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TCM formulas and monomeric compounds restore macrophage polarization balance in Sjögren's syndromeTraditional Chinese Medicine May Balance Immune Cells in Sjögren's Syndrome

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Key Takeaway
Note that TCM formulas may restore macrophage balance, but clinical efficacy remains theoretical at this stage.

This systematic review explores the mechanisms of macrophage polarization and the potential therapeutic role of traditional Chinese medicine (TCM) formulas and monomeric compounds in Sjögren's syndrome. The synthesis focuses on how M1 and M2 macrophage dynamics contribute to disease progression, specifically noting that M1 macrophages drive early pro-inflammatory damage while aberrant M2 polarization promotes late-stage glandular fibrosis.

The review suggests that both TCM formulas and specific monomeric compounds can effectively restore the balance of macrophage polarization by targeting relevant pathways and molecular nodes. These interventions are proposed as potential strategies to address chronic inflammation and fibrotic progression in Sjögren's syndrome.

Several limitations are noted, including significant clinical translation bottlenecks regarding delivery, timing, and patient stratification. The authors emphasize that specific therapeutic outcomes for Sjögren's syndrome remain theoretical or proposed rather than proven. Clinical evidence for the efficacy of specific TCM formulas is not tested in this review.

How this fits prior evidence

This systematic review addresses a gap by exploring macrophage-targeted strategies and integrated TCM-western medicine therapy in Sjögren's syndrome. It complements existing knowledge on Sjögren's animal models where MSC therapy improves salivary flow, and the role of RNA methylation in autoimmune rheumatic diseases. While it identifies potential mechanisms for restoring macrophage balance, the findings remain theoretical compared to established observations regarding SMN associations with inflammatory markers in pSS.

This review looked at how certain types of immune cells, called macrophages, behave in people with Sjögren's syndrome. These cells can cause early inflammation and lead to long-term scarring of the glands. The study focused on how these cells change over time and how they contribute to the progression of the condition.

Researchers found that traditional Chinese medicine (TCM) formulas and specific monomeric compounds may help restore the balance of these immune cells. By targeting specific molecular pathways, these treatments might help manage both early inflammation and later stages of tissue damage. This suggests a potential path for combining TCM with other medical approaches.

Because this is a review of biological mechanisms rather than a clinical trial, the results are currently theoretical. The study did not test specific outcomes in patients or report on side effects. While these findings offer hope for new treatment strategies, they are early and require more research to see how they work in real-world medical practice.

What this means for you:
TCM formulas may help balance immune cells to manage inflammation in Sjögren's syndrome, but more clinical trials are needed.

Common questions

How does Sjögren's syndrome affect the body's immune system?

In Sjögren's syndrome, certain immune cells called macrophages can cause early inflammatory damage. As the condition progresses into middle and late stages, these cells can lead to chronic inflammation and the scarring of glands. This research looks at how different compounds might help balance these cell types to slow down that process.

Can traditional Chinese medicine help with Sjögren's syndrome?

The review suggests that traditional Chinese medicine (TCM) formulas and monomeric compounds may effectively restore the balance of macrophage polarization. By targeting specific molecular nodes, these treatments could potentially manage both early inflammation and late-stage fibrosis. However, these results are currently theoretical and not yet proven in clinical trials.

Is this treatment safe for patients with Sjögren's syndrome?

Because this was a review of biological mechanisms rather than a clinical trial on people, no safety data or side effects were reported. The findings are currently theoretical. You should always speak with your doctor before starting any new supplement or traditional medicine to ensure it is safe for your specific condition.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
Sjögren’s syndrome (SS) is a chronic systemic autoimmune disease characterized by damage to exocrine glands, and no effective treatment is currently available to reverse glandular fibrosis. As core effector cells of innate immunity, macrophages play a pivotal role in the dynamic imbalance of polarization states, which critically influences inflammation initiation, tissue injury, and irreversible fibrosis in SS. This review systematically delineates the heterogeneity of M1/M2 macrophage subsets, their spatiotemporal dynamics, and their functional transitions across different pathological stages of SS: M1 predominance drives early pro-inflammatory damage, M1/M2 interplay sustains chronic inflammation in the middle stage, and aberrant M2 polarization promotes late-stage glandular fibrosis. We further dissect the multi-level regulatory network underlying macrophage polarization imbalance, including immune cell crosstalk, core signaling pathways, non-coding RNA epigenetic regulation, and immunometabolic reprogramming. The in-depth mechanisms by which M2 macrophages drive the progression of glandular fibrosis are also summarized. In this context, we describe how certain traditional Chinese medicine (TCM) formulas and monomeric compounds can effectively restore the balance of macrophage polarization by targeting relevant pathways and molecular nodes. Moreover, we analyze the major bottlenecks currently hindering the clinical translation of macrophage-targeted strategies and propose innovative approaches, including tissue-specific delivery, spatiotemporally tailored modulation, integrated TCM-western medicine therapy, biomarker-guided patient stratification, and early-window intervention. Finally, we discuss the potential of cutting-edge technologies such as single-cell multi-omics, spatial transcriptomics, gene editing, and organoid models to decode the heterogeneity of macrophage subsets and their interactions with the microenvironment. Integration of these multidisciplinary tools will facilitate the development of safe, effective, and personalized therapeutic strategies targeting macrophage polarization for SS.
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