Efficacy and potential mechanism of main active ingredients of Astragalus membranaceus in animals with hepatocellular carcinoma: a systematic review and meta-analysis

Background: (AM) in HCC. Methods: The study retrieved eight databases [PubMed, Web of Science, Embase, China Biomedical Literature Database (CBM), Cochrane Library, Wanfang Database (Wanfang), China Science and Technology Journal Database (VIP), and China National Knowledge Infrastructure (CNKI)]. The evaluation of methodological quality was conducted utilizing the risk of bias tool (SYRCLE). The study chose RevMan 5.4 for statistical analysis. Results: Fifty-three studies involving 1,110 animals were selected. The risk of bias in studies was rated as low, medium, or high. Low-dose AM [n=140; standardized mean difference (SMD), -5.03; 95% confidence interval (CI): -6.95 to -3.10, low certainty] and high-dose AM (n=149; SMD, -5.80; 95% CI: -8.26 to -3.34, low certainty) reduced tumor volume. Meta-analysis indicated that the AM's main active components exerted a beneficial effect on various indicators in HCC animals, including alanine aminotransferase (ALT) (n=156; SMD, -3.95; 95% CI: -6.13 to -1.78, low certainty), aspartate aminotransferase (AST) (n=126; SMD, -5.91; 95% CI: -9.00 to -2.82, low certainty), alkaline phosphatase (ALP) (n=80; SMD, -0.69; 95% CI: -1.80 to -0.42, low certainty), interleukin 2 (IL-2) (n=136; SMD, 2.88; 95% CI: 1.38 to 4.37, low certainty), interleukin 6 (IL-6) (n=95; SMD, 0.93; 95% CI: -2.05 to 3.91, low certainty), interferon-gamma (IFN-γ) (n=99; SMD, 4.67; 95% CI: 1.63 to 7.70, low certainty), and tumor necrosis factor-α (TNF-α) (n=236; SMD, 2.00; 95% CI: 0.66 to 3.33, low certainty). Conclusions: The meta-analysis certifies the effectiveness of the AM's main active ingredients in HCC based on early-phase investigations. The possible mechanism may link to inhibition of tumor weight, tumor volume, and regulation of inflammatory response.