Tao-Hong-Si-Wu Decoction ameliorates steroid-induced avascular necrosis of the femoral head by regulating the HIF-1α pathway and cell apoptosis

The aim of this study was to corroborate the hypothesis that Tao-Hong-Si-Wu Decoction (THSWD) affects steroid-induced avascular necrosis of the femoral head (SANFH) by regulating the hypoxia-inducible factor 1 alpha (HIF-1 alpha) pathway. Forty-eight New Zealand rabbits were randomly divided into a normal control group (NC group), a model group (SANFH group), a THSWD group, and a dimethyloxalylglycine group (DMOG group). Rabbits in the SANFH group were injected with both horse serum and methylprednisolone. Rabbits in the THSWD group were gavaged with THSWD in addition to receiving the same treatment as the SANFH group. Rabbits in the DMOG group were injected with extra DMOG in conjunction with the same treatment as the SANFH group. Rabbits in the NC group received the same amount of normal saline. Eight weeks after steroid treatment, the femoral heads of rabbits were removed to examine HIF-1 alpha, vascular endothelial growth factor (VEGF), caspase-3, and bcl-2. Results indicated that THSWD significantly promoted the expression of HIF-1 alpha and VEGF in the femoral head tissue of rabbits and markedly inhibit the apoptosis of osteocytes, chondrocytes, and bone marrow cells. In addition, THSWD suppressed caspase-3 expression and induced bcl-2 expression in femoral head tissues. In conclusion, THSWD can suppress SANFH by regulating the HIF-1 alpha pathway and cell apoptosis.