Baicalin as a potential candidate for treating systemic sclerosis

Systemic sclerosis (SSc) is a peculiar connective tissue disease characterized by a unique scenario that combines autoreactive cell activation with endothelial dysfunction and tissue fibrosis. Due to the only partially understood pathogenesis, the treatment of the disease is still controversial. Baicalin is a natural flavonoid extracted from the roots of Scutellaria baicalensis. It has been shown to be effective in preclinical models of pulmonary arterial hypertension, trophic ulcers, liver fibrosis, cancer and immune-mediated diseases. Baicalin may act via multiple mechanisms ranging from antagonizing TLR4-induced signaling to inhibiting the TGF-β/Smad3 pathway or enhancing antioxidant mechanisms. These pharmacologic properties make this agent a potential candidate for counteracting the pathogenic triad occurring in SSc. The aim of this narrative review is to summarize current knowledge on the effects of baicalin in contrasting vasculopathy, immune dysfunction and fibrosis and to explain the rationale for its use in SSc. As the efficacy/safety profile of baicalin has not been tested in SSc patients, further studies are indeed warranted.