Molecular insights into herbal medicines for the treatment of metabolic associated Steatohepatitis

Metabolic dysfunction-associated steatohepatitis (MASH), previously known as non-alcoholic steatohepatitis (NASH), represents a severe form of metabolic dysfunction-associated steatotic liver disease (MASLD). The condition is characterized by hepatic steatosis, inflammation, and progressive fibrosis, driven by insulin resistance and metabolic dysfunction. Current challenges in MASH management include the lack of FDA-approved treatments, the complexities of individualized patient responses, and the limited efficacy of existing pharmacological therapies. This review examines the molecular mechanisms and therapeutic potential of herbal medicines in MASH treatment, focusing on compounds such as silymarin, curcumin, and berberine. These herbal medicines aim to address critical challenges such as oxidative stress, inflammation, and insulin resistance, while analyzing their effects on key pathophysiological pathways. Current evidence suggests that herbal compounds exhibit multiple beneficial properties in MASH treatment through various molecular mechanisms. These include modulation of insulin signaling pathways, reduction of oxidative stress through antioxidant activities, and attenuation of inflammatory responses via NF-κB pathway regulation. Key compounds like silymarin demonstrate hepatoprotective effects, while berberine improves insulin sensitivity through AMPK pathway activation. Curcumin exhibits both anti-inflammatory and antifibrotic properties. Recent advances in delivery systems, particularly nanotechnology, have helped address traditional limitations of herbal medicines, such as poor bioavailability and standardization. Herbal medicines show promising potential as therapeutic options for MASH treatment through their multi-targeted approach to disease pathogenesis, addressing significant challenges in traditional therapies. While challenges in standardization and bioavailability exist, emerging technologies may help overcome these limitations. Further research, particularly well-designed clinical trials, is needed to establish the efficacy and safety of these compounds as standalone treatments or adjunct therapies for MASH management.