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2022, Vol. 26 ›› Issue (11): 1758-1764Chinese herbal prescriptions for tonifying kidney and promoting blood circulation in the intervention of steroid-induced avascular necrosis of the femoral head: relevant signal pathways and targetsHan Jie1, Ren Guowu2, Mo Jian1, Zhang Xiaoyun1, Wen Shuaibo2, Wu Yukun2
Abstract: BACKGROUND: The pathological changes of steroid-induced osteonecrosis of the femoral head involve multiple signal pathways. To elucidate the signal pathway of steroid-induced femoral head necrosis and to find the target of traditional Chinese medicine (TCM) compound intervention are of great significance for the early prevention and treatment of the disease. OBJECTIVE: To summarize the research progress in the signal pathways related to TCM prescriptions for tonifying kidney and promoting blood circulation in the intervention of steroid-induced femoral head necrosis. METHODS: PubMed, Medline, Embase, The Cochrane Library, CBM, CNKI, VIP and WanFang databases were retrieved with the keywords of “avascular necrosis of the femoral head, ANFH, glucocorticoids, pathogenesis, signal path, TCM compound, Wnt/β-catenin, HIF-1α, PPAR, TGF-β/Smad, AMPK, Notch” in English and Chinese, respectively. The articles concerning the signal pathways related to TCM prescriptions for tonifying kidney and promoting blood circulation in the intervention of steroid-induced femoral head necrosis were searched. Finally, 54 articles were included according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: At present, many clinical practices have shown that TCM prescriptions of tonifying kidney and promoting blood circulation have definite efficacy in the treatment of steroid-induced necrosis of the femoral head in the early and middle stages, but the mechanism of action is still unclear. TCM prescriptions of tonifying kidney and promoting blood circulation may intervene with steroid-induced femoral head necrosis through multiple signal pathways: increasing quantity and activity of osteoblasts via Wnt/β-catenin pathway, repairing partial necrotic vessels via hypoxia-inducible factor 1α pathway, promoting osteogenesis factor secretion via transforming growth factor-β/Smad pathway, regulating cell energy synthesis and metabolic rate via adenylate-activated protein kinase pathway, regulating cell autophagy via Notch pathway, restoring bone remodeling and absorption imbalances via receptor activator of nuclear factor kappa-B ligand/ nuclear factor kappa-B receptor activator/osteoprotegerin pathway, and regulating lipid metabolism and differentiation of bone marrow mesenchymal stem cells via peroxisome proliferator activated receptor γ pathway. To explore the influence of kidney-tonifying and blood-activating TCM compounds on the signal pathways related to femoral head necrosis, is expected to find a more effective TCM compounds for the prevention and treatment of steroid-induced femoral osteonecrosis in clinical practice. Key words:TCM prescriptions for tonifying kidney and promoting blood, Chinese herbal compound, steroid-induced necrosis of the femoral head, signal pathway, review |