Therapeutic potential of Asiaticoside in wound healing after endoscopic submucosal dissection (ESD)

Endoscopic submucosal dissection (ESD) is the standard treatment for early gastrointestinal cancers but is often complicated by delayed healing and stenosis. Current therapies like proton pump inhibitors primarily suppress acid without actively promoting mucosal regeneration. Asiaticoside (AS), a triterpenoid from Centella asiatica, shows promise in tissue repair.

This review evaluates the therapeutic potential of AS for ESD-induced wound healing, focusing on its pharmacological mechanisms and emerging delivery strategies.

A comprehensive literature search was conducted using databases such as PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI). Relevant in vitro, preclinical, and clinical studies regarding AS, wound healing, fibrosis, and drug delivery systems were selected and synthesized to analyze efficacy and safety.

AS accelerates healing through multifaceted mechanisms: it exerts anti-inflammatory effects via NF-κB and MAPK pathways, reduces oxidative stress through Nrf2/HO-1 signaling, and inhibits fibrosis by modulating TGF-β/Smad axes. Additionally, AS promotes angiogenesis and collagen synthesis. While clinical data supports its use in skin wounds, its gastrointestinal application is hindered by poor bioavailability. Novel delivery systems, including hydrogels and microneedles, are identified as solutions for localized, sustained release.

AS offers a promising therapeutic evolution, moving from reliance on passive acid suppression toward a synergistic model that integrates acid control with active mucosal regeneration for ESD management. Future research should focus on optimizing endoscope-compatible delivery platforms to facilitate clinical translation and reduce postoperative complications.