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TCM interventions targeting ferroptosis may offer multi-target anti-ferroptotic strategies for vascular cognitive impairmentTraditional Chinese medicine may slow brain damage from small strokes

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Key Takeaway
Note that TCM compounds show anti-ferroptotic effects in experimental models, but direct clinical evidence for VCI is lacking.

This narrative review examines the mechanisms of ferroptosis in the pathogenesis of vascular cognitive impairment (VCI) and evaluates the potential of traditional Chinese medicine (TCM) interventions to target these pathways. The authors synthesize evidence suggesting that ferroptosis contributes to VCI through iron overload, oxidative damage, glutathione depletion, lipid peroxidation, blood-brain barrier disruption, and neuroinflammation.

Specifically, the review highlights that TCM compounds including baicalein, salvianolic acid B, gastrodin, astragaloside IV, and Buyang Huanwu Decoction demonstrate anti-ferroptotic effects in experimental models. These compounds are noted to modulate key pathways such as GPX4, Nrf2/HO-1, System Xc-, and iron metabolism.

A primary limitation noted by the authors is the lack of direct clinical evidence for these TCM interventions in patients with VCI. Furthermore, much of the supporting evidence is derived from related cerebrovascular or non-neurological models rather than specific VCI models. While these findings suggest a potential multi-target, multi-pathway strategy for VCI, the evidence remains primarily preclinical and requires further clinical investigation.

How this fits prior evidence

This narrative review addresses a gap in clinical management for vascular cognitive impairment by exploring TCM interventions. It extends prior coverage of gastrodin, which was identified as a strategy for preventing postoperative cognitive dysfunction after cardiac surgery. Additionally, it builds upon previous reports of astragaloside IV, which was shown to modulate the tumor microenvironment in hepatocellular carcinoma models and reduce renal fibrosis markers in preclinical animal models.

When a person suffers from a stroke or a blood vessel issue in the brain, it can lead to lasting cognitive problems. Scientists are looking closely at a specific type of cell death called ferroptosis. This process happens when iron builds up and causes damage to brain cells, leading to inflammation and injury to the brain's protective barrier.

Researchers reviewed how certain traditional Chinese medicine ingredients, like baicalein and gastrodin, might fight this process. In laboratory models, these compounds showed they could block the pathways that lead to cell death. They may help by protecting cells from iron-related damage and keeping the brain's environment stable.

It is important to note that this research is currently in the early stages. Most of the evidence comes from laboratory models rather than direct clinical trials in humans with vascular cognitive impairment. While these ingredients show promise in the lab, we do not yet have direct clinical evidence of how they work in human patients.

What this means for you:
Certain traditional herbs show promise in lab tests for blocking a specific type of cell death in the brain.

Common questions

What is ferroptosis and why does it matter for brain health?

Ferroptosis is a specific type of cell death caused by iron overload and oxidative damage. In the brain, this process can lead to inflammation, damage to the blood-brain barrier, and injury to white matter. This can contribute to cognitive problems after a stroke or other blood vessel diseases.

Which specific ingredients showed promise in the study?

The review highlighted several traditional Chinese medicine components, including baicalein, salvianolic acid B, gastrodin, and astragaloside IV. These were also studied as part of the Buyang Huanwu Decoction. These compounds showed anti-ferroptotic effects in experimental models.

Can these treatments be used for patients today?

Not yet. While these compounds showed positive results in laboratory models, there is currently a lack of direct clinical evidence in humans with vascular cognitive impairment. You should speak with your doctor about any treatment options for brain health.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BackgroundVascular cognitive impairment (VCI) encompasses a spectrum of cognitive deficits arising from cerebrovascular disease, representing a major cause of dementia worldwide. Ferroptosis, a recently identified form of regulated cell death driven by iron-dependent lipid peroxidation, has emerged as a potential contributor to neuronal and glial cell injury in cerebrovascular pathologies, although direct evidence in VCI itself remains limited. Traditional Chinese medicine (TCM) has demonstrated promising neuroprotective effects, with growing evidence suggesting that its therapeutic benefits may partly involve the modulation of ferroptosis pathways.ObjectiveThis narrative review aims to comprehensively summarize the pathological mechanisms of ferroptosis in VCI, elucidate the molecular crosstalk between ferroptotic cascades and cerebrovascular injury, and highlight the therapeutic potential of TCM interventions targeting ferroptosis in VCI.MethodsA comprehensive literature search was conducted across PubMed, Web of Science, and CNKI databases for publications from January 2019 to June 2026 (final search performed on 15 April 2026), using predefined terms related to ferroptosis, vascular cognitive impairment, cerebrovascular disease, and traditional Chinese medicine; the full search strategy and evidence-classification scheme are described in Section 1.1.ResultsPreclinical evidence suggests that ferroptosis may contribute to VCI pathogenesis through multiple mechanisms, including iron overload-mediated oxidative damage, glutathione depletion, lipid peroxidation, blood–brain barrier disruption, neuroinflammation, and white matter injury. Several TCM compounds and formulas, including baicalein, salvianolic acid B, gastrodin, astragaloside IV, and Buyang Huanwu Decoction, have demonstrated anti-ferroptotic effects in experimental models through modulation of GPX4, Nrf2/HO-1, System Xc-, and iron metabolism pathways. These preclinical findings provide a preliminary mechanistic basis for the neuroprotective effects of TCM in VCI, although direct clinical evidence is still lacking.ConclusionTargeting ferroptosis represents a potential therapeutic strategy for VCI, and TCM offers a rich repository of multi-target, multi-pathway anti-ferroptotic agents. However, most supporting evidence is derived from related cerebrovascular or non-neurological models rather than from VCI itself. Future research should prioritize VCI-specific mechanistic studies, rigorous validation of ferroptosis-specific effects, and clinical translation of TCM-mediated ferroptosis regulation.
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