Research Progress on Traditional Chinese Medicine in Treating Diabetes Based on Ferroptosis Theory

Abstract

Ferroptosis is an iron-dependent form of cell death driven by dysregulated iron metabolism, lipid peroxidation, and impaired antioxidant defense. Its core regulatory mechanisms involve iron accumulation (via transferrin receptors and ferritin), lipid peroxidation (dependent on polyunsaturated fatty acids and lipoxygenases), and dysfunction of the System Xc⁻-GSH-GPX4 antioxidant axis. Traditional Chinese Medicine (TCM) theory associates ferroptosis with pathological mechanisms such as “blood stasis,” “heat-toxicity,” and “yin-yang imbalance,” suggesting that TCM may intervene in ferroptosis by regulating iron metabolism, scavenging free radicals, and improving metabolic homeostasis. Diabetes and its complications (e.g., pancreatic β-cell injury and vascular lesions) are closely linked to ferroptosis, as iron overload and oxidative stress exacerbate insulin resistance and organ damage. Recent studies highlight the potential of TCM in modulating ferroptosis for diabetes treatment: active components (e.g., emodin, astragalus polysaccharides, berberine) chelate iron, activate GPX4, or inhibit lipid peroxidation; compound formulas (e.g., Yi Tang Kang, Huanglian Jiedu Decoction) synergistically regulate iron metabolism and antioxidant systems through multi-target mechanisms. Future research should integrate modern molecular biology techniques to elucidate TCM’s targets in ferroptosis modulation and advance drug development based on ferroptosis theory, offering novel strategies for diabetes prevention and treatment. TCM’s holistic and multi-pathway regulatory approach provides unique advantages in treating ferroptosis-related diseases, but further clinical validation is needed to facilitate translational applications.