Cited by 22Bone and Joint DiseasesMesenchymal stem cell researchBone health and treatments

Recent Advances in Osteonecrosis of the Femoral Head: A Focus on Mesenchymal Stem Cells and Adipocytes

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Zhang, Shilei, Wang, Haojue, Meng, Qi, Lee, Wayne Yuk-wai, Li, Ziqing, Sun, Shui·2025·Journal of Translational Medicine

Abstract

Osteonecrosis of the femoral head (ONFH) is a debilitating orthopedic disease characterized by femoral head collapse and destruction of bone and articular cartilage, resulting in severe joint pain and loss of hip mobility. Bone marrow mesenchymal stem cells (BMSCs) exhibit multilineage differentiation potential, including osteoblasts, adipocytes, fibroblasts, chondrocytes, and neurocytes. The imbalance between osteogenesis and adipogenesis in BMSCs plays a critical role in ONFH pathogenesis. Factors such as alcohol consumption and glucocorticoid exposure promote adipogenic differentiation while inhibiting osteogenic differentiation, leading to excessive adipocyte accumulation, reduced bone formation, and vascular impairment. We highlight the molecular mechanisms underlying ONFH with a particular focus on the role of BMSCs and further discuss the involvement of adipocytes. Moreover, we suggest that the use of adipose-derived mesenchymal stem cells (ADMSCs) is a viable approach for stem cell therapy and may have immense potential in ONFH. Several signaling pathways, including the Wnt, TGFβ/BMP, and PI3K/AKT pathways, along with various RNAs and other regulators, govern the osteogenesis and adipogenesis of BMSCs. These signaling pathways target essential transcription factors, such as Runx2 for osteogenesis and PPARγ and C/EBPs for adipogenesis. Adipocytes and their secreted adipokines, including leptin and adiponectin, strongly influence ONFH progression. Emerging therapies involving ADMSCs show potential for promoting bone regeneration and neovascularization. Our review provides a comprehensive overview of the current understanding of ONFH mechanisms by focusing on mesenchymal stem cells and adipocytes and suggests future research directions for therapeutic interventions.

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Crossref · 10.1186/s12967-025-06564-6

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  • Leptin activates the PI3K/Akt pathway, which inhibits FoxO1 and supports appetite suppression.

    “Simultaneously, leptin activates the PI3K/Akt pathway, which inhibits the transcription factor Forkhead box protein O1 (FoxO1) and supports appetite suppression”

    From Exercise-Induced Muscle–Fat Crosstalk: Molecular Mediators and Their Pharmacological Modulation for the Maintenance of Metabolic Flexibility in Aging (2025) · cites this paper as [83]

    The adipokines section discusses leptin’s effects on bone-cell differentiation and JAK3/STAT3 signaling. The PI3K/AKT section discusses bone-marrow stem-cell differentiation, but does not link that pathway to leptin. Searches for FoxO1 and appetite suppression found no passage supporting the claimed mechanism. (LLM, conf=0.74)

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Authors
Zhang, S., Wang, H., Meng, Q., Lee, W. Y.-W., Li, Z., & Sun, S.
Affiliations
  • Shandong Provincial Hospital (CN)
  • Shandong University (CN)
  • Chinese University of Hong Kong (HK)
Corresponding author
  • Lee, Wayne Yuk-wai
  • Li, Ziqing
  • Sun, Shui
Venue
Journal of Translational Medicine
Published
2025-05-27
Volume
23
Issue
1
Pages
592-592
ISSN
1479-5876 (ISSN-L)
OpenAlex
W4410785943
Cited by
22
References
98
Citations by year
2026: 17 · 2025: 5
FWCI
4.83
Type
journal article
Language
en
Open access
Locations
  • Journal of Translational Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Natural Science Foundation of China (82272485, 82100936)
  • Taishan Scholar Foundation of Shandong Province (tsqnz20221170)
  • Natural Science Foundation of Shandong Province (ZR2024MH320)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone and Joint Diseases
  • Health Sciences › Medicine › Genetics › Mesenchymal stem cell research
  • Health Sciences › Medicine › Oncology › Bone health and treatments
Keywords
osteonecrosis of the femoral head, bone marrow mesenchymal stem cells, adipocytes, adipogenesis, osteogenic differentiation, adipose-derived stem cells, stem cell therapy, Wnt signaling, PI3K/Akt signaling, Runx2, PPARγ, C/EBP, adipokines, leptin, adiponectin, glucocorticoids, alcohol consumption, neovascularization, bone regeneration
MeSH terms
Animals, Femur Head, Femur Head Necrosis, Humans, Osteogenesis, Signal Transduction, Adipocytes, Adipogenesis, Mesenchymal Stem Cells

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