Yuan Lou1  Han Xu1  Zixuan Lu2  Bin Wang2*  Xiaofei Liu3*

1.First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shangdong, China

2.Department of Immunology, Binzhou Medical University, Yantai, Shandong, China

3.Breast and Thyroid Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shangdong, China

Granulomatous lobular mastitis (GLM) presents significant challenges, including high rates of morbidity, recurrence, and disability, ultimately impacting women’s health and quality of life. Local autoimmune imbalance involving dysregulated cytokines and immune cells has been recognized to play a key role in the pathology of GLM. Traditional Chinese medicine (TCM), with its multi-component, multi-pathway and multi-target characteristics, offers unique advantages and broad prospects in the treatment of GLM. Here, we review the relationship between immune dysregulation and GLM, as well as the regulatory mechanisms of TCM-based interventions, with the aim of providing new insights and foundational knowledge for the clinical treatment of GLM, while promoting the further application and development of TCM-based strategies for the treatment of GLM.

1 Introduction

Granulomatous lobular mastitis (GLM) is a distinct form of inflammatory breast disease, characterized by non-caseating necrosis of breast lobules and granuloma formation, accounting for 24% of all cases of inflammatory breast disease (1). GLM typically presents with a wide range of lesions, a prolonged course, and a high recurrence rate, severely impacting the physical and mental health, as well as the quality of life of patients (2). Current treatment options include hormone therapy, immunosuppressants, and localized surgical interventions. However, these approaches are often associated with extended treatment durations of 3 to 12 months, extensive surgeries required to achieve complete lesion removal, and notably, recurrence rates ranging from 10% to 50% (3). Therefore, finding effective therapies and drugs for treating GLM is an urgent clinical issue to be addressed.

Immune imbalance plays pivotal roles in the onset and progression of autoimmune diseases. Aberrantly activated immune cells release large amounts of cytokines, triggering autoimmune attacks on host tissues. This overexpression of cytokines further exacerbates immune system hyperactivity, creating a cycle that worsens disease severity. Studies have demonstrated that in GLM, dysregulation of T cells, B cells, and Natural killer (NK) cells, along with elevated release of inflammatory cytokines, are central to the disease process. These immune dysregulations can be alleviated by immunosuppressive treatments, suggesting that immune imbalance is a key mechanism underlying the pathological damage in GLM (2, 4, 5).

Traditional Chinese Medicine (TCM), known for its multi-component, multi-pathway, and multi-target approach, has demonstrated remarkable clinical efficacy in the treatment of GLM (6–8). Although the exact mechanisms by which TCM treats GLM remain unclear, its ability to restore the local immune microenvironment at the lesion site plays a critical role (9–11). In this review, we summarize the immune-mediated pathological mechanisms of GLM and the role of TCM in recovering local immune microenvironment, with the aim of advancing the application and research of TCM in the prevention and treatment of GLM.