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2024, Vol. 28 ›› Issue (23): 3751-3758

Active ingredients of Panax notoginseng regulate signaling pathways related to steroid-induced necrosis of the femoral head

Han Jie1, Peng Qinglin2, Xu Zhiwei1, Wu Yukun1, Ren Guowu2, Xie Xiaozhong2, Jin Wanqing2, Yang Ling2   

  1. 1Department of Joint and Sports Medicine, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530000, Guangxi Zhuang Autonomous Region, China; 2Guangxi University of Chinese Medicine, Nanning 530000, Guangxi Zhuang Autonomous Region, China

  • Received:2023-05-25 Accepted:2023-06-20 Online:2024-08-18 Published:2023-09-14

  • Contact: Han Jie, Department of Joint and Sports Medicine, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530000, Guangxi Zhuang Autonomous Region, China

  • About author:Han Jie, Master, Professor, Chief physician, Department of Joint and Sports Medicine, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530000, Guangxi Zhuang Autonomous Region, China

  • Supported by:

    National Natural Science Foundation of China, No. 82260858 (to HJ); Guangxi Education Department Young Teachers’ Scientific Research Ability Improvement Project, No. 2021KY0290 (to XZW); Three-year Action Plan Project for Construction of High-level Talent Team of Guangxi University of Chinese Medicine, No. 2022V001; Guangxi Young Qihuang Scholar Training Project in 2022, No. GTYKEF[2022]13 (to HJ)


Abstract: BACKGROUND: Steroid-induced osteonecrosis of the femoral head is a refractory disease in the field of orthopedics. There is no definitive idea to fully explain its pathogenesis. With the increased research on the active ingredients of Panax notoginseng interfering with the signaling pathways related to various diseases, the active ingredients of Panax notoginseng that treat steroid-induced necrosis of the femoral head via the regulation of relevant signaling pathways have gradually become a hot research topic.
OBJECTIVE: To systematically summarize the literature on the pathological mechanism of steroid-induced osteonecrosis of the femoral head and the regulation of signaling pathways by the active ingredients of Panax notoginseng in recent years, thereby providing a reference for the follow-up study on the active ingredients of Panax notoginseng in the treatment of this disease.
METHODS: CNKI, WanFang, and PubMed were searched for relevant literature with the key words of “glucocorticoid, steroid-induced osteonecrosis of the femoral head, pathological mechanism, signaling pathway, Panax notoginseng, active ingredient” in Chinese and English. Documents related to the pathological mechanism of steroid-induced osteonecrosis of the femoral head as well as related to the intervention of active ingredients of Panax notoginseng on the signaling pathway of steroid-induced osteonecrosis of the femoral head were retrieved. A total of 63 documents were finally included according to the inclusion and exclusion criteria.
RESULTS AND CONCLUSION: The main ingredients of Panax notoginseng include Panax notoginseng saponins, ginsenoside, Panax notoginseng saponins, quercetin, kaempferol, etc. Panax notoginseng saponins, ginsenoside Rb1 and quercetin can promote bone repair and angiogenesis by acting on the transforming growth factor-β/bone morphogenetic protein pathway. Panax notoginseng saponins, ginsenoside CK and kaempferol can promote osteogenic differentiation and lipid metabolism by acting on the Wnt/β-catenin pathway. Panax notoginseng saponins and Panax notoginseng saponins R1/R2 act on the MAPK pathway to inhibit osteoclastogenesis and promote bone repair. Panax notoginseng saponins, ginsenoside Rb2 and quercetin can inhibit osteoclast proliferation and promote osteoblastic differentiation by acting on the RANKL/RANK/OPG pathway. Panax notoginseng saponins, quercetin and kaempferol can repair vascular injury and promote osteogenesis by acting on the hypoxia-inducible factor-1α pathway. Panax notoginseng saponins R1, quercetin combined with hydroxyapatite nanoparticles, Panax notoginseng saponins combined with polyethylene-L-lactic acid and other biomaterials have good research prospects in the treatment of steroid-induced osteonecrosis of the femoral head. The active ingredients of Panax notoginseng can regulate the signaling pathways related to steroid-induced osteonecrosis of the femoral head through various mechanisms, and play an active intervention role in the disease. However, the depth and breadth of relevant research are insufficient at present, and the future research should be based on the existing mechanism to explore the specific mechanism of Panax notoginseng regulating different pathways and the interaction between pathways, which will be beneficial to the multi-development of the active ingredients of Panax notoginseng in the treatment of steroid-induced osteonecrosis of the femoral head.

Key words: Panax notoginseng, active ingredient, glucocorticoid, steroid-induced osteonecrosis of the femoral head, pathological mechanism, osteoblast, osteoclast, signaling pathway, review


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