostic criteria, variability in herbal formulations, methodological inconsistencies, and gaps in robust evidence. Integrating mechanistic, clinical, and translational data, this work delineates the scientific foundation, therapeutic promise, and future research directions for TCM in ANOCA-related coronary microcirculation disorders, advocating for standardized, mechanism-driven investigations to enable evidence-based integration into cardiovascular care.
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BibTeX
@article{duan2026decoding,
title = {{Decoding protein signaling networks in microvascular angina: the multi-target biochemical actions of traditional Chinese medicine}},
author = {Yingkai Duan and Kaifeng Yu and Jing Li and Yuhan Ao and Han Li and Ning Liu and Mingxue Zhang},
journal = {Frontiers in Molecular Biosciences},
year = {2026},
month = oct,
doi = {10.3389/fmolb.2026.1908353},
url = {https://doi.org/10.3389/fmolb.2026.1908353},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Decoding protein signaling networks in microvascular angina: the multi-target biochemical actions of traditional Chinese medicine
AU - Yingkai Duan
AU - Kaifeng Yu
AU - Jing Li
AU - Yuhan Ao
AU - Han Li
AU - Ning Liu
AU - Mingxue Zhang
PY - 2026
DA - 2026/10/13
JO - Frontiers in Molecular Biosciences
DO - 10.3389/fmolb.2026.1908353
UR - https://doi.org/10.3389/fmolb.2026.1908353
AB - Although angina pectoris is among the most common conditions in cardiology, a substantial proportion of symptomatic patients exhibit persistent ischemia without flow-limiting epicardial coronary artery disease—termed ANOCA (angina with nonobstructive coronary arteries). Accumulating evidence underscores coronary microvascular dysfunction as central to ANOCA’s pathophysiology, involving molecular mechanisms such as endothelial dysfunction, oxidative stress, vascular inflammation, impaired vasodilation, microvascular remodeling, metabolic disturbance, and reduced coronary flow reserve. These interconnected pathways challenge the efficacy of single-target therapies. Traditional Chinese medicine (TCM), with its multi-target systems-based approach, offers a promising therapeutic model. Preclinical and clinical studies reveal that representative TCM formulas and bioactive compounds preserve endothelial integrity, suppress pro-inflammatory cytokines, attenuate oxidative injury, restore mitochondrial and metabolic homeostasis, stimulate angiogenesis, and improve myocardial perfusion. Such effects align with the molecular complexity of ANOCA, suggesting TCM could complement conventional cardiovascular treatments. This review synthesizes current understanding of coronary microvascular pathobiology, traces the evolution of microvascular-protective therapeutic concepts, and evaluates TCM’s mechanistic and clinical evidence base. While findings highlight TCM’s therapeutic potential, translational limitations persist—including heterogeneity in diagnostic criteria, variability in herbal formulations, methodological inconsistencies, and gaps in robust evidence. Integrating mechanistic, clinical, and translational data, this work delineates the scientific foundation, therapeutic promise, and future research directions for TCM in ANOCA-related coronary microcirculation disorders, advocating for standardized, mechanism-driven investigations to enable evidence-based integration into cardiovascular care.
SN - 2296-889X
ER -