Chinese Journal of Tissue Engineering Research ›› 2025, Vol. 29 ›› Issue (29): 6161-6166.doi: 10.12307/2025.635

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Internal heat acupuncture inhibits osteoblast apoptosis and delays steroid-induced avascular necrosis of the femoral head in rabbits

Tian Xinbao1, Ma Liangchen2, Tian Fubao1, Liu Yuanyuan1, Xu Jianfeng3, Lin Ruizhu1, Zhu Ning1   

  1. 1Department of Rehabilitation Medicine, 2Department of Geriatrics and Special Needs Medicine, 3Department of Traditional Chinese Medicine Orthopedics, Ningxia Medical University General Hospital, Yinchuan 750004, Ningxia Hui Autonomous Region, China 
  • Received:2024-04-28 Accepted:2024-07-05 Online:2025-10-18 Published:2025-03-01
  • Contact: Zhu Ning, Chief physician, Professor, Master’s supervisor, Department of Rehabilitation Medicine, Ningxia Medical University General Hospital, Yinchuan 750004, Ningxia Hui Autonomous Region, China Co-corresponding author: Lin Ruizhu, MD, Chief physician, Associate professor, Master’s supervisor, Department of Rehabilitation Medicine, Ningxia Medical University General Hospital, Yinchuan 750004, Ningxia Hui Autonomous Region, Chin
  • About author:Tian Xinbao, MS, Primary therapist, Department of Rehabilitation Medicine, Ningxia Medical University General Hospital, Yinchuan 750004, Ningxia Hui Autonomous Region, China
  • Supported by:
    Special Project of Central Government Guidance for Local Science and Technology Development, No. 2021FRD05017 (to XJF); Key Research & Development Plan Project of Ningxia Science and Technology Department, No. 2022BEG03134 (to LRZ); School-Level Project of Ningxia Medical University, No. XM2023049 (to TXB); “New Master Training” Project of Ningxia Medical University General Hospital (to TXB) 

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Abstract: BACKGROUND: Steroid-induced avascular necrosis of the femoral head is a common progressive, crippling and high incidence of non-traumatic osteonecrosis of the femoral head, but its exact pathogenesis is not clear. Internal heat acupuncture therapy has a good clinical effect in the treatment of steroid-induced avascular necrosis of the femoral head, but its specific mechanism is not clear.
OBJECTIVE: To investigate the effect of internal heat acupuncture on osteoblast apoptosis and expression of Bcl-2-associated X protein (Bax) and B lymphocytoma-2 (Bcl-2 ) in steroid-induced avascular necrosis of the femoral head in rabbits. 
METHODS: Totally 24 male New Zealand rabbits were randomly divided into blank group, model group, and internal heat acupuncture group (n=8). The rabbit model of steroid-induced avascular necrosis of the femoral head was made in the last two groups by methylprednisolone sodium succinate combined with Escherichia coli endotoxin. After successful model establishment for 4 weeks, the rabbits in the internal heat acupuncture group received internal heat acupuncture intervention on the buttocks of rabbits, once a week for 20 minutes each time, while the other two groups did not receive any intervention. After 4 weeks of treatment, samples were harvested. Morphological changes of femoral head and osteoblast apoptosis were observed by hematoxylin-eosin staining and TUNEL assay. Protein expression of Bcl-2 and Bax in rabbit femoral head tissue was detected by immunohistochemistry and western blot assay.
RESULTS AND CONCLUSION: (1) In the blank group, there were abundant hematopoietic cells in the bone marrow cavity, clear and orderly trabecular structure, few adipocytes and few empty bone lacunae. In the model group, the number of adipocytes in the bone marrow cavity increased significantly, accompanied by hyperplasia, steatosis of some osteocytes and more empty bone lacunae. After the intervention of internal heat acupuncture, the number of adipocytes and hollow bone lacunae was less than that in the model group, but more obvious than that in the blank group. (2) Compared with the blank group, the apoptosis of osteoblasts in the model group was significantly increased, the expression of Bax was significantly increased (P < 0.001), and the expression of Bcl-2 was significantly decreased (P < 0.001). After the intervention of internal heat acupuncture, the apoptosis of osteoblasts was significantly decreased, the expression of Bax was significantly decreased (P < 0.001), and the expression of Bcl-2 was significantly increased (P < 0.001). (3) The results show that internal heat acupuncture can alleviate steroid-induced avascular necrosis of the femoral head by inhibiting osteoblast apoptosis in the femoral head.

Key words: internal heat acupuncture, steroid-induced avascular necrosis of the femoral head, osteoblast apoptosis, Bcl-2, Bax, engineered tissue construction

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