Signal Transduction Pathways Involved in Acupuncture-Mediated Inhibition of Synovitis in Knee Osteoarthritis: A Comprehensive Review

Qingxi Cao, Yuehua Li Department of Sports Medicine, The People’s Hospital of Baoan Shenzhen, Shenzhen, Guangdong Province, People’s Republic of ChinaCorrespondence: Yuehua Li, Department of Sports Medicine, The People’s Hospital of Baoan Shenzhen, Shenzhen, Guangdong Province, 518100, People’s Repu...

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Main Authors: Cao Q, Li Y
Format: Article
Language:English
Published: Dove Medical Press 2025-07-01
Series:International Journal of General Medicine
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Online Access:https://www.dovepress.com/signal-transduction-pathways-involved-in-acupuncture-mediated-inhibiti-peer-reviewed-fulltext-article-IJGM
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author Cao Q
Li Y
author_facet Cao Q
Li Y
author_sort Cao Q
collection DOAJ
description Qingxi Cao, Yuehua Li Department of Sports Medicine, The People’s Hospital of Baoan Shenzhen, Shenzhen, Guangdong Province, People’s Republic of ChinaCorrespondence: Yuehua Li, Department of Sports Medicine, The People’s Hospital of Baoan Shenzhen, Shenzhen, Guangdong Province, 518100, People’s Republic of China, Tel +13560331881, Email 18525428109@163.comAbstract: Knee osteoarthritis (KOA) is a prevalent degenerative joint disorder characterized by synovitis, cartilage degradation, and nociception, in which dysregulated immune responses and excessive pro‑inflammatory mediators drive synovial inflammation as a central pathogenic mechanism. Acupuncture, a cornerstone of traditional Chinese medicine, has demonstrated clinical efficacy in alleviating pain, attenuating synovial pathology, and restoring joint function in KOA. In this review, we systematically elucidate the molecular mechanisms by which acupuncture suppresses synovial inflammation, focusing on its multimodal modulation of five critical signaling cascades: norepinephrine (NE) signaling, the TLRs/NF‑κB pathway, the MCP1/CCR2 axis, the NLRP3 inflammasome, and the Ras‑Raf‑MEK1/2‑ERK1/2 pathway. Relevant studies published between 2000 and 2024 were identified through comprehensive searches of PubMed and CNKI using terms such as “acupuncture + synovitis + MAPK pathway”, “acupuncture + inflammation”, and “knee osteoarthritis + molecular mechanisms”. English and Chinese peer‑reviewed articles reporting preclinical or clinical data on acupuncture’s effects in KOA synovitis were included, while studies lacking mechanistic insights or unrelated to synovial inflammation were excluded. Study validity, risk of bias, and methodological rigor were appraised using the GRADE framework. Cumulative evidence indicates that acupuncture exerts anti‑inflammatory and chondroprotective effects by orchestrating multi‑pathway regulation, thereby reducing inflammatory mediators, promoting tissue repair, and improving joint function. As a promising adjunct to pharmacotherapy—particularly in early‑stage KOA—acupuncture merits further validation through large‑scale clinical trials aimed at optimizing treatment parameters, confirming long‑term efficacy, and exploring synergistic combinations with emerging therapies to enable personalized KOA management.Keywords: knee osteoarthritis, synovial inflammation, acupuncture, signaling pathway
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spelling doaj-art-1c7b08a0fd504d39a966b73ba02f94e02025-08-20T03:56:08ZengDove Medical PressInternational Journal of General Medicine1178-70742025-07-01Volume 18Issue 141054117105253Signal Transduction Pathways Involved in Acupuncture-Mediated Inhibition of Synovitis in Knee Osteoarthritis: A Comprehensive ReviewCao Q0Li Y1Department of rehabilitationDepartment of rehabilitationQingxi Cao, Yuehua Li Department of Sports Medicine, The People’s Hospital of Baoan Shenzhen, Shenzhen, Guangdong Province, People’s Republic of ChinaCorrespondence: Yuehua Li, Department of Sports Medicine, The People’s Hospital of Baoan Shenzhen, Shenzhen, Guangdong Province, 518100, People’s Republic of China, Tel +13560331881, Email 18525428109@163.comAbstract: Knee osteoarthritis (KOA) is a prevalent degenerative joint disorder characterized by synovitis, cartilage degradation, and nociception, in which dysregulated immune responses and excessive pro‑inflammatory mediators drive synovial inflammation as a central pathogenic mechanism. Acupuncture, a cornerstone of traditional Chinese medicine, has demonstrated clinical efficacy in alleviating pain, attenuating synovial pathology, and restoring joint function in KOA. In this review, we systematically elucidate the molecular mechanisms by which acupuncture suppresses synovial inflammation, focusing on its multimodal modulation of five critical signaling cascades: norepinephrine (NE) signaling, the TLRs/NF‑κB pathway, the MCP1/CCR2 axis, the NLRP3 inflammasome, and the Ras‑Raf‑MEK1/2‑ERK1/2 pathway. Relevant studies published between 2000 and 2024 were identified through comprehensive searches of PubMed and CNKI using terms such as “acupuncture + synovitis + MAPK pathway”, “acupuncture + inflammation”, and “knee osteoarthritis + molecular mechanisms”. English and Chinese peer‑reviewed articles reporting preclinical or clinical data on acupuncture’s effects in KOA synovitis were included, while studies lacking mechanistic insights or unrelated to synovial inflammation were excluded. Study validity, risk of bias, and methodological rigor were appraised using the GRADE framework. Cumulative evidence indicates that acupuncture exerts anti‑inflammatory and chondroprotective effects by orchestrating multi‑pathway regulation, thereby reducing inflammatory mediators, promoting tissue repair, and improving joint function. As a promising adjunct to pharmacotherapy—particularly in early‑stage KOA—acupuncture merits further validation through large‑scale clinical trials aimed at optimizing treatment parameters, confirming long‑term efficacy, and exploring synergistic combinations with emerging therapies to enable personalized KOA management.Keywords: knee osteoarthritis, synovial inflammation, acupuncture, signaling pathwayhttps://www.dovepress.com/signal-transduction-pathways-involved-in-acupuncture-mediated-inhibiti-peer-reviewed-fulltext-article-IJGMKnee osteoarthritisSynovial inflammationacupuncturesignaling pathway
spellingShingle Cao Q
Li Y
Signal Transduction Pathways Involved in Acupuncture-Mediated Inhibition of Synovitis in Knee Osteoarthritis: A Comprehensive Review
International Journal of General Medicine
Knee osteoarthritis
Synovial inflammation
acupuncture
signaling pathway
title Signal Transduction Pathways Involved in Acupuncture-Mediated Inhibition of Synovitis in Knee Osteoarthritis: A Comprehensive Review
title_full Signal Transduction Pathways Involved in Acupuncture-Mediated Inhibition of Synovitis in Knee Osteoarthritis: A Comprehensive Review
title_fullStr Signal Transduction Pathways Involved in Acupuncture-Mediated Inhibition of Synovitis in Knee Osteoarthritis: A Comprehensive Review
title_full_unstemmed Signal Transduction Pathways Involved in Acupuncture-Mediated Inhibition of Synovitis in Knee Osteoarthritis: A Comprehensive Review
title_short Signal Transduction Pathways Involved in Acupuncture-Mediated Inhibition of Synovitis in Knee Osteoarthritis: A Comprehensive Review
title_sort signal transduction pathways involved in acupuncture mediated inhibition of synovitis in knee osteoarthritis a comprehensive review
topic Knee osteoarthritis
Synovial inflammation
acupuncture
signaling pathway
url https://www.dovepress.com/signal-transduction-pathways-involved-in-acupuncture-mediated-inhibiti-peer-reviewed-fulltext-article-IJGM
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