Ovariectomy-induced osteoporosis

卵巢切除术引起的骨质疏松症
  • 文章类型: Journal Article
    本研究旨在探讨重组人成纤维细胞生长因子18(rhFGF18)对绝经后骨质疏松症的作用及其机制。
    使用MC3T3-E1细胞系的氧化应激模型评估rhFGF18对成骨细胞的增殖和凋亡的作用以及这种作用的潜在机制。此外,对ICR小鼠进行卵巢切除术以模仿雌激素缺乏的绝经后骨质疏松症。评估卵巢切除(OVX)小鼠的骨代谢和骨形态参数。
    从细胞模型获得的结果表明,FGF18通过激活细胞外信号调节激酶(ERK)和p38而不是c-JunN末端激酶(JNK)来促进MC3T3-E1细胞增殖。FGF18还通过抑制细胞凋亡来防止细胞受到氧化应激造成的损伤。FGF18给药后,小鼠抗凋亡蛋白Bcl-2表达上调,而促凋亡蛋白Bax和caspase-3的表达下调。施用FGF18还改善了OVX小鼠的骨代谢和骨形态参数。
    FGF18可以通过增强成骨细胞的生成和保护成骨细胞免受氧化应激诱导的凋亡,从而有效预防OVX小鼠的骨丢失。
    UNASSIGNED: This study aimed to investigate the effect and the mechanism of recombinant human fibroblast growth factor 18 (rhFGF18) on postmenopausal osteoporosis.
    UNASSIGNED: The effect of rhFGF18 on the proliferation and apoptosis of osteoblasts and the mechanism underlying such an effect was evaluated using an oxidative stress model of the MC3T3-E1 cell line. Furthermore, ovariectomy was performed on ICR mice to imitate estrogen-deficiency postmenopausal osteoporosis. Bone metabolism and bone morphological parameters in the ovariectomized (OVX) mice were evaluated.
    UNASSIGNED: The results obtained from the cell model showed that FGF18 promoted MC3T3-E1 cell proliferation by activating the extracellular signal-regulated kinase (ERK) and p38 instead of c-Jun N-terminal kinase (JNK). FGF18 also prevented cells from damage inflicted by oxidative stress via inhibition of apoptosis. After FGF18 administration, the expression level of anti-apoptotic protein Bcl-2 in the mice was upregulated, whereas those of the pro-apoptotic proteins Bax and caspase-3 were downregulated. Administering FGF18 also improved bone metabolism and bone morphological parameters in OVX mice.
    UNASSIGNED: FGF18 could effectively prevent bone loss in OVX mice by enhancing osteoblastogenesis and protecting osteoblasts from oxidative stress-induced apoptosis.
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  • 文章类型: Journal Article
    背景:Alamandine是肾素血管紧张素系统的新特征肽。我们的研究目的是调查alamandine的骨防腐作用,探讨潜在的机制,为未来的绝经后骨质疏松症提供潜在的预防策略。
    方法:建立卵巢切除(OVX)诱导的大鼠骨质疏松模型进行体内实验。显微计算机断层扫描和三点弯曲试验用于评估骨强度。处理组织学股骨切片用于免疫组织化学(IHC)。采用酶联免疫吸附试验(ELISA)测定血清骨转换标志物和一氧化氮(NO)浓度。小鼠胚胎成骨细胞前体(MC3T3-E1)细胞用于体外实验。用细胞计数试剂盒-8分析细胞活力。我们进行了茜素红S染色和碱性磷酸酶(ALP)活性测定,以观察成骨细胞的分化状态。采用蛋白质印迹法检测成骨细胞成骨相关蛋白和AMP活化蛋白激酶/内皮型一氧化氮合酶(AMPK/eNOS)的表达。DAF-FM二乙酸酯用于细胞内NO的半定量。
    结果:在OVX大鼠中,alamandine缓解骨质疏松症和保持骨强度。IHC显示alamandine增加了骨钙蛋白和I型胶原蛋白α1(COL1A1)的表达。酶联免疫吸附试验显示,阿兰明降低了骨转换标志物,并恢复了血清中的NO水平。在MC3T3-E1细胞中,alamandine促进成骨分化。Westernblotting显示Alamandine上调骨桥蛋白的表达,Runt相关转录因子2和COL1A1。细胞内NO也由alamandine升高。此外,AMPK/eNOS轴的激活介导了alamandine对MC3T3-E1细胞和骨组织的影响。PD123319和dorsomorphin可以抑制alamandine对骨代谢的调节作用。
    结论:Alamandine通过AMPK/eNOS轴促进成骨分化,减轻卵巢切除诱导的骨质疏松症。
    BACKGROUND: Alamandine is a newly characterized peptide of renin angiotensin system. Our study aims to investigate the osteo-preservative effects of alamandine, explore underlying mechanism and bring a potential preventive strategy for postmenopausal osteoporosis in the future.
    METHODS: An ovariectomy (OVX)-induced rat osteoporosis model was established for in vivo experiments. Micro-computed tomography and three-point bending test were used to evaluate bone strength. Histological femur slices were processed for immunohistochemistry (IHC). Bone turnover markers and nitric oxide (NO) concentrations in serum were determined with enzyme-linked immunosorbent assay (ELISA). The mouse embryo osteoblast precursor (MC3T3-E1) cells were used for in vitro experiments. The cell viability was analysed with a Cell Counting Kit‑8. We performed Alizarin Red S staining and alkaline phosphatase (ALP) activity assay to observe the differentiation status of osteoblasts. Western blotting was adopted to detect the expression of osteogenesis related proteins and AMP-activated protein kinase/endothelial nitric oxide synthase (AMPK/eNOS) in osteoblasts. DAF-FM diacetate was used for semi-quantitation of intracellular NO.
    RESULTS: In OVX rats, alamandine alleviated osteoporosis and maintained bone strength. The IHC showed alamandine increased osteocalcin and collagen type I α1 (COL1A1) expression. The ELISA revealed alamandine decreased bone turnover markers and restored NO level in serum. In MC3T3-E1 cells, alamandine promoted osteogenic differentiation. Western blotting demonstrated that alamandine upregulated the expression of osteopontin, Runt-related transcription factor 2 and COL1A1. The intracellular NO was also raised by alamandine. Additionally, the activation of AMPK/eNOS axis mediated the effects of alamandine on MC3T3-E1 cells and bone tissue. PD123319 and dorsomorphin could repress the regulating effect of alamandine on bone metabolism.
    CONCLUSIONS: Alamandine attenuates ovariectomy-induced osteoporosis by promoting osteogenic differentiation via AMPK/eNOS axis.
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  • 文章类型: Journal Article
    UNASSIGNED:骨质疏松症(OP)是一种全身性代谢性骨病,其特征是骨量减少和骨微结构破坏,这往往会导致骨脆性增强和相关的骨折。绝经后骨质疏松症(PMOP)占比较高,大量研究表明,雌激素缺乏与肠道微生物群(GM)失衡有关,肠粘膜屏障功能受损,炎症反应性增强。然而,潜在的机制仍不清楚,现有的干预措施也很少.
    未经批准:在这项研究中,我们建立了卵巢切除术(OVX)诱导的小鼠模型,并通过每天灌胃进行粪便微生物移植(FMT),持续8周。随后,通过显微计算机断层扫描(Micro-CT)评估小鼠的骨量和微结构。肠道通透性,促破骨细胞细胞因子表达,通过免疫组织学分析检测成骨和破骨细胞活性,组织学检查,相应的酶联免疫吸附测定(ELISA)和蛋白质印迹分析。此外,通过16SrRNA测序评估GM的组成和丰度,并通过代谢组学测定粪便短链脂肪酸(SCFAs)水平.
    UNASSIGNED:我们的结果表明FMT抑制了过度的破骨细胞生成并防止了OVX诱导的骨丢失。具体来说,与OVX组相比,FMT增强了紧密连接蛋白(闭合zonula蛋白1(ZO-1)和Occludin)的表达,并抑制了促破骨细胞细胞因子(肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β))的释放。此外,FMT还优化了GM的组成和丰度,并增加粪便SCFA水平(主要是乙酸和丙酸)。
    未经批准:集体,基于GM-骨轴,FMT通过纠正GM的失衡来预防OVX引起的骨丢失,提高SCFA水平,优化肠道通透性和抑制促破骨细胞细胞因子的释放,这可能是一个替代选择,作为一个有希望的候选人在未来的PMOP的预防和治疗。
    UNASSIGNED:这项研究表明GM-骨轴在PMOP中的巧妙参与以及FMT在重塑GM状态和改善OVX诱导的小鼠骨丢失中的作用。FMT可能成为未来PMOP预防和治疗的有希望的候选者。
    UNASSIGNED: Osteoporosis (OP) is a systemic metabolic bone disease characterized by decreased bone mass and destruction of bone microstructure, which tends to result in enhanced bone fragility and related fractures. The postmenopausal osteoporosis (PMOP) has a relatively high proportion, and numerous studies reveal that estrogen-deficiency is related to the imbalance of gut microbiota (GM), impaired intestinal mucosal barrier function and enhanced inflammatory reactivity. However, the underlying mechanisms remain unclear and the existing interventions are also scarce.
    UNASSIGNED: In this study, we established a mouse model induced by ovariectomy (OVX) and conducted fecal microbiota transplantation (FMT) by gavage every day for 8 weeks. Subsequently, the bone mass and microarchitecture of mice were evaluated by the micro computed tomography (Micro-CT). The intestinal permeability, pro-osteoclastogenic cytokines expression, osteogenic and osteoclastic activities were detected by the immunohistological analysis, histological examination, enzyme-linked immunosorbent assay (ELISA) and western blot analysis accordingly. Additionally, the composition and abundance of GM were assessed by 16S rRNA sequencing and the fecal short chain fatty acids (SCFAs) level was measured by metabolomics.
    UNASSIGNED: Our results demonstrated that FMT inhibited the excessive osteoclastogenesis and prevented the OVX-induced bone loss. Specifically, compared with the OVX group, FMT enhanced the expressions of tight junction proteins (zonula occludens protein 1 (ZO-1) and Occludin) and suppressed the release of pro-osteoclastogenic cytokines (tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β)). Furthermore, FMT also optimized the composition and abundance of GM, and increased the fecal SCFAs level (mainly acetic acid and propionic acid).
    UNASSIGNED: Collectively, based on GM-bone axis, FMT prevented the OVX-induced bone loss by correcting the imbalance of GM, improving the SCFAs level, optimizing the intestinal permeability and suppressing the release of pro-osteoclastogenic cytokines, which may be an alternative option to serve as a promising candidate for the prevention and treatment of PMOP in the future.
    UNASSIGNED: This study indicates the ingenious involvement of GM-bone axis in PMOP and the role of FMT in reshaping the status of GM and ameliorating the bone loss in OVX-induced mice. FMT might serve as a promising candidate for the prevention and treatment of PMOP in the future.
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  • 文章类型: Journal Article
    骨髓间充质干细胞移植(BMSCT)是治疗骨质疏松的潜在方法,能够促进骨组织修复。BMSCT已经证明了骨诱导作用和调节微环境代谢的能力;然而,其在雌激素水平降低引起的骨丢失中的作用和机制尚不清楚.在这项研究中,评估BMSCT对卵巢切除术(OVX)诱导的小鼠骨质疏松症的影响,进行骨组织的液相色谱-质谱(LC-MS)代谢组学研究以鉴定潜在的代谢分子标志物。结果表明,BMSCT减少了OVX诱导的小鼠骨丢失,同时改善了小鼠股骨的机械性能并增加了外周血中成骨标志物的表达。在代谢组学研究中,筛选出18种代谢物作为BMSCT抗骨质疏松作用的潜在生物标志物。这些代谢产物主要参与花生四烯酸的代谢,牛磺酸和下牛磺酸代谢,以及戊糖和葡糖醛酸的相互转化。总的来说,这些结果说明了代谢产物与骨质疏松发生的潜在机制之间的相关性,对于理解外源性骨髓间充质干细胞(BMSCs)在骨质疏松治疗中的作用和机制具有重要意义.本研究为BMSCs作为骨质疏松治疗策略的研究奠定了基础。
    Bone marrow mesenchymal stem cell transplantation (BMSCT) is a potential treatment for osteoporosis, capable of contributing to bone tissue repair. BMSCT has demonstrated osteoinductive effects and the ability to regulate microenvironmental metabolism; however, its role and mechanisms in bone loss due to reduced estrogen levels remain unclear. In this study, the effect of BMSCT on ovariectomy (OVX)-induced osteoporosis in mice was assessed, and liquid chromatography-mass spectrometry (LC-MS) metabolomic studies of bone tissue were conducted to identify potential metabolic molecular markers. The results revealed that BMSCT reduces OVX-induced bone loss in mice while improving the mechanical properties of mouse femurs and increasing the expression of osteogenic markers in peripheral blood. In a metabolomic study, 18 metabolites were screened as potential biomarkers of the anti-osteoporotic effect of BMSCT. These metabolites are mainly involved in arachidonic acid metabolism, taurine and hypotaurine metabolism, and pentose and glucuronate interconversions. Collectively, these results illustrate the correlation between metabolites and the underlying mechanisms of osteoporosis development and are important for understanding the role and mechanisms of exogenous bone marrow mesenchymal stem cells (BMSCs) in osteoporosis management. This study lays the foundation for research on BMSCs as a treatment strategy for osteoporosis.
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  • 文章类型: Journal Article
    骨质疏松症是一种常见的疾病,其特征是骨骼脆弱和微观结构恶化。然而,现有的常规药物疗效有限,可引起严重的不良反应;此外,和新的基于干细胞的疗法没有表现出足够的治疗功效。我们的假设是,适当的成骨诱导剂可以提高其治疗效果。在这项研究中,我们发现双去甲氧基姜黄素(BDMC)刺激人羊膜间充质干细胞(hAMSCs)分化为成骨细胞而不诱导细胞毒性。在这里,BDMC增强hAMSCs中的钙沉积,同时促进成骨细胞分化早期和晚期标志物的表达,包括ALP,runt相关转录因子2,osterix,COL1-α1,骨钙蛋白,以及转录和翻译水平的骨桥蛋白。机械上,发现BDMC激活JAK2/STAT3途径;而AG490(JAK2/STAT3途径抑制剂)抑制BDMC功能。随后,我们发现BDMC和hAMSC的联合治疗对双侧卵巢切除术诱导的骨质疏松小鼠模型有积极的协同作用,包括抑制骨丢失和骨吸收以及改善骨微结构。此外,BDMC抑制I型胶原骨吸收标志物C-末端端肽的产生,和抗酒石酸酸性磷酸酶,同时促进骨形成标志物OCN的血清水平,和前胶原IN端前肽。BDMC还改善了骨质疏松小鼠模型的肝肾功能。总的来说,在骨质疏松小鼠模型中,BDMC通过增强hAMSC成骨作用来改善骨质疏松,并表现出对肝脏和肾脏功能的保护作用。因此,BDMC可以作为一种有效的佐剂,与hAMSCs联合治疗是一种有前途的骨质疏松症治疗新方法。
    Osteoporosis is a common disease characterized by skeletal fragility and microarchitectural deterioration. However, existing conventional drugs exhibit limited efficacy and can elicit severe adverse effects; moreover, and novel stem cell-based therapies have not exhibited sufficient therapeutic efficacy. Our hypothesis is that an appropriate osteogenic inducer may improve their therapeutic efficacy. In this study, we found that bisdemethoxycurcumin (BDMC) stimulates the differentiation of human amniotic mesenchymal stem cells (hAMSCs) into osteoblasts without inducing cytotoxicity. Here BDMC enhances calcium deposition in hAMSCs, while promoting the expression of early and late markers of osteoblast differentiation, including ALP, runt-related transcription factor 2, osterix, COL1-α1, osteocalcin, and osteopontin at the transcriptional and translational levels. Mechanistically, BDMC was found to activate the JAK2/STAT3 pathway; whereas AG490 (JAK2/STAT3 pathway inhibitor) inhibited BDMC functioning. Subsequently, we found that the combinatorial therapy of BDMC and hAMSC had a positive synergistic effect on osteoporotic mouse model induced by bilateral ovariectomy, including inhibiting bone loss and bone resorption and improving bone micro-architecture. Moreover, BDMC inhibited production of the bone resorption markers C-terminal telopeptide of type I collagen, and tartrate resistant acid phosphatase, while promoting serum levels of bone formation markers OCN, and procollagen I N-terminal propeptide. BDMC also improved liver and kidney function in osteoporotic mouse model. Collectively, BDMC improved osteoporosis by enhancing hAMSC osteogenesis and exhibited a protective effect on liver and kidney function in an osteoporotic mouse model. Hence, BDMC may serve as an effective adjuvant, and combined therapy with hAMSCs is a promising new approach toward osteoporosis treatment.
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  • 文章类型: Journal Article
    作为一种有前途的资源,动物骨已被广泛加工成功能性食品。然而,关于粒径对牦牛骨粉(YBP)理化性质和消化率的影响研究甚少,以及其抗骨质疏松活性。在这项研究中,制备了中值粒径(MPS)为19.68至128.37μm的YBP,并研究了它们的消化率和抗骨质疏松活性。结果表明,较小的MPS显着增加了保水性和蛋白质溶解度,而不改变组成。MPS的减少大大促进了蛋白质的消化,在胃肠道消化过程中产生更多的<3kDa的肽和游离氨基酸,同时减少Ca2和P5的释放。体内结果表明,YBP对卵巢切除术引起的大鼠骨质疏松症具有积极作用。通过调节骨转换标志物(B-ALP,OCN,S-CTX,ES和陷阱),因此,有可能揭示骨质疏松症的缓解。然而,不同MPS对OVX大鼠骨质疏松的影响较弱。因此,YBP可以在不牺牲食品感官质量的情况下以相对较大的粒度生产,加工时间也可以缩短,以提高生产率和降低成本。
    As a kind of promising resource, animal bone has been widely processed into functional foods. However, there is little research about the effect of particle size on the physicochemical properties and digestibility of yak bone powder (YBP), as well as its anti-osteoporosis activity. In this study, the YBP with median particle sizes (MPS) ranging from 19.68 to 128.37 μm were prepared, and their digestibility and anti-osteoporosis activity were investigated. The results showed that smaller MPS significantly increased water holding capacity and protein solubility without changing composition. The MPS reduction greatly promoted protein digestion, producing more peptides<3 kDa and free amino acids while decreased Ca2+ and P5+ release during gastrointestinal digestion. The in vivo results revealed the positive effect of YBP on ovariectomy-induced osteoporosis in rats. The bone mineral density of ovariectomized (OVX) rats was obviously improved by regulating bone turnover markers (B-ALP, OCN, S-CTX, ES and TRAP), thus potentially shedding light on osteoporosis remission. However, different MPS exhibited a weak effect on osteoporosis in OVX rats. Therefore, YBP could be produced in relatively large particle size without sacrificing food sensory quality, the processing time of which could also be shortened for higher productivity and lower cost.
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  • 文章类型: Journal Article
    Bergapten(BP),源自Cnidiummonnieri(L.)库森,是中药中广泛使用的成分,具有重要的生物和药理活性。然而,BP对去卵巢所致骨质疏松的影响及其机制尚不完全清楚。在这项研究中,我们在体内和体外研究了BP对卵巢切除术诱导的骨质疏松症和核因子-κB配体受体激活剂(RANKL)诱导的破骨细胞生成的影响,并探讨了潜在的机制。我们发现,BP治疗对卵巢切除术引起的体内骨质疏松症具有有益作用。Further,BP减弱骨髓巨噬细胞(BMM)和RAW264.7细胞中的破骨细胞生成,而没有任何细胞毒性。此外,BP特异性抑制RANKL诱导的NF-κB和JNK信号,但没有抑制p38和ERK。在mRNA水平,BP抑制OC相关转录因子NFATc1和c-fos,从而影响OC分化相关基因的表达。此外,BP破坏了F-肌动蛋白环的形成,这对骨吸收活动很重要,并损害OC骨吸收。因此,BP可能是绝经后骨质疏松症的有用替代疗法。
    Bergapten (BP), derived from Cnidium monnieri (L.) Cusson, is an ingredient widely used in traditional Chinese medicine and has important biological and pharmacological activities. However, the effect of BP on ovariectomy-induced osteoporosis and the underlying mechanism are not entirely clear. In this study, we investigated the effects of BP on ovariectomy-induced osteoporosis and receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclastogenesis in vivo and in vitro, and explored the underlying mechanism. We found that BP treatment exerted beneficial effects on ovariectomy-induced osteoporosis in vivo. Further, BP attenuated osteoclastogenesis in bone marrow macrophages (BMMs) and RAW264.7 cells without any cytotoxicity. Additionally, BP specifically inhibited RANKL-induced NF-κB and JNK signaling,but did not suppress p38 and ERK. At the mRNA level, BP inhibits the OC-associated transcription factor NFATc1 and c-fos, thereby affecting the expression of OC differentiation-related genes. Moreover, BP disrupted the formation of F-actin rings, which are important for bone-resorbing activity, and impairs OC bone resorption. Therefore, BP may be a useful alternative therapy for post-menopausal osteoporosis.
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  • 文章类型: Journal Article
    本研究旨在探讨miRNA-543在去卵巢大鼠骨质疏松中的作用。采用去卵巢诱导法建立骨质疏松大鼠模型。通过定量实时聚合酶链反应测量成骨细胞中的miRNA-543表达。通过3-(4,5-二甲基噻唑-2-基)-2,5-二苯基四唑溴化物和流式细胞术测定细胞增殖和凋亡。分别。进行蛋白质印迹分析以检查YAF-2和AKT信号传导的表达。进行TargetScan分析和双荧光素酶报告基因测定以确定miRNA-543的靶基因。miRNA-543在骨质疏松大鼠模型中显著上调。miRNA-543过表达显著抑制成骨细胞的生长和促进凋亡,而miRNA-543的下调显着增强了细胞生长并抑制了细胞凋亡。miRNA-543上调显著抑制YAF-2的表达,并抑制成骨细胞中AKT和p38丝裂原活化蛋白激酶(MAPK)的磷酸化和表达。此外,YAF-2敲低增强miRNA-543对成骨细胞凋亡的影响。AKT抑制剂MK2206和p38MAPK抑制剂SB203580也增强了miRNA-543对成骨细胞凋亡的影响。我们的发现表明,抑制miRNA-543可以通过靶向YAF2的AKT/p38MAPK信号通路保护成骨细胞免受卵巢切除术诱导的骨质疏松症。
    The present study aimed to determine the roles of miRNA-543 in osteoporosis in rats induced by ovariectomy. The osteoporosis rat model was established by ovariectomy induction. MiRNA-543 expression in osteoblasts was measured by quantitative real-time polymerase chain reaction. The cell proliferation and apoptosis were measured by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and flow cytometry assays, respectively. Western blot analysis was conducted to examine the expression of YAF-2 and AKT signaling. TargetScan analysis and dual-luciferase reporter assay were performed to determine the target gene of miRNA-543. MiRNA-543 was significantly upregulated in osteoporosis rat model. Overexpression of miRNA-543 significantly suppressed cell growth and promoted apoptosis in osteoblasts, whereas downregulation of miRNA-543 significantly enhanced cell growth and inhibited apoptosis. MiRNA-543 upregulation significantly inhibited YAF-2 expression and suppressed the phosphorylation and expression of AKT and p38 mitogen-activated protein kinases (MAPK) in osteoblasts. Furthermore, YAF-2 knockdown enhanced the effects of miRNA-543 on apoptosis in osteoblasts. AKT inhibitor MK2206 and p38 MAPK inhibitor SB203580 also enhanced the effects of miRNA-543 on apoptosis in osteoblasts. Our findings revealed that inhibition of miRNA-543 could protect osteoblasts against ovariectomy-induced osteoporosis through AKT/p38 MAPK signaling pathway by targeting YAF2.
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  • 文章类型: Journal Article
    In the present study, we investigated the antiosteoporotic effect of geraniin on osteoporosis induced by OVX in rats. The analysis of biochemical parameters showed that geraniin could significantly increase serum calcium, estradiol and calcitonin levels, and decrease serum ALP, tartrate-resistant acid phosphatase, serum crosslinked C-terminal telopeptide of type I collagen, and urinary deoxypyridinoline/creatinine ratio levels, respectively. Geraniin was also found to prevent OVX-induced bone loss in bone mineral density and bone mineral content, to elevate femur weight and bone calcium content, and to enhance the bone mechanical properties as compared with OVX group. In addition, geraniin was demonstrated to improve the histomorphological parameters of OVX-induced bone loss, including bone trabecular number, thickness, and separation. These results indicated that geraniin have a protective effect against OVX-induced rat osteoporosis.
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