Schisandra chinensis Fructus and its active metabolites for the treatment of metabolic dysfunction-associated steatotic liver disease.

Schisandra chinensis Fructus (SCF) is a traditional Chinese herbal medicine with both medicinal and culinary uses. Its main active ingredients, including lignans, triterpenoids, volatile oils, and organic acids, have been utilized to treat liver diseases. SCF extract exhibits pharmacological activities such as protecting hepatocytes, reducing hepatic fat accumulation, alleviating insulin resistance, and mitigating oxidative stress, thus holding promising application prospects in alleviating metabolic dysfunction-associated steatotic liver disease (MASLD). The aim of our review is to summarize and organize recent literature regarding the active metabolites and pharmacology of SCF, so as to clarify the pharmacological mechanism of this herbal medicine and provide a reference for the research, development, and utilization of SCF, its compound preparations, and related health foods. Literature selection was performed using relevant databases in traditional Chinese medicine and biomedical sciences, based on the ethnopharmacological uses (medicinal and culinary) of SCF. Studies investigating the roles and mechanisms of SCF's active metabolites in alleviating MASLD were primarily chosen. SCF contains multiple active metabolites, among which lignans, triterpenoids, volatile oils, and organic acids play crucial roles in alleviating MASLD. These metabolites exert pharmacological effects by protecting hepatocytes from damage, regulating hepatic lipid metabolism, improving insulin sensitivity, and resisting oxidative stress, collectively contributing to the mitigation of MASLD. However, systematic exploration of the integrated mechanisms involving these metabolites remains necessary. The active metabolites of SCF possess diverse pharmacological activities in alleviating MASLD. Clarifying their underlying mechanisms is beneficial for promoting further research, development, and application of SCF in medicine and health foods, providing a solid basis for related drug development and functional food utilization.