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Total glucosides of paeony may interrupt the gut-liver axis cycle in liver cirrhosisTGP May Improve Gut Health in Liver Cirrhosis Patients

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Key Takeaway
Note that TGP may improve gut-liver axis markers in liver cirrhosis, but evidence is limited to preclinical data.

This narrative review explores the potential therapeutic role of total glucosides of paeony (TGP) in managing liver cirrhosis. The authors synthesize preclinical evidence suggesting that TGP may intervene in the pathological cycle of liver cirrhosis through a hierarchical cascading reaction involving the gut-liver axis.

Key findings indicate that TGP may improve microbiota balance by increasing Lactobacillus, Akkermansia, and Lachnospira. Additionally, TGP may upregulate tight junction proteins (ZO-1, Occludin, Claudin-3) and reduce endotoxin and bacterial translocation in the portal vein. The review also notes that TGP may normalize primary-to-secondary bile acid conversion and activate FXR via PKCα/MAPK inhibition and SIRT1 upregulation. Furthermore, TGP may provide dual inhibition of NF-κB and inhibit NLRP3 Ser295 phosphorylation.

A significant limitation of these findings is that the evidence is predominantly preclinical, and clinical causality has not been established. The authors note that while TGP shows potential to intervene in the cycle of liver cirrhosis, more clinical trials are required to determine its efficacy and safety in human patients.

How this fits prior evidence

This narrative review addresses a gap in the management of liver cirrhosis by exploring the mechanism of total glucosides of paeony (TGP). While the prior coverage of SGLDQR TCM formulas showed potential clinical benefits for cholelithiasis, this review focuses on the gut-liver axis and TGP's role in liver cirrhosis. The findings regarding TGP are currently limited to preclinical models.

Researchers reviewed how a compound called Total glucosides of paeony (TGP) might affect liver cirrhosis. This review focused on how TGP interacts with the gut-liver axis to potentially improve liver health. The findings are based primarily on preclinical data, which means the research was conducted in laboratory settings rather than in human clinical trials.

In these early studies, TGP was linked to a more balanced gut microbiome and the strengthening of proteins that protect the intestinal barrier. These changes may help reduce the movement of harmful bacteria and toxins into the liver. The study also noted that TGP might activate specific pathways to reduce inflammation and normalize bile acid levels.

Because these results come from preclinical studies, the evidence is currently not enough to confirm how TGP works in humans. More clinical trials are needed to determine if these effects are safe and effective for people with liver cirrhosis. Patients should speak with their doctors before considering any new supplements or treatments.

What this means for you:
Early laboratory studies suggest TGP may improve gut health in liver cirrhosis, but more human trials are needed.

Common questions

What is TGP and how does it work?

TGP stands for Total glucosides of paeony. In laboratory studies, it was shown to potentially balance gut bacteria, strengthen intestinal proteins, and inhibit inflammatory pathways like NF-kB and NLRP3. These actions may help protect the liver from damage caused by toxins moving from the gut.

Is TGP safe for people with liver cirrhosis?

The safety of TGP in humans is not yet known. The current evidence comes almost entirely from preclinical studies, which are not the same as clinical trials in people. You should always consult your doctor before starting any new treatment or supplement.

How does TGP affect the gut-liver axis?

The study suggests TGP may improve the gut-liver axis by increasing beneficial bacteria like Lactobacillus and Akkermansia. It may also help normalize bile acid conversion and reduce the amount of endotoxins and bacteria moving into the portal vein.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
Background & aimLiver cirrhosis, the end-stage of chronic liver diseases, imposes a high global burden. Gut–liver axis dysregulation—microbiota imbalance, barrier failure, endotoxin translocation, bile acid disturbance, suppressed FXR signaling, and NLRP3 activation—drives cirrhosis progression. Total glucosides of paeony (TGP), a Paeonia lactiflora extract rich in paeoniflorin (>90%), possesses anti-inflammatory and immunomodulatory properties. However, a systematic review of TGP’s mechanisms via the gut–liver axis is lacking. This review aims to systematically summarize and critically evaluate the molecular mechanisms by which TGP modulates the gut–liver axis to treat cirrhosis, covering its effects on microbiota restoration, barrier repair, bile acid normalization, FXR reactivation, and dual inhibition of NF-κB and NLRP3 inflammatory pathways, thereby providing a comprehensive mechanistic framework for its therapeutic application.Main findingsPreclinical evidence shows TGP is associated with improved microbiota balance (increased Lactobacillus, Akkermansia, Lachnospira), Through short-chain fatty acids, the expression of tight junction proteins (ZO-1, Occludin, Claudin-3) may be upregulated, and the levels of endotoxin and bacterial translocation in the portal vein may be reduced. TGP normalizes primary-to-secondary bile acid conversion (CA/CDCA to DCA/LCA), thereby activating intestinal and hepatic farnesoid X receptor (FXR). Its main component, paeoniflorin, enhances FXR through PKCα/MAPK inhibition and SIRT1 upregulation. Activated FXR dually suppresses NF-κB (directly and via Nrf2/HO-1) and inhibits NLRP3 Ser295 phosphorylation, while reducing bile acid synthesis, achieving coordinated anti-inflammatory and barrier-protective effects.ConclusionTGP may intervene in the vicious cycle of liver cirrhosis through a hierarchical cascading reaction - barrier repair, bile acid restoration, FXR activation, and dual NF-κB/NLRP3 inhibition. Despite predominantly preclinical data, TGP’s multi-target profile offers promising therapeutic potential; future large-scale clinical trials and formulation refinement are needed to enable TGP to meet the demand for the transition from preclinical evidence to clinical application, benefiting patients with liver cirrhosis.
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