Studies on the therapeutic effects of three TCM methods on steroid-induced osteonecrosis of femoral head

Abstract

Purpose: To determine the therapeutic effects of kidney yang-tonifying, blood-activating and phlegmeliminating methods on steroid-induced osteonecrosis of femoral head (SONFH), and their mechanisms of action.Methods: A rabbit model of SONFH was established. Six rabbit groups were used: control, SONFH (given normal saline); tongluo shenggu group, kidney-tonifying group, blood-activating group, and phlegm--eliminating group, which received tongluo shenggu capsule (0.28 g/kg/day), yougui yin (YGY, 2.52 g/kg/day), taohong siwu decoction (TSD, 2.38 g/kg/day) and linggui zhugan decoction (LZD,1.54 g/kg/day), respectively, for 8 weeks. The following serum indices were assayed on the 2nd, 4th and 8th weeks: total cholesterol, triglycerides, thromboxane B2 (TXB2), 6-keto-PGF1α, osteoprotegerin (OPG), and receptor activator of nuclear factor kappa-Β ligand (RANKL). At the end of the 8th week, mRNA levels of OPG, BMP-2 and VEGF were assayed using real-time fluorescent quantitative polymerase chain reaction (RTF-qPCR).Results: Serum OPG in the kidney-tonifying group was increased, while its RANKL was decreased on the 2nd week, but these parameters, along with mRNA of OPG and BMP-2, reached normal levels at the 8th week (p <0.05). The TXB2 of blood-activating group was decreased, while its 6-keto-PGF1 level was increased at the 2nd week, but both of them attained normal levels at the 8th week, along with VEGF mRNA. Serum total cholesterol, triglycerides and TXB2 in the phlegm-eliminating group were decreased, while its 6-keto-PGF1α was increased at the 2nd week, but the levels of serum total cholesterol and triglycerides were normalized at the 8th week (p <0.05). Histological examination showed increases in bone trabeculae and bone marrow cells, while the proliferation of fat cells was decreased in kidney-tonifying, blood-activating and phlegm-eliminating groups.Conclusion: These findings suggest that the therapeutic effects of the three different TCM methods on SONFH involve different mechanisms. Keywords: Steroid-induced osteonecrosis, Femoral head, Yougui yin, Taohong siwu, Linggui zhugan decoction, Kidney-tonifying yang, Phlegm