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Xia C, Xu H, Fang L, Chen J, Yuan W, Fu D, Wang X, He B, Xiao L, Wu C, Tong P, Chen D, Wang P, Jin H. β-catenin inhibition disrupts the homeostasis of osteogenic/adipogenic differentiation leading to the development of glucocorticoid-induced osteonecrosis of the femoral head. eLife 2024; 12:RP92469. [PMID: 38376133 PMCID: PMC10942600 DOI: 10.7554/elife.92469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
Glucocorticoid-induced osteonecrosis of the femoral head (GONFH) is a common refractory joint disease characterized by bone damage and the collapse of femoral head structure. However, the exact pathological mechanisms of GONFH remain unknown. Here, we observed abnormal osteogenesis and adipogenesis associated with decreased β-catenin in the necrotic femoral head of GONFH patients. In vivo and in vitro studies further revealed that glucocorticoid exposure disrupted osteogenic/adipogenic differentiation of bone marrow mesenchymal cells (BMSCs) by inhibiting β-catenin signaling in glucocorticoid-induced GONFH rats. Col2+ lineage largely contributes to BMSCs and was found an osteogenic commitment in the femoral head through 9 mo of lineage trace. Specific deletion of β-catenin gene (Ctnnb1) in Col2+ cells shifted their commitment from osteoblasts to adipocytes, leading to a full spectrum of disease phenotype of GONFH in adult mice. Overall, we uncover that β-catenin inhibition disrupting the homeostasis of osteogenic/adipogenic differentiation contributes to the development of GONFH and identify an ideal genetic-modified mouse model of GONFH.
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Affiliation(s)
- Chenjie Xia
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
- Department of Orthopedic Surgery, the Affiliated Lihuili Hospital of Ningbo UniversityNingboChina
| | - Huihui Xu
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
- The First College of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhouChina
| | - Liang Fang
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Jiali Chen
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Wenhua Yuan
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Danqing Fu
- School of Basic Medical Sciences, Zhejiang Chinese Medical UniversityHangzhouChina
| | - Xucheng Wang
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Bangjian He
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Luwei Xiao
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Chengliang Wu
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Peijian Tong
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Di Chen
- Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced TechnologyShenzhenChina
| | - Pinger Wang
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
- The First College of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhouChina
| | - Hongting Jin
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
- The First College of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhouChina
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Yang HZ, Dong R, Jia Y, Li Y, Luo G, Li T, Long Y, Liang S, Li S, Jin X, Sun T. Morroniside ameliorates glucocorticoid-induced osteoporosis and promotes osteoblastogenesis by interacting with sodium-glucose cotransporter 2. PHARMACEUTICAL BIOLOGY 2023; 61:416-426. [PMID: 36786302 PMCID: PMC9930836 DOI: 10.1080/13880209.2023.2173787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 12/10/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT Morroniside (MOR) possesses antiosteoporosis (OP) effects, but its molecular target and relevant mechanisms remain unknown. OBJECTIVE We investigated the effects of MOR on glucocorticoid-induced OP and osteoblastogenesis and its underlying mechanisms. MATERIALS AND METHODS The effects of MOR (10-100 μM) on the proliferation and differentiation of MC3T3-E1 cells were studied in vitro. The glucocorticoid-induced zebrafish OP model was treated with 10, 20 and 40 μM MOR for five days to evaluate its effects on vertebral bone density and related osteogenic markers. In addition, molecular targets prediction and molecular docking analysis were carried out to explore the binding interactions of MOR with the target proteins. RESULTS In cultured MC3T3-E1 cells, 20 μM MOR significantly increased cell viability (1.64 ± 0.12 vs. 0.95 ± 0.16; p < 0.01) and cell differentiation (1.57 ± 0.01 vs. 1.00 ± 0.04; p < 0.01) compared to the control group. MOR treatment significantly ameliorated vertebral bone loss in the glucocorticoid-induced OP zebrafish model (0.86 ± 0.02 vs. 0.40 ± 0.03; p < 0.01) and restored the expression of osteoblast-specific markers, including ALP, Runx2 and Col-І. Ligand-based target prediction and molecular docking revealed the binding interaction between MOR and the glucose pockets in sodium-glucose cotransporter 2 (SGLT2). DISCUSSION AND CONCLUSIONS These findings demonstrated that MOR treatment promoted osteoblastogenesis and ameliorated glucocorticoid-induced OP by targeting SGLT2, which may provide therapeutic potential in managing glucocorticoid-induced OP.
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Affiliation(s)
| | | | - Yutao Jia
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yuqiao Li
- Tianjin Medical University, Tianjin, China
| | - Gan Luo
- Tianjin Medical University, Tianjin, China
| | - Tianhao Li
- Tianjin Medical University, Tianjin, China
| | - Yao Long
- School of Medicine, Nankai University, Tianjin, China
| | - Shuang Liang
- School of Medicine, Nankai University, Tianjin, China
| | - Shanshan Li
- School of Medicine, Nankai University, Tianjin, China
| | - Xin Jin
- School of Medicine, Nankai University, Tianjin, China
| | - Tianwei Sun
- Tianjin Medical University, Tianjin, China
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, China
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Ruan H, Zhang H, Feng J, Luo H, Fu F, Yao S, Zhou C, Zhang Z, Bian Y, Jin H, Zhang Y, Wu C, Tong P. Inhibition of Caspase-1-mediated pyroptosis promotes osteogenic differentiation, offering a therapeutic target for osteoporosis. Int Immunopharmacol 2023; 124:110901. [PMID: 37839278 DOI: 10.1016/j.intimp.2023.110901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/20/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Pyroptosis, an emerging inflammatory form of cell death, has been previously demonstrated to stimulate a massive inflammatory response, thus hindering the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Nevertheless, the impact of pyroptosis in thwarting osteogenic differentiation and exacerbating the advancement of osteoporosis (OP) remains enigmatic. METHODS We evaluated the expression levels of pyroptosis-associated indicators, including NOD-like receptor family pyrin domain-containing protein 3 (NLRP3), CASPASE-1, IL-1β, and IL-18, in specimens obtained from femoral heads of OP patients, as well as in an ovariectomy-induced mouse model of OP. Subsequently, the precise roles of pyroptosis in osteogenic differentiation were investigated using bioinformatics analysis, alongside morphological and biochemical assessments. RESULTS The pivotal pyroptotic proteins, including NLRP3, Caspase-1, IL-1β, and IL-18, exhibited significant upregulation within the bone tissue samples of clinical OP cases, as well as in the femoral tissues of ovariectomy (OVX)-induced mouse OP model, displaying a negatively associated with compromised osteogenic capacity, as represented by lessened bone mass, suppressed expression of osteogenic proteins such as Runt-related transcription factor 2 (RUNX2), Alkaline phosphatase (ALP), Osterix (OSX), and Osteopontin (OPN), and increased lipid droplets. Moreover, bioinformatics analysis substantiated shared gene expression patterns between pyroptosis and OP pathology, encompassing NLRP3, Caspase-1, IL-1β, IL-18, etc. Furthermore, our in vitro investigation using ST2 cells revealed that dexamethasone treatment prominently induced pyroptosis while impeding osteogenic differentiation. Notably, gene silencing of Caspase-1 effectively counteracted the inhibitory effects of dexamethasone on osteogenic differentiation, as manifested by increased ALP activity and enhanced expression of RUNX2, ALP, OSX, and OPN. CONCLUSION Our findings unequivocally underscore that inhibition of Caspase-1-mediated pyroptosis promotes osteogenic differentiation, providing a promising therapeutic target for managing OP.
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Affiliation(s)
- Hongfeng Ruan
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huihao Zhang
- Department of Orthopaedics, First Hospital of Wuhan, Wuhan, Hubei, China; Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology, Hangzhou, Zhejiang, China
| | - Jing Feng
- Department of Orthopaedics, First Hospital of Wuhan, Wuhan, Hubei, China
| | - Huan Luo
- Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fangda Fu
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Sai Yao
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chengcong Zhou
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhiguo Zhang
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yishan Bian
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hongting Jin
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yuliang Zhang
- Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology, Hangzhou, Zhejiang, China.
| | - Chengliang Wu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Peijian Tong
- Institute of Orthopaedics and Traumatology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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Liang G, Zhao J, Zhao D, Dou Y, Huang H, Yang W, Zhou G, Gu Z, Pan J, Liu J. Longbie capsules reduce bone loss in the subchondral bone of rats with comorbid osteoporosis and osteoarthritis by regulating metabolite alterations. Front Med (Lausanne) 2023; 10:1256238. [PMID: 37915330 PMCID: PMC10616798 DOI: 10.3389/fmed.2023.1256238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
Background and objective With the development of global population aging, comorbidity (≥2 diseases) is a common health problem among elderly people. Osteoarthritis (OA) and osteoporosis (OP) are common in elderly individuals. There is a lack of drug therapy for OA and OP comorbidities. The purpose of this study was to explore the efficacy and mechanism of Longbie capsule (LBJN), which contains various plant herbs, in treating OA and OP comorbidities (OA + OP) in rats using metabolomics techniques. Methods We created an OA + OP rat model through bilateral oophorectomy combined with meniscus instability surgery. Thirty SD rats were randomly divided into five groups (six in each group), namely, the sham group, OA group, OA + OP group, LBJN low-dose group (0.625 g/kg, OA + OP+LB-L group) and LBJN high-dose group (1.25 g/kg, OA + OP+LB-H group). After 8 weeks of intervention, we used micro-CT to detect bone microstructure status, ELISA to measure bone metabolism indicators, and UPLC-MS technology for metabolomics analysis. Finally, the screened differentially expressed metabolites were subjected to Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and functional enrichment analysis. Results The micro-CT results showed that LBJN significantly improved the bone mineral density (BMD) and bone quality of subchondral bone in OA + OP rats, and LBJN regulated the expression of bone alkaline phosphatase (BALP), osteoprotegerin (OPG), and tartrate-resistant acid phosphatase (TRACP) in serum to maintain bone metabolism balance. Metabolomics analysis showed that the metabolic trajectory of OA + OP rats after intervention in the OA + OP+LB-H group showed significant changes, and 107 potential biomarkers could be identified. Among them, 50 metabolites were upregulated (such as zeranol) and 57 were downregulated (such as vanillactic acid). The KEGG functional enrichment results indicated that the differentially expressed metabolites are mainly involved in amino acid metabolism, lipid metabolism, and carbohydrate metabolism. The KEGG pathway enrichment results indicated that LBJN may exert therapeutic effects on OA + OP rats by regulating the cAMP signaling pathway, and the FoxO signaling pathway. Conclusion LBJN can maintain bone metabolism balance by regulating serum lipid metabolism, amino acid metabolism, carbohydrate metabolism, and estrogen, thereby reducing bone loss in subchondral bone, which may be a potential mechanism through which LBJN treats OA + OP.
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Affiliation(s)
- Guihong Liang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jinlong Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Di Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yaoxing Dou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Hetao Huang
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Weiyi Yang
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Guanghui Zhou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhuoxu Gu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianke Pan
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Chinese Medicine Hospital (Guangdong Province Enginering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
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Xia C, Zhu H, Li J, Jin H, Fu D. Network pharmacology-based mechanism prediction and pharmacological validation of Bushenhuoxue formula attenuating postmenopausal osteoporosis in ovariectomized mice. J Orthop Surg Res 2023; 18:200. [PMID: 36918900 PMCID: PMC10012505 DOI: 10.1186/s13018-023-03696-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Bushenhuoxue (BSHX) formula, a ten-compound herbal decoction, is widely used to treat postmenopausal osteoporosis (PMOP) in China. However, the mechanism is not clear yet. METHODS The underlying biological processes and signaling pathways were predicted by network pharmacology. In vivo experimental study, 24 female C57BL/6 J mice were randomly divided into sham, ovariectomized (OVX) and BSHX formula groups. Mice in the latter two groups were subjected to bilateral ovariectomy, and mice in the BSHX formula group were extra treated by BSHX formula at an oral dosage of 0.2 mL/10 g for 8 weeks. The femur samples were harvested for tissue analyses including μCT assay, histology and immunohistochemical (IHC) staining of VEGF signaling. RESULTS A total of 218 active ingredients and 274 related targets were identified in BSHX formula. After matching with 292 targets of PMOP, 64 overlapping genes were obtained. GO and KEGG enrichment analyses on these 64 genes revealed that angiogenesis and VEGF signaling were considered as the potential therapeutic mechanism of BSHX formula against PMOP. Animal experiments showed that mice in the BSHX formula-treated group presented increased bone mass, microstructural parameters, blood vessel numbers and an activation of VEGF signaling (VEGF, COX2, eNOS and CD31) compared to the OVX mice. CONCLUSION This study revealed that BSHX formula exerts anti-PMOP effects possibly through activating VEGF signaling-mediated angiogenesis.
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Affiliation(s)
- Chenjie Xia
- Department of Orthopedic Surgery, Li Huili Hospital Affiliated to Ningbo University, Ningbo, 315048, People's Republic of China
| | - Haowei Zhu
- Department of Orthopedic Surgery, Ningbo Yinzhou No. 2 Hospital, Ningbo, 315199, People's Republic of China
| | - Jin Li
- Department of Orthopedic Surgery, Li Huili Hospital Affiliated to Ningbo University, Ningbo, 315048, People's Republic of China
| | - Hongting Jin
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Danqing Fu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, No. 548, Binwen Road, Hangzhou, 310053, Zhejiang Province, People's Republic of China.
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Pan J, Bao Y, Pan S, Zhuang D, Xu Y, Pan X, Li H. Hydroxysafflor Yellow A-Induced Osteoblast Differentiation and Proliferation of BM-MSCs by Up-Regulating Nuclear Vitamin D Receptor. Curr Mol Med 2023; 23:410-419. [PMID: 35996252 DOI: 10.2174/1566524023666220820125924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/03/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitamin D receptor (VDR) is critical for mineral and bone homeostasis since it plays an essential role in the osteoblast differentiation of bone marrow mesenchymal stem cells (BM-MSCs). Hydroxysafflor yellow A (HSYA) has the potential to promote bone mineralization and inhibit bone resorption, while its detailed mechanism needs to be elaborated. OBJECTIVE This study intends to explore the action of HSYA on the proliferation and differentiation of BM-MSC and the underlying mechanism. METHODS Different concentrations of HSYA to BM-MSC and CCK-8, and EdU were used to detect cell viability and proliferation. The alkaline phosphatase (ALP) was used to observe the differentiation ability of BM-MSC osteoblasts. The calcium uptake and mineralization of osteoblast-like cells were observed by alizarin red staining. The level of calcium ion uptake in cells was detected by flow cytometry. AutoDock was performed for molecular docking of HSYA to VDR protein. Immunofluorescence and western blotting were performed to detect the expression of VDR expression levels. Finally, the effect of VDR was verified by a VDR inhibitor. RESULTS After treatment with HSYA, the proliferation and calcium uptake of BM-MSC were increased. The level of ALP increased significantly and reached its peak on the 12th day. HSYA promoted calcium uptake and calcium deposition, and mineralization of osteoblasts. The western blotting and immunofluorescence showed that HSYA increased the expression of VDR in the osteoblast-like cell's nucleus and upregulated Osteocalcin, S100 calcium-binding protein G, and CYP24A1. In addition, HYSA treatment increased the expression of osteopontin and the synthesis of osteogenic proteins, such as Type 1 collagen. After the addition of the VDR inhibitor, the effect of HSYA was weakened. CONCLUSION HSYA could significantly promote the activity and proliferation of osteoblasts and increase the expression level of VDR in osteoblasts. HSYA may also improve calcium absorption by osteoblasts by regulating the synthesis of calciumbinding protein and vitamin D metabolic pathway-related proteins.
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Affiliation(s)
- Jiewen Pan
- Key Laboratory of Comprehensive Prevention and Treatment of Congenital Anomalies, Women's and Children's Hospital of Ningbo, Ningbo, China
| | - Youwei Bao
- Key Laboratory of Comprehensive Prevention and Treatment of Congenital Anomalies, Women's and Children's Hospital of Ningbo, Ningbo, China
| | - Shuqing Pan
- Key Laboratory of Comprehensive Prevention and Treatment of Congenital Anomalies, Women's and Children's Hospital of Ningbo, Ningbo, China
| | - Danyan Zhuang
- Key Laboratory of Comprehensive Prevention and Treatment of Congenital Anomalies, Women's and Children's Hospital of Ningbo, Ningbo, China
| | - Yanan Xu
- Science and Education Department, Women's and Children's Hospital of Ningbo, Ningbo, China
| | - Xiaoli Pan
- Key Laboratory of Comprehensive Prevention and Treatment of Congenital Anomalies, Women's and Children's Hospital of Ningbo, Ningbo, China
| | - Haibo Li
- Key Laboratory of Comprehensive Prevention and Treatment of Congenital Anomalies, Women's and Children's Hospital of Ningbo, Ningbo, China
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Elucidation of the Underlying Mechanism of Gujian Oral Liquid Acting on Osteoarthritis through Network Pharmacology, Molecular Docking, and Experiment. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9230784. [PMID: 35937393 PMCID: PMC9352474 DOI: 10.1155/2022/9230784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 11/20/2022]
Abstract
Gujian oral liquid (GJ), a traditional herbal formula in China, has been widely used to treat patients with osteoarthritis (OA). Nevertheless, the active component and potential mechanism of GJ are not fully elucidated. Thus, we investigate the effect of GJ and explore its underlying mechanism on OA through network pharmacology and experimental validation. First, a total of 175 bioactive compounds were identified, and 134 overlapping targets were acquired after comparing the targets of the GJ with those of OA. 8 hub targets, including IL6 and AKT1, were obtained in PPI network analysis. Then, we built up GJ-target-OA network and protein-protein interaction (PPI) network, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. The results underlined inflammatory tumor necrosis factor (TNF) as a promising signaling pathway of GJ for OA treatment. Moreover, molecular docking also verified the top two active compounds had direct bindings with the top three target genes. Finally, we verified the effect of GJ on OA in vivo and in vitro. In vivo experiments validated that GJ not only significantly attenuated OA phenotypes including articular cartilage degeneration and subchondral bone sclerosis but also reduced the expressions of tumor necrosis factor-α (TNF-α) and p-p65 in articular chondrocytes. Besides, GJ serum also had a protective effect on chondrocytes against inflammation caused by TNF-α in vitro. Hence, our study predicted and verified that GJ could exert anti-inflammation and anticatabolism effects partially via regulating TNF-α/NF-kappa B (NF-κB) signaling.
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Zhao J, Xiao X, Zhou G, Xu N, Liu J. Effectiveness of Yushen Hezhi therapy for postmenopausal osteoporosis: An overview of systematic reviews of randomized controlled trials. Front Endocrinol (Lausanne) 2022; 13:1015483. [PMID: 36225202 PMCID: PMC9548895 DOI: 10.3389/fendo.2022.1015483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To review systematic reviews (SRs) and meta-analyses (MAs) of Yushen Hezhi therapy (YSHZT) for postmenopausal osteoporosis (PMOP) to provide an evidence-based recommendation for researchers and decision makers. METHODS We searched the PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM) and Wanfang databases for published SRs and MAs on YSHZT for the treatment of PMOP. The retrieval time was limited to July 2022. The Assessing the Methodological Quality of Systematic Reviews (AMSTAR)-2 tool and Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) classification system were used to evaluate the methodological quality and the evidence quality of the SRs and MAs, respectively. RESULTS A total of 14 SRs and MAs involving 14720 cases of PMOP were included. The results of the methodological quality evaluation indicated that there were no studies with medium- or high-quality methodology included in the study and that there were 9 and 5 low- and very low-quality studies, respectively. The GRADE evaluation results show that while there was no high-level evidence based on 86 evaluation indicators, there was 1 study with moderate-level evidence (1%), 44 studies with low-level evidence (51%) and 41 with very low-level evidence (48%) based on other indicators. YSHZT can significantly improve the bone mineral density (BMD) of Ward's triangle, with a mean difference range of 0.03 to 0.12. Different conclusions were reported regarding the BMD of the lumbar spine, femoral trochanter, femoral neck, and hip, as well as bone turnover markers, adverse reactions and other outcome indicators in different SRs and thus still need further study. CONCLUSIONS The methodological quality and the evidence quality of the outcome indicators for YSHZT in the treatment of PMOP are poor, and the efficacy and safety of YSHZT in the treatment of PMOP still need to be further verified by more high-quality studies.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Xiao Xiao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guanghui Zhou
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nanjun Xu
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Enginering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- *Correspondence: Jun Liu,
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9
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Zhang P, Ye J, Dai J, Wang Y, Chen G, Hu J, Hu Q, Fei J. Gallic acid inhibits osteoclastogenesis and prevents ovariectomy-induced bone loss. Front Endocrinol (Lausanne) 2022; 13:963237. [PMID: 36601012 PMCID: PMC9807166 DOI: 10.3389/fendo.2022.963237] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Osteoporosis is a common metabolic bone disease with a rapidly increasing prevalence, characterized by massive bone loss because of excessive osteoclast formation. Gallic acid (GA), a phenolic acid isolated from Cornus officinalis, has anti-inflammatory and anti-oxidant effects, but its effect on osteoclast formation has not been confirmed. In our study, we demonstrated that GA significantly inhibited RANKL-induced osteoclast formation and function of osteoclast in bone marrow monocytes (BMMs) and RAW264.7 cells in a dose-dependent manner without cytotoxicity. For molecular mechanisms, GA repressed osteoclastogenesis by blocking Akt, ERK, and JNK pathways, and suppressed osteoclastogenesis-related marker expression, including nuclear factor of the activated T-cell cytoplasmic 1 (NFATc1), c-Fos, and cathepsin K (CTSK). In addition, we further assessed the effect of GA in an ovariectomized mouse model, which indicated that GA has a notable effect on preventing bone loss. In conclusion, GA exerts notable effects in inhibiting osteoclastogenesis and preventing ovariectomy-induced bone loss, suggesting that GA is a potential agent in osteoporosis treatment.
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Affiliation(s)
- Peng Zhang
- Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Jiekai Ye
- Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Jiale Dai
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ying Wang
- Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Genjun Chen
- Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Jinping Hu
- Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Qimiao Hu
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Qimiao Hu, ; Jun Fei,
| | - Jun Fei
- Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
- *Correspondence: Qimiao Hu, ; Jun Fei,
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10
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Liu Y, Fu B, Li X, Chen C, Li X, Xu L, Wang B. Bushen huoxue decoction inhibits RANKL-stimulated osteoclastogenesis and glucocorticoid-induced bone loss by modulating the NF-κB, ERK, and JNK signaling pathways. Front Pharmacol 2022; 13:1007839. [PMID: 36467086 PMCID: PMC9716084 DOI: 10.3389/fphar.2022.1007839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis, which is caused by a disorder in bone metabolism due to excessive activation of osteoclasts. Bushen Huoxue decoction (BHD) is an herbal formula with multiple pharmacological effects, including anti-inflammatory, antioxidant activity and stem cell migration promotion. However, the effect of BHD on osteoclastogenesis has not been reported. In this study, we aimed to elucidate the effect of BHD on RANKL-stimulated osteoclastogenesis and explored its underlying mechanisms of action in vitro. Our results show that BHD had no effect on BMMs and RAW264.7 cells viability, but inhibited RANKL-induced osteoclast formation in vitro. Furthermore, BHD attenuated RANKL-induced NF-κB, ERK, and JNK signaling. The attenuation of NF-κB, ERK, and JNK activation were enough to impede downstream expression of c-fos and NFATc1 and related specific genes. Meanwhile, we investigated the therapeutic effect of BHD on glucocorticoid-induced osteoporosis (GIOP) mice. The result indicated that BHD prevents glucocorticoid-induced osteoporosis and preserves bone volume by repressing osteoclast activity. Collectively, BHD shows significant osteoclast inhibition and holds great promise in the treatment of osteoporosis.
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Affiliation(s)
- Yamei Liu
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Binlan Fu
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China.,Laboratory of Orthopedics and Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoman Li
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China.,Laboratory of Orthopedics and Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chen Chen
- School of Chinese Herbal Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xican Li
- School of Chinese Herbal Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liangliang Xu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bin Wang
- Department of Traumatology, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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11
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Wang L, Li Y, Xie S, Huang J, Song K, He C. Effects of Pulsed Electromagnetic Field Therapy at Different Frequencies on Bone Mass and Microarchitecture in Osteoporotic Mice. Bioelectromagnetics 2021; 42:441-454. [PMID: 34082467 DOI: 10.1002/bem.22344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/16/2021] [Accepted: 04/11/2021] [Indexed: 02/05/2023]
Abstract
A pulsed electromagnetic field (PEMF) can promote osteogenesis. However, studies have shown variation in the signal characteristics in terms of waveform type, intensity, frequency, and treatment duration. Among the factors that affect electromagnetic fields, frequency plays a major role. However, few studies have investigated the effects of PEMF at different frequencies in osteoporotic mice. Therefore, our objective was to determine the effect of PEMF frequency in osteoporotic mice. Forty 3-month-old female mice were randomly divided into the following five groups: sham, OVX, and OVX followed by 1.6-mT PEMF exposure groups (8 Hz, 50 Hz, and 75 Hz, 1.6 mT). The PEMF was applied for 1 h/day, 7 days/week, for 4 weeks. After 4 weeks, the micro-computed tomography showed that PEMF with (50 and 75 Hz) ameliorated the deterioration of bone microarchitecture. Improvements in the bone histological analysis were identified for PEMF with 50 and 75 Hz groups compared with the ovariectomy (OVX) controls. Osteoclast numbers were decreased in PEMF with (50 and 75 Hz). Moreover, the real-time PCR demonstrated PEMF with (50 and 75 Hz) significantly promoted the expression of the osteoblast-related genes (ALP, OCN, Runx2), and increased the serum PINP. PEMF with (50 and 75 Hz) exerted significant inhibitory effects on the osteoclast-related mRNA expression (CTSK, NFATc1, TRAP) and bone resorption markers CTX-I and IL-1β. Taken together, our results showed that PEMF at 50 and 75 Hz with 1.6 mT significantly ameliorate the deterioration of bone microarchitecture in OVX mice. The inhibitory effect of PEMF may be associated with IL-1β inhibition. © 2021 Bioelectromagnetics Society.
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Affiliation(s)
- Liqiong Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China.,Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China.,Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, P. R. China
| | - Yi Li
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China.,Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Suhang Xie
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China.,Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Jinming Huang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China.,Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Kangping Song
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China.,Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Chengqi He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China.,Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China.,Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, P. R. China
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12
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Effect of resveratrol and mesenchymal stem cell monotherapy and combined treatment in management of osteoporosis in ovariectomized rats: Role of SIRT1/FOXO3a and Wnt/β-catenin pathways. Arch Biochem Biophys 2021; 703:108856. [PMID: 33781770 DOI: 10.1016/j.abb.2021.108856] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 02/08/2023]
Abstract
Osteoporosis is a skeletal disorder that is common in postmenopausal women. It is characterized by deteriorated bone mass and microarchitecture. In this study, we aimed to explore the effects and molecular mechanisms of resveratrol and mesenchymal stem cell (MSC) individual and combined treatment in management of osteoporosis in ovariectomized rats. Our results demonstrated that treatment of ovariectomized rats with resveratrol or MSCs improved bone mass and microstructure as indicated by increased bone mineral content and density. Moreover, resveratrol and MSCs stimulated osteogenesis as shown by increased levels of osteogenic markers such as runt-related transcription factor 2 (RUNX2). In addition, resveratrol and MSCs inhibited adipogenesis and osteoclastogenesis as indicated by the suppression of the adipogenic marker, peroxisome proliferator-activated receptor gamma (PPARγ) and the osteoclastogenesis marker, receptor activator of nuclear factor-κB ligand (RANKL). Mechanistically, our results showed that management of osteoporosis in resveratrol or MSC treated rats was achieved by activating two signaling pathways, sirtuin 1 (SIRT1) and wingless-related MMTV integration site (Wnt). Finally, the combination of resveratrol and MSCs was more effective in increasing bone mass and improving osteoporosis than individual treatments.
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13
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Li R, Dong Y, Li F. ETS Proto-Oncogene 1 Suppresses MicroRNA-128 Transcription to Promote Osteogenic Differentiation Through the HOXA13/β-Catenin Axis. Front Physiol 2021; 12:626248. [PMID: 33746773 PMCID: PMC7965964 DOI: 10.3389/fphys.2021.626248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/09/2021] [Indexed: 12/23/2022] Open
Abstract
ETS proto-oncogene 1 (ETS1) has been implicated in osteoporosis (OP), but the exact molecular mechanisms are complex. This work focuses on the impact of ETS1 on the osteogenic differentiation and the molecules involved. A mouse pre-osteoblast cell line MC3T3-E1 was used for in vitro experiments. ETS1 was upregulated during the process of osteogenic differentiation of MC3T3-E1 cells. Overexpression of ETS1 promoted expression of osteogenic markers, alkaline phosphate concentration, and calcareous accumulation in cells. ETS1 was found to specifically bind to miR-128 promoter to suppress its transcription, while miR-128 could target homeobox A13 (HOXA13). Therefore, ETS1 suppressed miR-128 transcription to upregulate HOXA13 expression. Overexpression of HOXA13 promoted the osteogenic differentiation ability of cells and increased the protein level of β-catenin. Either overexpression of miR-128 or downregulation of β-catenin by CWP232228, a β-catenin-specific antagonist, blocked the promoting roles of ETS1 in cells. To conclude, this study provided evidence that ETS1 suppresses miR-128 transcription to activate the following HOXA13/β-catenin axis, therefore promoting osteogenic differentiation ability of MC3T3-E1 cells. This finding may offer novel ideas for OP treatment.
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Affiliation(s)
- Renyao Li
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ying Dong
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Feipeng Li
- Naton Biotech (Beijing) Co., Ltd., Beijing, China
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14
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Zhang H, Zhou C, Zhang Z, Yao S, Bian Y, Fu F, Luo H, Li Y, Yan S, Ge Y, Chen Y, Zhan K, Yue M, Du W, Tian K, Jin H, Li X, Tong P, Ruan H, Wu C. Integration of Network Pharmacology and Experimental Validation to Explore the Pharmacological Mechanisms of Zhuanggu Busui Formula Against Osteoporosis. Front Endocrinol (Lausanne) 2021; 12:841668. [PMID: 35154014 PMCID: PMC8831245 DOI: 10.3389/fendo.2021.841668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Osteoporosis (OP) is a common skeletal disease, characterized by decreased bone formation and increased bone resorption. As a novel Chinese medicine formula, Zhuanggu Busui formula (ZGBSF) has been proved to be an effective prescription for treating OP in clinic, however, the pharmacological mechanisms underlying the beneficial effects remain obscure. In this study, we explored the pharmacological mechanisms of ZGBSF against OP via network pharmacology analysis coupled with in vivo experimental validation. The results of the network pharmacology analysis showed that a total of 86 active ingredients and 164 targets of ZGBSF associated with OP were retrieved from the corresponding databases, forming an ingredient-target-disease network. The protein-protein interaction (PPI) network manifested that 22 core targets, including Caspase-3, BCL2L1, TP53, Akt1, etc, were hub targets. Moreover, functional enrichment analyses revealed that PI3K-Akt and apoptosis signalings were significantly enriched by multiple targets and served as the targets for in vivo experimental study validation. The results of animal experiments revealed that ZGBSF not only reversed the high expression of Caspase-3, Bax, Prap, and low expression of Bcl-2 in osteoblasts of the OP mouse model but also contributed to the phosphorylation of Akt1 and expression of PI3K, thereby promoting osteogenesis and ameliorating the progression of OP. In conclusion, this study systematically and intuitively illustrated that the possible pharmacological mechanisms of ZGBSF against OP through multiple ingredients, targets, and signalings, and especially the inhibition of the apoptosis and the activation of PI3K-Akt signaling.
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Affiliation(s)
- Huihao Zhang
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengcong Zhou
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiguo Zhang
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Sai Yao
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yishan Bian
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Fangda Fu
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Huan Luo
- Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Li
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuxin Yan
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuying Ge
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuying Chen
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Kunyu Zhan
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ming Yue
- Department of Physiology, College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Weibin Du
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Research Institute of Orthopedics, The Affiliated Jiang Nan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kun Tian
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongting Jin
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaofeng Li
- Department of Orthopedics and Traumatology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Hongfeng Ruan, ; Peijian Tong, ; Xiaofeng Li,
| | - Peijian Tong
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Hongfeng Ruan, ; Peijian Tong, ; Xiaofeng Li,
| | - Hongfeng Ruan
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Hongfeng Ruan, ; Peijian Tong, ; Xiaofeng Li,
| | - Chengliang Wu
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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