The anti-hepatocellular carcinoma effects of polysaccharides from Ganoderma lucidum by regulating macrophage polarization via the MAPK/NF-κB signaling pathway

Bibliometric analysis of traditional Chinese medicine in cancer treatment via immune system modulation (2015-2025)

Objective

The application of Traditional Chinese Medicine (TCM) in treating cancer by regulating the immune system has garnered significant attention in the academic community. However, comprehensive quantitative analyses in this field remain limited. This study aims to assess the research progress and key trends over the past decade, providing a framework for future studies.

Methods

A comprehensive literature search was conducted on the application of TCM in treating cancer by regulating the immune system from 2015 to 2025 using the Web of Science database. The search terms mainly included cancer, Traditional Chinese Medicine, immunity and so on. Data were analyzed and visualized using Origin, R software, VOSviewer, and CiteSpace.

Results

A total of 2,459 articles were included in the analysis. The number of related publications has steadily increased since 2015. China leads in publication volume and plays a crucial role in international collaboration. The Journal of Ethnopharmacology is the leading journal in this field, publishing a substantial number of highly cited studies. Key research areas include keywords such as "apoptosis," "expression," "inflammation," "extract," "in vitro," "activation," "antioxidant," and "NF-kappa B," focusing on exploring the role, mechanisms, and efficacy of TCM in modulating immune responses.

Conclusion

Research interest in TCM's role in treating cancer through immune system regulation continues to grow, underscoring its potential in cancer therapy. Current research primarily focuses on the mechanisms by which TCM treats cancer through the modulation of immune cell functions, inhibition of tumor immune evasion, and regulation of immune-related signaling pathways. It also explores its clinical applications and the potential for enhancing the efficacy of immunotherapy.

Ganoderma lucidum Polysaccharide/carboxymethyl Chitosan Hydrogels Modulate Macrophage Polarization for Wound Healing

Wound healing remains a global challenge for clinical and experimental research. Hydrogels prepared from natural polysaccharides show great potential in the wound healing process. In this study, novel hydrogels (G-GLP) were prepared using oxidized Ganoderma lucidum polysaccharides (OGLPs) and carboxymethyl chitosan via the Schiff base reaction, which did not require the addition of any chemical cross-linking agent. The hydrogels showed excellent mechanical properties and biocompatibility. Moreover, the hydrogels showed superior hemostatic performance in mouse liver trauma and tail amputation models. Importantly, G-GLP improved inflammation by promoting the polarization of the macrophage M2 subtype, inhibiting the M1 subtype and reducing intracellular levels of reactive oxygen species. In vivo experiments demonstrated that G-GLP accelerated healing in a total defect wound model by reducing inflammation and promoting blood vessel repair and collagen deposition. These results demonstrate that G-GLP has potential as an effective wound repair dressing.

A review of polysaccharides from Ganoderma lucidum: Preparation methods, structural characteristics, bioactivities, structure-activity relationships and potential applications

Ganoderma lucidum (G. lucidum), commonly known as "fairy grass", is a saprophyte fungus belonging to the Polyporaceae family with a lengthy history of use as a food ingredient and traditional medicine in China. G. lucidum is abundant in diverse chemical compounds that encompass polysaccharides, alkaloids, steroids, terpenoids, proteins, as well as amino acids. Among these, polysaccharides as the main active ingredients prepared from G. lucidum have exhibited a multitude of biological activities, such as anti-tumor effect, antioxidant activity, antidiabetic effect, anti-inflammatory effect, immune regulation and so forth. The main methods for extracting GLPs are hot water extraction, ultrasound-assisted extraction, microwave-assisted extraction and enzyme-assisted extraction. The research on GLPs poses challenges, especially in optimizing extraction and purification processes to enhance the yield and preserve the structural characteristics. Furthermore, it remains ambiguous whether the bioactivities of GLPs are closely related to their extraction methods and structural characteristics, necessitating further exploration and elucidation of the structure-activity relationships. This review comprehensively and systematically outlines an overview of the preparation methods, structural characteristics, bioactivities, structure-activity relationships and potential applications of GLPs. The review emphasizes their therapeutic potential and health functions, providing a reference for further exploitation and application in various fields of GLPs.

Antrodia cinnamomea Formula Suppresses Prostate Cancer Progression via Immune Modulation and PD-1/PD-L1 Pathway Inhibition

Prostate cancer remains a significant global health challenge, necessitating the development of novel therapeutic approaches. This study investigated the therapeutic potential of the Antrodia cinnamomea formula (XIANZHIFANG formula, XZF), comprising Antrodia cinnamomea, Sanghuangporus sanghuang, Ganoderma lucidum, Ganoderma sinense, and Inonotus obliquus, in prostate cancer treatment. HPLC analysis confirmed the presence of key triterpenoids, including Antcin A, B, C, K, and Zhankuic acid B, C, and 4,7-dimethoxy-5-methyl-1,3-benzodioxole. Cytotoxicity assays demonstrated that XZF (50-200 μg/mL) exhibited selective activity, maintaining viability in non-cancerous 293T-cells while enhancing the viability of activated CD8+ and CD4+ T-cells in a dose-dependent manner. XZF significantly reduced PD-1 expression in CD8+ T-cells but not in CD4+ T-cells and inhibited the PD-L1/PD-1 interaction, achieving 93% inhibition at 200 μg/mL. Furthermore, when combined with atezolizumab (1 μg/mL), XZF demonstrated complete blockade of PD-L1/PD-1 interaction. In prostate cancer cells, XZF exhibited differential antiproliferative effects. In PC-3 cells, XZF significantly reduced viability across a concentration range of 25-200 μg/mL, whereas DU145 cells showed only partial inhibition at higher concentrations (100-200 μg/mL). LNCaP cells exhibited a dose-dependent reduction in viability, mirroring the response pattern of PC-3 cells. Conditioned medium from XZF-treated macrophages, particularly human THP-1 cells, significantly suppressed the viability and migration of prostate cancer cells in a dose-dependent manner. Notably, the conditioned medium from XZF-treated THP-1 cells exhibited a stronger inhibitory effect on prostate cancer cell viability and migration compared to murine RAW 264.7 macrophages. These findings indicate that XZF exerts its therapeutic potential through multiple mechanisms, including direct antiproliferative effects on cancer cells, enhancement of T-cell responses, modulation of immune checkpoint pathways, and macrophage-mediated suppression of prostate cancer cell survival and migration. The pronounced effects observed in human macrophage models suggest a promising avenue for further investigation in clinical settings, particularly in combination with existing immunotherapies.

Atractylenolide I prevents acute liver failure in mouse by regulating M1 macrophage polarization

Acute liver failure (ALF) is a life-threatening clinical syndrome with a substantial risk of mortality. A murine model of lipopolysaccharide (LPS)- and D-galactosamine (D-GalN)-induced ALF is widely used to investigate the underlying mechanisms and potential therapeutic drugs for human liver failure. Atractylenolide I (ATR-I) is an active component of the Atractylodes macrocephala rhizome and possesses various pharmacological activities, including anti-tumor, anti-inflammatory, and anti-oxidant properties. Given the key role of oxidative stress and inflammation in ALF pathogenesis, this study investigates the protective effects of ATR-I on LPS/D-GalN-induced ALF in mice. The results suggest that ATR-I pretreatment significantly ameliorates ALF, as evidenced by decreased serum aminotransferase levels and prolonged mice survival. Additionally, ATR-I pretreatment inhibits oxidative stress. Furthermore, the ATR-I pretreatment markedly suppresses M1 macrophage activation in hepatic mononuclear cells. In vitro experiments with bone marrow-derived macrophages indicate that ATR-I regulates macrophage polarization through the mitogen-activated protein kinase (MAPK) and interferon regulatory factor (IRF) signaling pathways. Collectively, ATR-I pretreatment protects mice from LPS/D-GalN-induced ALF partially by regulating M1 macrophage polarization.

Extraction, purification, structural characterization, biological activity, mechanism of action and application of polysaccharides from Ganoderma lucidum: A review

Ganoderma lucidum is a traditional tonic medicine in China, known as the "fairy grass" and "spiritual grass". It contains various chemical components, such as polysaccharides, triterpenoids, alkaloids, nucleosides, sterols, and acid compounds, which have the effects of tonifying qi and calming the mind, stopping cough and asthma, and are used to treat restlessness, lung deficiency cough and asthma, fatigue and shortness of breath, and lack of appetite. Ganoderma lucidum polysaccharides (GLPs) are one of the main bioactive ingredients and are widely used in traditional Chinese medicine and traditional medicine fields. They have shown good medicinal value in enhancing immunity, inhibiting tumor cell growth, delaying aging, lowering blood sugar, lowering blood lipids, protecting the heart, anti-radiation, anti-fatigue, and other aspects. This article reviews the research progress on the extraction and purification, structural characteristics, pharmacological activity, and mechanisms of GLPs, as well as their applications in industries such as medicine, food, and daily chemical products. The aim is to provide theoretical basis for the treatment of traditional Chinese medicine compound preparations and lay the foundation for the potential value development of Ganoderma lucidum products.

Fungal influence on immune cells and inflammatory responses in the tumor microenvironment (Review)

In recent years, a growing body of research has highlighted the significant influence of the microbiota on tumor immunity within the tumor microenvironment (TME). While much attention has been given to bacteria, emerging evidence suggests that fungi also play crucial roles in tumor development. The present review aimed to consolidate the latest findings on the mechanisms governing the interactions between fungi and the immune system or TME. By elucidating these intricate mechanisms, novel insights into the modulation of tumor immunity and therapeutic strategies may be uncovered. Ultimately, a deeper understanding of the interplay between fungi and the TME holds promise for the development of innovative management strategies and targeted drugs to enhance tumor therapy efficacy.

Polysaccharides isolated from Ampelopsis grossedentata and their immunomodulatory activity

To explore the immunomodulatory activity of polysaccharides from Ampelopsis grossedentata, two polysaccharides named AGP1 and AGP2 were isolated and purified by DEAE-cellulose 52 column and Sephacryl S-300HR chromatography. AGP1 and AGP2 were composed of fucose, arabinose, rhamnose, galactose, glucose, mannose, galacturonic acid, and glucuronic acid, with a ratio of 0.5: 10.2: 0.9: 31.8: 7.4: 3.4: 21.6: 24.2 and 0.4: 6.0: 0.5: 23.3: 3.3: 6.2: 33.5: 26.8, respectively. The average molecular weights of AGP1 and AGP2 were found to be 6.60 × 105 Da and 7.24 × 105 Da, respectively. AGP1 contained →4,6)-Galp-(1 → glycosidic linkages, while AGP2 contained →2)-Galp-(1 → and →2,3,4)-Glcp-(1 → glycosidic linkages. The structures of AGPs were characterized by Fourier transform infrared spectroscopy, nuclear magnetic resonance, and scanning electron microscope. The immunomodulatory activity of AGPs was investigated in RAW264.7 cells, and the results indicated that AGPs significantly activated macrophages, promoted cells differentiation and NO secretion, increased the expression of IL-6 and TNF-α, and induced macrophage M1 polarization. Transcriptomic analysis indicated that AGP1 and AGP2 regulated a total of 1043 and 970 differentially expressed genes respectively, which were identified in different immune related signaling pathways. Moreover, the immunoblot demonstrated that AGPs exerted immune-promoting effects through the TLR4, MAPK and NF-κB signaling pathways in macrophages. Consequently, AGPs have potent immunomodulatory activity and can be considered as immunomodulators in medical and food industries.

Innate immunity champions: The diverse functions of macrophages

Macrophages are instrumental in maintaining tissue homeostasis, modulating inflammation, and driving regeneration. The advent of omics techniques has led to the identification of numerous tissue-specific macrophage subtypes, thereby introducing the concept of the "macrophage niche". This paradigm underscores the ability of macrophages to adapt their functions based on environmental cues, such as tissue-specific signals. This adaptability is closely linked to their metabolic states, which are crucial for their function and role in health and disease. Macrophage metabolism is central to their ability to switch between proinflammatory and anti-inflammatory states. In this regard, environmental factors, including the extracellular matrix, cellular interactions, and microbial metabolites, profoundly influence macrophage behavior. Moreover, diet and gut microbiota significantly impact macrophage function, with nutrients and microbial metabolites influencing their activity and contributing to conditions like inflammatory bowel disease. Targeting specific macrophage functions and their metabolic processes is leading to the development of novel treatments for a range of chronic inflammatory conditions. The exploration of macrophage biology enriches our understanding of immune regulation and holds the promise of innovative approaches to managing diseases marked by inflammation and immune dysfunction, offering a frontier for scientific and clinical advancement.

Effect of the immunoregulation activity of a pectin polysaccharide from Saussurea laniceps petals on macrophage polarization

Saussurea laniceps is a traditional medicinal herb. In our previous study, a pectin polysaccharide, SLP-4, was isolated from the petals of S. laniceps. In this study, the immunomodulatory activity of SLP-4 was studied by analyzing its effects on macrophage (RAW 264.7 cells) polarization. The immunomodulatory activity assays indicated that SLP-4 could significantly enhance the pinocytic and phagocytic capacity and promote the expression and secretion of cytotoxic molecules (nitric oxide, increased by 6.4 times when the SLP-4 concentration was 800 μg/mL) and cytokines (tumor necrosis factor-α and interleukin-6 increased by 7.7 and 11.9 times, respectively) in original macrophage. The possible mechanism could be attributed to the activation of the mitogen-activated protein kinase and nuclear factor-κB signaling pathways through Toll-like receptors 2 and 4. Moreover, SLP-4 significantly induced M1 polarization of original macrophages and transferred macrophages from M2 to M1, but had little effect on the conversion of M1 macrophages into M2 phenotype. Overall, these results demonstrate the potential of SLP-4 as an attractive immunomodulating functional supplement.

Explore the mechanisms of triterpenoids from Ganoderma lucidum in the protection against Alzheimer's disease via microbiota-gut-brain axis with the aid of network pharmacology

Ganoderma lucidum (Curtis) P. Karst.(G. lucidum) is a kind of fungi, which also a traditional Chinese medicine used for "wisdom growth" in China. Triterpenoids from G. lucidum (GLTs) are one of the main active ingredients. Based on the strategy of early intervention on Alzheimer's disease (AD) and the inextricable association between disordered gut microbiota and metabolites with AD, this study aimed to explore the mechanisms of GLTs in the protection against AD via microbiota-gut-brain axis with the aid of network pharmacology. In this study, LC-MS/MS was used to identify the main active ingredients of GLTs. Network pharmacology was used to predict the potential target and validated with Caco-2 cell model. D-galactose was used to induce the slow-onset AD on rats. Metabolomics methods basing on GC-MS combined with 16S rRNA sequencing technology was used to carry out microbiota-gut-metabolomics analysis in order to reveal the potential mechanisms of GLTs in the protection of AD. As results, GLTs showed a protection against AD effect on rats by intervening administration. The mechanisms were inextricably linked to GLTs interference with the balance of gut microbiota and metabolites. The main fecal metabolites involved were short-chain fatty acids and aromatic amino acid metabolites.

Enhancing cancer immunotherapy: Nanotechnology-mediated immunotherapy overcoming immunosuppression

Immunotherapy is an important cancer treatment method that offers hope for curing cancer patients. While immunotherapy has achieved initial success, a major obstacle to its widespread adoption is the inability to benefit the majority of patients. The success or failure of immunotherapy is closely linked to the tumor's immune microenvironment. Recently, there has been significant attention on strategies to regulate the tumor immune microenvironment in order to stimulate anti-tumor immune responses in cancer immunotherapy. The distinctive physical properties and design flexibility of nanomedicines have been extensively utilized to target immune cells (including tumor-associated macrophages (TAMs), T cells, myeloid-derived suppressor cells (MDSCs), and tumor-associated fibroblasts (TAFs)), offering promising advancements in cancer immunotherapy. In this article, we have reviewed treatment strategies aimed at targeting various immune cells to regulate the tumor immune microenvironment. The focus is on cancer immunotherapy models that are based on nanomedicines, with the goal of inducing or enhancing anti-tumor immune responses to improve immunotherapy. It is worth noting that combining cancer immunotherapy with other treatments, such as chemotherapy, radiotherapy, and photodynamic therapy, can maximize the therapeutic effects. Finally, we have identified the challenges that nanotechnology-mediated immunotherapy needs to overcome in order to design more effective nanosystems.

A Review of Ganoderma lucidum Polysaccharide: Preparations, Structures, Physicochemical Properties and Application

Ganoderma lucidum (GL) is a kind of edible fungus with various functions and a precious medicinal material with a long history. Ganoderma lucidum polysaccharide (GLP) is one of the main bioactive substances in GL, with anti-tumor, anti-oxidation, anti-cancer, and other biological activities. GLP is closely related to human health, and the research on GLP is getting deeper. This paper reviewed the extraction and purification methods of GLP, the relationship between structure and activity, and the qualitative and quantitative methods. This review provides solutions for the analysis and application of GLP. At the same time, some new methods for extraction, purification and analysis of GLP, the relationship between advanced structures and activity, and future applications of and research into GLP were emphasized. As a kind of bioactive macromolecule, GLP has unique functional properties. Through the comprehensive summary of the extraction, purification, and analysis of GLP and its future prospects, we hope that this review can provide valuable reference for the further study of GLP.

Revolutionizing cancer treatment: Harnessing the power of terrestrial microbial polysaccharides

Cancer treatment faces numerous challenges, such as inadequate drug targeting, steep price tags, grave toxic side effects, and limited therapeutic efficacy. Therefore, there is an urgent need for a safe and effective new drug to combat cancer. Microbial polysaccharides, complex and diverse biological macromolecules, exhibit significant microbial variability and uniqueness. Studies have shown that terrestrial microbial polysaccharides possess a wide range of biological activities, including immune enhancement, antioxidant properties, antiviral effects, anti-tumour potential, and hypoglycemic functions. To delve deeper into the structure-activity relationship of these land-based microbial polysaccharides against cancer, we conducted a comprehensive review and analysis of anti-cancer literature published between 2020 and 2024. The anticancer efficacy of terrestrial microbial polysaccharides is influenced by multiple factors, including the microbial species, existing form, chemical structure, and polysaccharide purity. According to the literature, an optimal molecular weight and good water solubility are essential for demonstrating anticancer activity. Furthermore, the addition of mannose and galactose has been found to significantly enhance the anticancer properties of these polysaccharides. These insights will serve as a valuable reference for future research and progress in the field of cancer drug therapy, particularly with regards to terrestrial microbial polysaccharides.

Therapeutic Effects of Natural Products on Liver Cancer and Their Potential Mechanisms

Liver cancer ranks third globally among causes of cancer-related deaths, posing a significant public health challenge. However, current treatments are inadequate, prompting a growing demand for novel, safe, and effective therapies. Natural products (NPs) have emerged as promising candidates in drug development due to their diverse biological activities, low toxicity, and minimal side effects. This paper begins by reviewing existing treatment methods and drugs for liver cancer. It then summarizes the therapeutic effects of NPs sourced from various origins on liver cancer. Finally, we analyze the potential mechanisms of NPs in treating liver cancer, including inhibition of angiogenesis, migration, and invasion; regulation of the cell cycle; induction of apoptosis, autophagy, pyroptosis, and ferroptosis; influence on tumor metabolism; immune regulation; regulation of intestinal function; and regulation of key signaling pathways. This systematic review aims to provide a comprehensive overview of NPs research in liver cancer treatment, offering a foundation for further development and application in pharmaceuticals and functional foods.

Mechanistic and Functional Studies on the Microbial Induction of Wolfiporia cocos Liquid Fermentation Products

Liquid fermentation is an efficient culture for obtaining polysaccharides from edible mushrooms. In this study, the polysaccharide content and biomass were examined by introducing microorganisms into the Wolfiporia cocos fermentation system. Three edible mushroom co-fermentation systems were established, among which the Wolfiporia cocos-Ganoderma lucidum co-fermentation system significantly increased the mycelial biomass of the system by 57.71% compared to Wolfiporia cocos alone and 91.22% compared to Ganoderma lucidum alone, and the intracellular polysaccharide content was significantly increased. Physiological activities of polysaccharides showed that mycelial polysaccharides in the Wolfiporia cocos-Ganoderma lucidum system had stronger anti-tumor cell value-adding and anti-tumor cell migration activities compared with Wolfiporia cocos and Ganoderma lucidum fermentation alone. The transcriptomic study of Wolfiporia cocos mycelium induced by exogenous substances suggested that the exogenous substances could enhance the intracellular polysaccharide content of Wolfiporia cocos through the upregulation of the expression of α-glycosyltransferase encoded by ALG10 and the downregulation of α-glycosidases encoded by MAN1B in the glycolytic metabolism of Wolfiporia cocos. This study provides a new direction for the transformation of polysaccharides from Wolfiporia cocos and Ganoderma lucidum into functional foods and new product development, and provides an experimental basis.

Engineering M2 type macrophage-derived exosomes for autoimmune hepatitis immunotherapy via loading siRIPK3

Autoimmune hepatitis (AIH) is a progressive liver disease mediated by the immune system that involves an imbalance in pro-inflammatory and regulatory mechanisms including regulatory T cells (Tregs), T helper 17 (Th17) cells, Th1, macrophages, and many other immune cells. Current steroid therapy for AIH has significant systemic side effects and is poorly tolerated by some individuals. Therefore, there is an urgent need for alternative treatments. Maintaining homeostasis in macrophage differentiation and activation is crucial for regulating immune responses in hepatitis. In this study, we loaded small interfering RNA (siRNA) targeting receptor-interacting protein kinase 3 (RIPK3) into M2-type macrophage-derived exosomes (M2 Exos) to create functionalized exosomes called M2 Exos/siRIPK3. These exosomes demonstrated a natural ability to target the liver in mice, as they were efficiently taken up by hepatic macrophages and showed significant and stable accumulation. M2 Exos/siRIPK3 effectively mitigated immune-mediated hepatitis by suppressing the expression of RIPK3, resulting in a reduced release of pro-inflammatory cytokines and chemokines in both liver tissues and serum. Additionally, M2 Exos/siRIPK3 exhibited immunomodulatory effects, as its administration resulted in a decreased proportion of hepatic and splenic Th17 cells, along with an increased ratio of Tregs. Overall, this study suggests that loading small molecule drugs onto M2 Exos could be a promising approach for developing immunomodulators that specifically target liver macrophages to treat AIH. This strategy has the potential to provide a safer and more effective alternative to current therapy for AIH patients.

Ganoderma lucidum methyl ganoderate E extends lifespan and modulates aging-related indicators in Caenorhabditis elegans

Methyl Ganoderate E (MGE) is a triterpenoid derived from Ganoderma lucidum (Reishi), an edible mushroom, commonly processed into food forms such as soups, drinks, culinary dishes, and supplements. MGE has been shown to inhibit 3T3-L1 murine adipocyte differentiation when combined with other G. lucidum triterpenes. However, the specific effect of MGE on biological processes remains unknown. In this study, we present the first evidence of MGE's anti-aging effect in Caenorhabditis elegans. Through our screening process using the UPRER regulation ability, we evaluated a library of 74 pure compounds isolated from G. lucidum, and MGE exhibited the most promising results. Subsequent experiments demonstrated that MGE extended the lifespan by 26% at 10 μg ml-1 through daf-16, hsf-1, and skn-1-dependent pathways. MGE also enhanced resistance to various molecular stressors, improved healthspan, increased fertility, and reduced the aggregation of alpha-synuclein and amyloid-beta. Transcriptome data revealed that MGE promoted processes associated with proteolysis and neural activity, while not promoting cell death processes. Collectively, our findings suggest that G. lucidum MGE could be considered as a potential anti-aging intervention, adding to the growing list of such interventions.

A Systematic Review on the Research Progress on Polysaccharides from Fungal Traditional Chinese Medicine

Traditional Chinese medicine (TCM) is a class of natural drugs with multiple components and significant therapeutic effects through multiple targets. It also originates from a wide range of sources containing plants, animals and minerals, and among them, plant-based Chinese medicine also includes fungi. Fungal traditional Chinese medicine is a medicinal resource with a long history and widespread application in China. Accumulating evidence confirms that polysaccharide is the main pharmacodynamic material on which fungal TCM is based. The purpose of the current systematic review is to summarize the extraction, isolation, structural identification, biological functions, quality control and medicinal and edible applications of polysaccharides from fungal TCM in the past three years. This paper will supplement and deepen the understanding and application of polysaccharides from fungal TCM, and propose some valuable insights for further research and development of drugs and functional foods.

Exploring the potential of treating chronic liver disease targeting the PI3K/Akt pathway and polarization mechanism of macrophages

Chronic liver disease is a significant public health issue that can lead to considerable morbidity and mortality, imposing an enormous burden on healthcare resources. Understanding the mechanisms underlying chronic liver disease pathogenesis and developing effective treatment strategies are urgently needed. In this regard, the activation of liver resident macrophages, namely Kupffer cells, plays a vital role in liver inflammation and fibrosis. Macrophages display remarkable plasticity and can polarize into different phenotypes according to diverse microenvironmental stimuli. The polarization of macrophages into M1 pro-inflammatory or M2 anti-inflammatory phenotypes is regulated by complex signaling pathways such as the PI3K/Akt pathway. This review focuses on investigating the potential of using plant chemicals targeting the PI3K/Akt pathway for treating chronic liver disease while elucidating the polarization mechanism of macrophages under different microenvironments. Studies have demonstrated that inhibiting M1-type macrophage polarization or promoting M2-type polarization can effectively combat chronic liver diseases such as alcoholic liver disease, non-alcoholic fatty liver disease, and liver fibrosis. The PI3K/Akt pathway acts as a pivotal modulator of macrophage survival, migration, proliferation, and their responses to metabolism and inflammatory signals. Activating the PI3K/Akt pathway induces anti-inflammatory cytokine expression, resulting in the promotion of M2-like phenotype to facilitate tissue repair and resolution of inflammation. Conversely, inhibiting PI3K/Akt signaling could enhance the M1-like phenotype, which exacerbates liver damage. Targeting the PI3K/Akt pathway has tremendous potential as a therapeutic strategy for regulating macrophage polarization and activity to treat chronic liver diseases with plant chemicals, providing new avenues for liver disease treatment.