Jintiange proteins promote osteogenesis and inhibit apoptosis of osteoblasts by enhancing autophagy via PI3K/AKT and ER stress pathways

ETHNOPHARMACOLOGICAL RELEVANCE

Tiger bone, which had long been used in traditional Chinese medicine, had the action of removing wind and alleviating pain, strengthening the sinews and bones, and often used to treat bone impediment, and atrophic debility of bones in TCM clinical practice. As a substitute of natural bone tiger, artificial tiger bone Jintiange (JTG), has been approved by the State Food and Drug Administration of China for relief the symptom of osteoporosis, such as lumbago and back pain, lassitude in loin and legs, flaccidity and weakness legs, and walk with difficulty based on TCM theory. JTG has similar chemical profile to natural tiger bone, and contains mineral substance, peptides and proteins, and has been shown to protect bone loss in ovariectomized mice and exert the regulatory effects on osteoblast and osteoclast activities. But how the peptides and proteins in JTG modulate bone formation remains unclear.

AIM

To investigate the stimulating effects of JTG proteins on osteogenesis and explore the possible underlying mechanisms.

MATERIALS AND METHODS

JTG proteins were prepared from JTG Capsules by extracting calcium, phosphorus and other inorganic elements using SEP-PaktC18 desalting column. MC3T3-E1 cells were treated with JTG proteins to evaluate their effects and explore the underlying mechanisms. Osteoblast proliferation was detected by CCK-8 method. ALP activity was detected using a relevant assay kit, and bone mineralized nodules were stained with alizarin red-Tris-HCl solution. Cell apoptosis was analyzed by flow cytometry. Autophagy was observed by MDC staining, and autophagosomes were observed by TEM. Nuclear translocations of LC3 and CHOP were detected by immunofluorescence and observed under a laser confocal microscope. The expression of key proteins related to osteogenesis, apoptosis, autophagy and PI3K/AKT and ER stress pathways was analyzed by Western Blot analysis.

RESULTS

JTG proteins improved osteogenesis as evidenced by the alteration of proliferation, differentiation and mineralization of MC3T3-E1 osteoblasts, inhibited their apoptosis, and enhanced autophagosome formation and autophagy. They also regulated the expression of key proteins of PI3K/AKT and ER stress pathways. In addition, PI3K/AKT and ER stress pathway inhibitors could reverse the regulatory effects of JTG proteins on osteogenesis, apoptosis, autophagy and PI3K/AKT and ER stress pathways.

CONCLUSION

JTG proteins increased the osteogenesis and inhibited osteoblast apoptosis by enhancing autophagy via PI3K/AKT and ER stress signaling pathways.

Effect of Artificial Tiger Bone Powder (Jintiange Capsule®) on Vertebral Height Ratio, Cobb's Angle, Bone Mineral Density, and Visual Analog Score

Objectives

To investigate the effect of Jintiange capsule on acute bone atrophy (vertebral height, Cobb's angle, bone mineral density, and visual analog score (VAS) in patients with osteoporotic vertebral compression fracture.

Methods

A total of 106 patients with osteoporotic vertebral compression fractures were selected and randomly divided into study and control group. Vertebral height ratio (VHR), Cobb's angle, bone mineral density (BMD), and VAS analyses were performed as study indexes. The study was performed from January 2019 to December 2019 as a double‐blind, randomized, controlled trial and all the participants were blinded throughout the study. There were 24 males and 29 females in the study group, with 14 cases of thoracic fractures and 39 cases of lumbar fractures. The age was 61–75 years, with an average of 67.5 ± 2.7 years, and the course of disease was 1–9 days, with an average of 2.7 ± 0.5 days. There were 22 males and 31 females in the control group, with 17 cases of thoracic fractures and 36 cases of lumbar fractures. Patients in the control group received conventional postoperative treatment, while patients in the study group were treated with Jintiange capsule. The treatment continued for 3 months. The ages of the participants were from 60 to 70 years, while the average ages of both groups were 67 ± 2.8 years and the study recruited participants of both sexes.

Results

The clinical efficacy, vertebral imaging indexes before and after treatment, as well as pain and daily activity dysfunction scores were compared. The effect of the Jintiange capsule was followed for 3 months and both the groups were compared. The total effective score of the study group was significantly increased (90.6%) in contrast to the control group (67.9) and the P value was less than the 0.5. The vertebral height and bone mineral density of the study group was significantly improved compared to the control group (P < 0.034) using t‐test. However, the Cobb's angle of the study group was significantly (P < 0.047) lower than the control group using t‐test after the treatment. On the other hand, the VAS score and Oswestry score of the study group were significantly lower than control group at 1 month and 3 months after treatment (P < 0.05). There was no significance difference (all P > 0.05) in term of gender and ages in both the recruited groups.

Conclusion

It can be concluded that Jintiange capsule can significantly improve the clinical efficacy rate, vertebral height, Cobb's angle, and bone mineral density, pain relief, and daily activity function.

Jintiange Capsules Ameliorate Osteoarthritis by Modulating Subchondral Bone Remodeling and Protecting Cartilage Against Degradation

Osteoarthritis (OA) is the most prevalent joint disease worldwide, making it a major cause of pain and disability. Identified as a chronic and progressive disease, effective treatment at the early stages of OA has become critical to its management. Jintiange (Jtg) capsules are a traditional Chinese medicine produced from multiple organic components of various animal bones and routinely used to treat osteoporosis in China. However, the effect of Jtg on subchondral bone and cartilage degeneration in OA remains unknown. The purpose of the present study was to investigate the biomolecular role and underlying mechanisms of Jtg in OA progression. Herein, we found that Jtg inhibited receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclast formation and it functions through the NF-κB signaling pathway. Jtg also inhibited chondrocyte apoptosis via reducing the reactive oxygen species concentration in these cells. Moreover, in vivo evaluation revealed that Jtg significantly attenuates subchondral bone remodeling and cartilage destruction in anterior cruciate ligament transection (ACLT) mouse models. Taken together, our data demonstrate that Jtg inhibits osteoclast differentiation in subchondral bone and chondrocyte apoptosis in cartilage, supporting its potential therapeutic value for treating OA.

Efficacy of Jintiange Capsules in the Treatment of Osteoporosis: A Network Meta-analysis

Objective

To evaluate the efficacy of Jintiange capsules and Jintiange combined with other therapies in the treatment of osteoporosis.

Methods

A systematic review of the literature was conducted through databases including China National Knowledge Infrastructure (CNKI), the VIP Database for Chinese Technical Periodicals (VIP), Wanfang, and PubMed from inception to April 2018. Network meta‐analysis was used to determine the relative efficacy of related treatments on osteoporosis. The primary outcome measures are the bone mineral density (BMD) of the lumbar and femoral neck, and the secondary outcome measures are visual analog pain score (VAS) and adverse events. Two reviewers independently selected the studies, extracted information, and assessed the quality of included trials. Data extracted from eligible studies was pooled and meta‐analyzed, and the mean differences (MD) with their 95% confidence intervals were estimated as the effect size between treatments.

Results

Thirty‐one studies were included in this study, containing 28 randomized controlled trials (RCT) and 3 non‐randomized controlled trials (non‐RCT), with a total of 14 regimens treating osteoporosis. According to the surface under the cumulative ranking (SUCRA) curves, Jintiange capsules combined with atorvastatin (89.9%) and Jintiange combined with bisphosphonates (88.2%) have the best efficacy in terms of the BMD of the lumbar and femoral neck, respectively. Based on the VAS, Jintiange combined with calcium has the best analgesic effect (83.4%).

Conclusion

Jintiange capsules alone and combined with other therapies is a good choice for treating patients with osteoporosis in terms of improving BMD, relieving pain, and reducing adverse events. More large‐scale and well‐designed RCT are warranted to confirm the results of this study.