miRNA-Targeted Herbal Compounds Against Gastric Precancerous Evolution in Chronic Atrophic Gastritis

Gastric cancer (GC) ranks third globally in cancer mortality. It develops via a well-defined pathological sequence: normal gastric mucosa progresses sequentially to superficial gastritis, chronic atrophic gastritis (CAG), intestinal metaplasia, dysplasia, and ultimately invasive carcinoma. Given this stepwise carcinogenic cascade, early intervention during the precancerous stage, particularly in CAG, is paramount for secondary GC prevention. Emerging evidence underscores that microRNAs (miRNAs), a major subclass of non-coding RNAs (ncRNAs), exert crucial regulatory effects on gastric carcinogenesis. Dysregulated miRNAs are frequently detected in Helicobacter pylori-infected gastric mucosa, driving chronic inflammation, epithelial-mesenchymal transition (EMT), and subsequent malignant transformation. Recently, traditional Chinese medicine (TCM) has gained increasing recognition as a promising therapeutic approach for precancerous lesions of gastric cancer (PLGC). Classical TCM formulations and bioactive herbal compounds have been shown to exert multi-targeted and multi-pathway efficacy in inhibiting the progression of this disease. This review integrates available evidence and indicates that TCM interventions, including herbal prescriptions and acupuncture, exert anti-inflammatory, anti-fibrotic and anti-metastatic effects by regulating microRNA expression profiles, thereby alleviating chronic inflammation, pathological remodeling and tumor cell invasion. Collectively, these findings demonstrate TCM's adjunctive potential in CAG treatment and GC prevention, providing a novel mechanistic approach to halt precancerous gastric carcinogenesis.