Phytotherapy for Liver Fibrosis: Insights From the Biology of Hepatic Stellate Cells—A Narrative Review

Abstract

Chronic liver diseases frequently progress to liver fibrosis, characterized by the accumulation of extracellular matrix (ECM) proteins and the formation of fibrous scars. This fibrous tissue disrupts normal liver architecture, impairing its physiological functions. Advanced liver fibrosis can lead to cirrhosis, portal hypertension and liver failure, often necessitating transplantation. Hepatic stellate cells (HSCs) are pivotal in collagen production and play a crucial role in the fibrotic process. Notably, mild to moderate fibrosis can be reversed upon removal of its causative agents, with recovery rates varying based on the cause and severity of fibrosis. Emerging anti-fibrotic therapies focus on inhibiting fibrogenic cell accumulation and preventing ECM deposition. This review highlights herbal extracts with proven effects on HSCs in vivo, showing potential in mitigating liver fibrosis. These extracts inhibit HSC proliferation and ECM release by targeting critical signalling pathways, including TGF-β, NF-κB, MAPK, STAT3 and NRF2. While many of these plants have been validated in pre-clinical studies, further research is needed to identify active compounds and establish clinical efficacy.