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Huang H, Tang S, Zhou Y, Cai Y. Tectorigenin inhibits inflammatory responses in murine inflammatory bowel disease and LPS-stimulated macrophages via inactivating MAPK signaling pathway. Immun Inflamm Dis 2024; 12:e1077. [PMID: 38722267 PMCID: PMC11080961 DOI: 10.1002/iid3.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/28/2023] [Accepted: 10/27/2023] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Considering the antihepatitis effects of Tectorigenin (TEC), and the same adenosine mitogen-activated protein kinase (MAPK) pathway in both hepatitis and inflammatory bowel disease (IBD) models, exploring the role of TEC in IBD is contributive to develop a new treatment strategy against IBD. METHODS The IBD mouse model was constructed by feeding with dextran sodium sulfate (DSS) and injection of TEC. Afterward, the mouse body weight, colon length, and disease activity index (DAI) were tested to assess the enteritis level. Mouse intestine lesions were detected by hematoxylin and eosin staining. Murine macrophages underwent lipopolysaccharide (LPS) induction to establish an inflammation model. Cell viability was determined by cell counting kit-8 assay. Enzyme-linked immunosorbent assay was performed to measure interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) levels. Cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) expressions were quantified via quantitative reverse transcription polymerase chain reaction. Levels of MAPK pathway-related proteins (p-P38, P38, p-Jun N-terminal kinase (JNK), JNK, signal-regulated kinase (ERK), p-ERK), COX-2 and iNOS were quantitated by Western blot. RESULTS TEC improved the inflammatory response through ameliorating weight loss, shortening colon, and increasing DAI score in IBD mouse. Expressions of intestinal inflammatory factors (IL-6, TNF-α, iNOS and COX-2) and MAPK pathway-related proteins (p-P38, p-JNK, and p-ERK) were increased both in DSS-induced mouse intestinal tissue, but TEC inhibited expressions of inflammatory factors. The same increased trend was identified in LPS-induced macrophages, but TEC improved macrophage inflammation, as evidenced by downregulation of inflammatory factors. CONCLUSION TEC mitigates IBD and LPS-induced macrophage inflammation in mice via inhibiting MAPK signaling pathway.
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Affiliation(s)
- Hong Huang
- Department of TCM and Integrated TCM and Western MedicineHunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Sanhui Tang
- Department of TCM and Integrated TCM and Western MedicineHunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Yanghong Zhou
- Department of TCM and Integrated TCM and Western MedicineHunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Yi Cai
- Department of Liver and Gall SurgicalHunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal UniversityChangshaChina
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Li J, Yang J, Zhu B, Fan J, Hu Q, Wang L. Tectorigenin protects against unilateral ureteral obstruction by inhibiting Smad3-mediated ferroptosis and fibrosis. Phytother Res 2021; 36:475-487. [PMID: 34964161 DOI: 10.1002/ptr.7353] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/09/2021] [Accepted: 11/27/2021] [Indexed: 12/20/2022]
Abstract
Renal tubular epithelial cell (TEC) injury and fibrosis are the key factors of the pathogenesis of chronic kidney disease. Here, we reported that tectorigenin is effectively protected against obstructive nephropathy established by unilateral ureteral obstruction (UUO). In vivo, tectorigenin administration significantly alleviated the deteriorations of renal functions including blood urea nitrogen and creatinine. Meanwhile, results from the histology suggested that renal injury characterized by tubular cell damage and fibrosis lesions of kidneys in UUO group were markedly attenuated following tectorigenin treatment. Mechanistically, we found that tectorigenin treatment greatly inhibited Smad3 phosphorylation, and the transcription and protein level of Nox4, a newly identified direct downstream molecule of Smad3 and a modulator of ferroptosis, while it indirectly restored the expression of glutathione peroxidase 4, a negative regulator of ferroptosis. Consistent with in vivo studies, treatment with tectorigenin also suppressed the ferroptosis induced by erastin/RSL3 and fibrosis stimulated by transforming growth factor β1 (TGF-β1) in primary renal TECs. What is more, treatment with ferroptosis inhibitor, ferrostatin-1, also impeded TGF-β1 stimulated the profibrotic effects in TECs, indicating that tectorigenin may relieve fibrosis by inhibiting ferroptosis in TECs. In addition, tectorigenin treatment exhibited a similar tendency, which inhibited Smad3 activation, and the docking analysis revealed that tectorigenin docked well into the Smad3 binding cavity with strong binding affinity (-7.9 kcal/mol). Thus, this study deciphers the protective effect of tectorigenin against obstructive nephropathy through inhibiting Smad3-mediated ferroptosis and fibrosis.
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Affiliation(s)
- Jianchun Li
- Research Center of Intergated Traditional Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Jieke Yang
- Research Center of Intergated Traditional Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Bingwen Zhu
- Research Center of Intergated Traditional Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Junming Fan
- Research Center of Intergated Traditional Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Chengdu Medical College, Chengdu, China
| | - Qiongdan Hu
- Department of Nephrology, The Affiliated Traditional Medicine Hospital of Southwest Medical University, Luzhou, China
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Li Wang
- Research Center of Intergated Traditional Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
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Mehling B, Hric M, Salatkova A, Vetrak R, Santora D, Ovariova M, Mihalyova R, Manvelyan M. A Retrospective Study of Stromal Vascular Fraction Cell Therapy for Osteoarthritis. J Clin Med Res 2020; 12:747-751. [PMID: 33224377 PMCID: PMC7665865 DOI: 10.14740/jocmr4354] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 01/11/2023] Open
Abstract
Background Osteoarthritis (OA) is progressive degenerative damage to articular cartilage. Current therapeutic options are reduced to control the OA-associated symptoms, leaving the degenerative changes to progress until a joint replacement becomes mandatory. Therefore, therapeutic alternatives are warranted to improve the patient’s quality of life. Cell-based therapy is a developing therapeutic modality, showing promising results in the regeneration of injured cartilage and reduction of on-going inflammation within the affected joint. The current retrospective chart review study was aimed to analyze changes in pain and mobility of subjects with OA after stromal vascular fraction (SVF) cell therapy. Methods Three hundred fifty subjects with hip and knee OA, treated with autologous SVF cells at the Malacky Hospital (Bratislava, Slovakia) in the period from 2015 to 2018, were included in the retrospective chart review study. Results Seven days after SVF cell therapy, 45.2% of subjects experienced improved pain levels and mobility. Three, 6, and 12 months after therapy, improvement in pain levels reached 75.3%, 84.4%, and 84.9%, and improvement in mobility reached 75.2%, 84.4%, and 84.9%. Conclusions Our study of 350 subjects with hip and knee OA showed a significant improvement in pain levels and mobility 3, 6, and 12 months compared to 7 days after autologous SVF cell administration. The treatment demonstrated a strong safety profile with no severe adverse events or complications reported. The results of the study are showing that SVF cell therapy was more effective in subjects with arthritis stage III compared to arthritis stages I, II, and IV.
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Affiliation(s)
- Brian Mehling
- BHI Therapeutic Sciences, 214 State Street, Hackensack, NJ 07601, USA
| | - Milan Hric
- Malacky Hospital, Nemocnicna, Duklianskych hrdinov 34, 901 22 Malacky, Slovakia
| | - Adriana Salatkova
- Malacky Hospital, Nemocnicna, Duklianskych hrdinov 34, 901 22 Malacky, Slovakia
| | - Robert Vetrak
- Malacky Hospital, Nemocnicna, Duklianskych hrdinov 34, 901 22 Malacky, Slovakia
| | - Doreen Santora
- BHI Therapeutic Sciences, 214 State Street, Hackensack, NJ 07601, USA
| | - Miriama Ovariova
- Blue Horizon International, Grosslingova 17, 801 29 Bratislava, Slovakia
| | - Renata Mihalyova
- Blue Horizon International, Grosslingova 17, 801 29 Bratislava, Slovakia
| | - Marine Manvelyan
- BHI Therapeutic Sciences, 214 State Street, Hackensack, NJ 07601, USA
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Wang J, Tang Y, Lv X, Zhang J, Ma B, Wen X, Bao Y, Wang G. Tectoridin inhibits osteoclastogenesis and bone loss in a murine model of ovariectomy-induced osteoporosis. Exp Gerontol 2020; 140:111057. [PMID: 32798609 DOI: 10.1016/j.exger.2020.111057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
Osteoporosis is a systemic disease that typically affects older adults and that remains a major threat to global public health owing to its high morbidity and mortality rates. In those with osteoporosis, excess osteoclast (OC)-mediated resorption of bone tissue can lead to an imbalance in normal bone metabolism resulting in the onset of diseases including postmenopausal osteoporosis (PMOP). In the present study, we found that the natural Belamcanda chinensis (L.) DC derivative tectoridin can reduce bone loss in ovariectomized mice. TRAP staining further revealed that tectoridin suppresses OC differentiation in a dose-dependent fashion, and qPCR analyses indicated that this compound also dose-dependently inhibits the RANKL-induced upregulation of OC marker genes including Trap, Ctsk, ATP60, DC-Stamp, c-Fos, and NFATc1 in bone marrow macrophages (BMMs). Tectoridin treatment further suppressed actin ring formation and in vitro bone resorption as determined via F-actin staining and scanning electron microscopy. At the mechanistic level, we found that tectoridin was capable of inhibiting osteoclastogenesis at least in part owing to its ability to interfere with NF-κB pathway activation. In addition, we confirmed that tectoridin was able to protect against in vivo estrogen-deficiency-associated bone loss. Together, these results suggest that tectoridin can inhibit osteoclastogenesis and OC functionality in the context of PMOP at least in part via modulating RANKL-induced NF-κB signaling.
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Affiliation(s)
- Jirong Wang
- Zhejiang Hospital, Hangzhou, Zhejiang Province 310030, China
| | - Ying Tang
- Zhejiang Hospital, Hangzhou, Zhejiang Province 310030, China
| | - Xiaoling Lv
- Zhejiang Hospital, Hangzhou, Zhejiang Province 310030, China
| | - Jing Zhang
- Zhejiang Hospital, Hangzhou, Zhejiang Province 310030, China
| | - Bo Ma
- Zhejiang Hospital, Hangzhou, Zhejiang Province 310030, China
| | - Xiaolin Wen
- Zhejiang Hospital, Hangzhou, Zhejiang Province 310030, China
| | - Yizhong Bao
- Zhejiang Hospital, Hangzhou, Zhejiang Province 310030, China.
| | - Guofu Wang
- Zhejiang Hospital, Hangzhou, Zhejiang Province 310030, China.
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Shukla S, Srivastava A, Kumar P, Tandon P, Maurya R, Singh R. Vibrational spectroscopic, NBO, AIM, and multiwfn study of tectorigenin: A DFT approach. J Mol Struct 2020. [DOI: 10.1016/j.molstruc.2020.128443] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Li XZ, Zhang SN. Recent advance in treatment of osteoarthritis by bioactive components from herbal medicine. Chin Med 2020; 15:80. [PMID: 32765641 PMCID: PMC7395386 DOI: 10.1186/s13020-020-00363-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is a common chronic articular degenerative disease, and characterized by articular cartilage degradation, synovial inflammation/immunity, and subchondral bone lesion, etc. The disease affects 2-6% of the population around the world, and its prevalence rises with age and exceeds 40% in people over 70. Recently, increasing interest has been devoted to the treatment or prevention of OA by herbal medicines. In this paper, the herbal compounds with anti-OA activities were reviewed, and the cheminformatics tools were used to predict their drug-likeness properties and pharmacokinetic parameters. A total of 43 herbal compounds were analyzed, which mainly target the damaged joints (e.g. cartilage, subchondral bone, and synovium, etc.) and circulatory system to improve the pathogenesis of OA. Through cheminformatics analysis, over half of these compounds have good drug-likeness properties, and the pharmacokinetic behavior of these components still needs to be further optimized, which is conducive to the enhancement in their drug-likeness properties. Most of the compounds can be an alternative and valuable source for anti-OA drug discovery, which may be worthy of further investigation and development.
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Affiliation(s)
- Xu-zhao Li
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Dong Qing Nan Road, Guian New Area, 550025 People’s Republic of China
| | - Shuai-nan Zhang
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Dong Qing Nan Road, Guian New Area, 550025 People’s Republic of China
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Anti-inflammatory and anti-osteoarthritis effects of Cm-02 and Ck-02. Biochem Biophys Res Commun 2019; 517:155-163. [PMID: 31353084 DOI: 10.1016/j.bbrc.2019.07.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/11/2019] [Indexed: 12/25/2022]
Abstract
Osteoarthritis (OA) is a common degenerative joint disease characterized by progressive deterioration of articular cartilage. There have been reports that small molecule inhibitors have anti-osteoarthritis effects; however, the effects of 3-(4-chloro-2-fluorophenyl)-6-(2,4-difluorophenyl)-2H-benzo[e] [1,3]oxazine-2,4(3H)-dione (Cm-02) and 6-(2,4-difluorophenyl)-3-(3,4-difluorophenyl)-2H-benzo[e] [1,3]oxazine-2,4(3H)-dione (Ck-02), small molecule inhibitors which share many structural similarities with quercetin (a potent anti-inflammatory flavonoid), remain unclear. In this study, TNF-α-stimulated porcine and human chondrocyte models were used to investigate the inhibitory effects of Cm-02 and Ck-02 on the molecular mechanisms underlying the anti-OA effects. TNF-α was used to stimulate porcine and human chondrocytes to mimic immunomodulatory potency in-vitro. Anti-osteoarthritic effects were characterized in terms of protein and mRNA levels associated with the pathogenesis of OA. We also examined (1) the inducible nitric oxide synthase (iNOS)-nitric oxide (NO) system in cultured chondrocytes, (2) matrix metalloproteinases (MMPs) in cultured chondrocytes, and (3) aggrecan degradation in cartilage explants. Finally, we tested the activation of nuclear factor-kappaB (NF-κB), interferon regulatory factor-1 (IRF-1), and activate the protein-1 (AP-1), and we tested the signal transduction and activation of transcription-3 (STAT-3). Our results indicate that, in chondrocytes, Cm-02 and Ck-02 inhibit TNF-α induced NO production, iNOS, MMP, the expression of disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS), and the enzyme activity of MMP-13. Furthermore, both Cm-02 and Ck-02 were found to stimulate TNF-α, which has been shown to suppress the activation of several transcription factors, including NF-κB, STAT-3, and IRF-1 in porcine and human chondrocytes. Cm-02 and Ck-02 were also found to help prevent the release of proteoglycans from cartilage explants. Our findings demonstrate that both Cm-02 and Ck-02 have potent anti-inflammatory activities and the ability to protect cartilage in an OA cell model. These findings indicate that Cm-02 and Ck-02 have the potential to be further developed for the therapeutic treatment of OA.
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Zhang L, Zhao Y, Fan L, Xu K, Ji F, Xie Z, Ouyang X, Wu D, Li L. Tectorigenin protects against experimental fulminant hepatic failure by regulating the TLR4/mitogen-activated protein kinase and TLR4/nuclear factor-κB pathways and autophagy. Phytother Res 2019; 33:1055-1064. [PMID: 30701601 PMCID: PMC6590665 DOI: 10.1002/ptr.6299] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/06/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
Tectorigenin has received attention due to its antiproliferation, anti-inflammatory, and antioxidant activities. In this study, we investigated the effects of tectorigenin on lipopolysaccharide (LPS)/D-galactosamine(D-GalN)-induced fulminant hepatic failure (FHF) in mice and LPS-stimulated macrophages (RAW 264.7 cells). Pretreatment with tectorigenin significantly reduced the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), histological injury, apoptosis, and the mortality of FHF mice, by suppressing the production of inflammatory cytokines such as TNF-α and IL-6. Tectorigenin also suppressed the activation of the inflammatory response in LPS-stimulated RAW 264.7 cells. Tectorigenin-induced protection is mediated through its mitigation of TLR4 expression, inhibition of mitogen-activated protein kinase (MAPK) and nuclear factor-κB (NF-κB) pathway activation, and promotion of autophagy in FHF mice and LPS-stimulated RAW 264.7 cells. Therefore, tectorigenin has therapeutic potential for FHF in mice via the regulation of TLR4/MAPK and TLR4/NF-κB pathways and autophagy.
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Affiliation(s)
- Lingjian Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yalei Zhao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Linxiao Fan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Kai Xu
- Department of Orthopaedic Surgery, Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Feiyang Ji
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Zhongyang Xie
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaoxi Ouyang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Daxian Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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Ma C, Xu K, Meng J, Ran J, Adel Abdo Moqbel S, Liu A, Yan S, Wu L. Tectorigenin inhibits RANKL-induced osteoclastogenesis via suppression of NF-κB signalling and decreases bone loss in ovariectomized C57BL/6. J Cell Mol Med 2018; 22:5121-5131. [PMID: 30063119 PMCID: PMC6156464 DOI: 10.1111/jcmm.13801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 12/19/2022] Open
Abstract
Metabolism of bone is regulated by the balance between osteoblast‐mediated bone formation and osteoclast‐mediated bone resorption. Activation of osteoclasts could lead to osteoporosis. Thus, inhibiting the activity of osteoclasts becomes an available strategy for the treatment of osteoporosis. Tectorigenin is an extract of Belamcanda chinensis In the present study, the anti‐osteoclastogenesis effects of tectorigenin were investigated in vitro and in vivo. The results showed preventive and therapeutic effects of tectorigenin at concentrations of 0, 10, 40, and 80 μmol/L in the maturation and activation of osteoclasts. A signalling study also indicated that tectorigenin treatment reduces activation of NF‐κB signalling in osteoclastogenesis. Animal experiment demonstrated that tectorigenin treatment (1‐10 mg/kg, abdominal injection every 3 days) significantly inhibits bone loss in ovariectomized C57BL/6. Our data suggest that tectorigenin is a potential pharmacological choice for osteoporosis.
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Affiliation(s)
- Chiyuan Ma
- Department of Orthopaedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kai Xu
- Department of Orthopaedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiahong Meng
- Department of Orthopaedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jisheng Ran
- Department of Orthopaedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Safwat Adel Abdo Moqbel
- Department of Orthopaedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - An Liu
- Department of Orthopaedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shigui Yan
- Department of Orthopaedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lidong Wu
- Department of Orthopaedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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