Therapeutic Potential of Saikosaponins in MASLD and Cross-Organ Protection: A Research Update.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has emerged as the most prevalent chronic liver disorder in China, posing a significant threat to public health. While current Western pharmacological therapies demonstrate efficacy, they don't comprehensively ameliorate pathological components of MASLD and are often associated with substantial adverse effects. Saikosaponins (SSs), as the main active components of Bupleurum chinense, a traditional Chinese medicine (TCM), have been demonstrated to exert potential therapeutic effects on MASLD in recent years. However, there is a lack of systematic integration of their mechanisms of action and clinical evidence. This review aims to summarize the molecular mechanisms, clinical research progress, and existing challenges regarding the regulation of MASLD by SSs and systematically reviews the multiple therapeutic mechanisms of SSs, including the regulation of lipid metabolism, improvement of insulin resistance, exertion of anti-inflammatory and antioxidant effects, modulation of intestinal flora, and inhibition of fibrosis, while summarizing the clinical applications of its compound formulas. Additionally, this article summarizes the cross-organ protective effects of SSs in the liver, cardiovascular system, kidneys, immune system, and central nervous system, providing further theoretical references for the treatment of MASLD and its complications.