The TCM theory of " Kidney dominates bone" put forward the function of marrow. The significance of marrow on orthopedic diseases was underlined by our team that summarized other classical TCM theories, introduced the theory of "myeloid bone diseases", and clarified that stem cells are the existing form of marrow of TCM at the cellular level. The etiology and pathogenesis of ONFH in TCM can be attributed to the dysfunction marrow caused by kidney deficiency, the imbalance of Yin and Yang, and the dystrophy of bone(4). The modern medical etiology and pathogenesis can be summarized as the lack of blood supply to the femoral head, which resulted in the death of bone cells in the area, abnormal bone metabolism, and damage to the trabecular structure, which in turn led to microfractures and eventually caused the femoral head to collapse and change shape(16). In the above process, bone formation and bone resorption phases coexist. Therefore, for ONFH treatment, its repairing effect should be strengthened, which can start from two aspects of bolstering angiogenesis and osteogenesis. CHRM is an effective measure in promoting bone repair and preventing or delaying the progression of ONFH(17). Consequently, it is of great significance to illuminate the specific action mechanism of CHRM in the treatment of bone and joint disease.
Through network pharmacology, it was screened out 54 active components of HF-CHRM, 1219 targets related to ONFH, and 39 targets of intersecting diseas and drug in this study. The top 3 key components were obtained, namely quercetin, wogonin, and kaempferol, by performing the topological analysis of the herbs-active components-targets-disease network. Quercetin is one of the natural polyphenols, which widely exists in various plants and was consumed worldwide(18). It has multiple pharmacological effects reported by many studies, such as protecting the bone, reduceing blood glucose, blood pressure, and lipid, and immunomodulatory, anti-inflammatory, and antioxidation activities(19–21). Wogonin, a compound extracted from the Scutellaria baicalensis plant, exhibits high anti-inflammatory and antioxidative properties, which is achieved reduce expression of transforming growth factor β1 (TGF-β1), high temperature receptor A1 (HTRA1), matrix metalloprotease 13 (MMP-13) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB)(22, 23). Moreover, kaempferol have a wide range of pharmacological and biological activities, which mainly include cardioprotective, anxiolytic, anti-allergic, anti-cancer, anti-microbial, anti-hyperlipidemic, anti-oxidative, anti-inflammatory and anti-osteoporotic effects(24–26). Trivedi et al.(27) investigated the anti-osteoclastogenic role of kaempferol that can markedly attenuate adipocyte formation and shows lower serum ALP (bone turnover marker) and higher bone mineral density (BMD) in the trabecular regions (proximal tibia, femur neck, and vertebrae). In summary, most of these core components exhibit beneficial effects on bone metabolism through anti-inflammatory, antioxidant, and anti-hyperlipidemic. Interestingly, the research results suggest that NX is a key herb for the treatment of ONFH with HF-CHRM, which does not correspond to the frequency of use. We speculate that NX may be used less frequently in such MBD such as knee osteoarthritis and osteoporosis.
It is concluded that IL6, TP53, and VEGFA targets play a central role in HF-CHRM treatment of ONFH. IL6 and P53, as representative proteins of inflammation and tumors in the body, are closely related to osteogenesis and osteoclast(28, 29). It was reported that IL6 can regulate the role and activity of various immune cells, promote angiogenesis, and induce the process of bone remodeling(30, 31). TP53, the most frequently altered gene in human tumors, was associated with adverse prognosis in many sporadic cancers, which regulates cell cycle arrest, apoptosis, senescence and DNA repair(32, 33). VEGFA can promote the proliferation and migration of vascular endothelial cells to induce angiogenesis. Besides, some studies(34, 35) have confirmed that it has an important role in the formation of subchondral bone.
The enrichment analysis of the GO and KEGG pathways were undertaken to predict the treatment mechanism. The results of above analysis demonstrate that the targets of HF-CHRM was related to biological response processes of angiogenesis, bone and lipid metabolism, and inflammation. Moreover, KEGG enrichment analysis showed that the key targets were mainly concentrated in the AGE-RAGE signal pathway. Studies(36, 37) have shown that the interaction between AGE and RAGE can produce a series of increase of inflammation and oxidation, causing vascular endothelial damage. At the same time, it can activate the expression NF-κB and TNF-α, diminish osteogenic, bring about osteoclastogenesis increase. The HF-CHRM participate in the regulation of a variety of response processes to work.
What's more, MD results showed that the ligand of the degree top 3 components of HF-CHRM had a strong binding activity with the repector of the degree top 3 components of ONFH, of which the conformations were stable. The HF-CMRM is effective and solid therapeutic role.
However, there are certain limitations in this study. Firstly, the usage frequency of CHRM in our research was formed by the summary statistics of marrow-regulating prescriptions of medical specialists of the past dynasties, which mainly reflects the academic thought of marrow-regulating the ancient orthopaedic specialists. In the later period, the modern usage of marrow-regulating prescriptions will be summarized to obtain experience applied with contemporary orthopedic doctors. And both differences were analysed to derive a better usage regularity of the CHRM. Then, we are unable to perform basic scientific researches and clinical trials to validate the results in a short time.