Targeting bone marrow mesenchymal stem cells with traditional Chinese medicine active ingredients: Restoring hematopoietic microenvironment homeostasis to prevent and treat myelosuppression.

Myelosuppression is a common and dose-limiting severe complication in tumor radiotherapy and chemotherapy. The disruption of hematopoietic microenvironment homeostasis mediated by bone marrow mesenchymal stem cells (BMSCs) may be one of the important pathological factors for its persistent non-healing. Traditional Chinese medicine (TCM) can regulate BMSCs function through multi-target and multi-pathway mechanisms, reshape the hematopoietic microenvironment, and support hematopoietic regeneration. This article systematically explains the network mechanisms by which BMSCs regulate hematopoiesis and the pathological mechanisms by which factors like radiotherapy and chemotherapy damage BMSCs. It explores how active ingredients in Chinese medicine can restore BMSCs function and remodel the hematopoietic microenvironment by regulating differentiation and enhancing paracrine effects, suggesting that shifting treatment strategies from "protecting the seeds" to "remodeling the soil" might be a promising direction. At the same time, it summarizes the potential application value of nano-targeted delivery to improve bone marrow homing efficiency of active ingredients and other new technology research progress. Although most studies are still at the preclinical stage, these findings suggest the potential value of TCM in treating myelosuppression and provide ideas and directions for using single-cell multi-omics to identify abnormal BMSCs subpopulations and their molecular targets, developing intelligent drug delivery systems, and conducting clinical translational research.