du-moxibustion in the treatment of ankylosing spondylitis (as) in an as mouse model

Exploring the Therapeutic Potential of Du-Moxibustion in Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a progressively worsening and disabling form of arthritis that primarily affects the axial skeleton. According to the latest epidemiological survey, ~0.01%-1.8% of people in the world suffer from this condition1, most of whom are young males (male to female ratio is ~2-3:1)2. The incidence of AS in the Chinese population is 0.2%-0.4%. This disease mainly involves the spine and the sacroiliac joint. Fusion of the spine and the sacroiliac joint may occur in the later stages of the disease, resulting in spinal stiffness and kyphosis, as well as difficulty in walking, which seriously affects the quality of work and daily living activities and imposes a heavy burden on the patient, family, and society1. Currently, there is no definitive solution for AS, and the provided treatments, both pharmacological and non-pharmacological, primarily focus on alleviating pain, slowing disease progression, and enhancing the quality of life. In recent years, because pharmacotherapeutic options have been very limited3, increasing attention has been paid to non-pharmacotherapy, which has become an alternative therapy for AS. In China, patients often prefer external treatment consisting of Traditional Chinese Medicine (TCM), which has minor side effects and great convenience during the treatment.
Moxibustion is an ancient therapeutic technique used in TCM. Du-moxibustion is an external treatment technique consisting of &#34;medicated moxibustion with foam&#34; on the spine segment of the Du meridian. It is mainly used in the treatment of AS and has shown safety and effectiveness. Compared with ordinary moxibustion, Du-moxibustion has the characteristics of a wide moxibustion area, a large moxa cone, strong firepower, and high temperature4. A systematic review and meta-analysis suggest that moxibustion is an effective complementary treatment for AS5. A recent study confirmed that the clinical symptoms and some inflammatory factors of AS patients were improved by moxibustion6. Studies have revealed that Du-moxibustion can increase the brain content of &#946;-endorphin and exert a central analgesic effect7, downregulate the expression of the HLA-B27 gene8, and delay the recurrence rate of AS. Du-moxibustion also has an ameliorating effect on the progression of AS by decreasing the inflammatory index ESR (ESR) and levels of C-reactive protein (CRP), C-terminal peptide of type I collagen (CTX-I), and Dickkopf1 protein (DKK1)9,10.
Another clinical study showed that Du-moxibustion can further adjust the disordered T cell subsets, Ig, and complement C3 to balance the immune mechanism11. In terms of bone metabolism, moxibustion can inhibit the rise of serum alkaline phosphatase (ALP) and serum phosphorus (S-P), increase serum calcium (S-Ca), bone mineral density (BMD), and bone strength12. Moreover, Du-moxibustion can repair spinal function at multiple points to relieve fatigue symptoms in AS patients13. Some animal studies have revealed the potential mechanism of moxibustion in treating AS. A study indicated that moxibustion significantly improved the overall health status, reduced the levels of paw thickness, and decreased the levels of IL-1&#946;, PGE2, IL-6, and TNF-&#945; in the ligament tissue samples of the spine. Metabolic pathway analysis linked the identified metabolites to the TCA cycle, as well as lipid, amino acid, intestinal flora, and purine metabolism14. Another study showed that moxibustion suppressed the expression of pro-inflammatory cytokines, IL-1&#946;, TNF-&#945;, IL-17, and IL-6; reduced the mRNA levels of RANKL, RANK, ALP, and OCN; and improved the histopathological features in AS mice15.
While these studies suggest that moxibustion may be effective in the treatment of AS, more research is needed to confirm these findings and determine the optimal treatment protocol for moxibustion in patients with AS. Our team created and modified the moxibustion therapy based on the basic theory and practical operation of traditional Chinese moxibustion, which has been widely carried out and applied in Chinese clinical practice for over 35 years. Although there are few high-quality studies on the treatment of AS by Du-moxibustion, its indication in treating AS has been supported by evidence. However, the mechanism of treating AS with Du-moxibustion is worthy of further study. Animal study is an important method to explore the mechanism of Du-moxibustion in the treatment of AS. The clinical operation of Du-moxibustion is relatively mature but rarely used in the study of the mechanism in animal experiments. This paper describes in detail the operation and precautions to be taken during Du-moxibustion in the treatment of AS experimental mice.

Author Spotlight: Evaluating Traditional Chinese Therapy for Ankylosing Spondylitis in Mice 

Du-Moxibustion in a Mouse Model of Ankylosing Spondylitis

The scope of our research focuses on the treatment of ankylosing spondylitis using du-moxibustion, the traditional Chinese external therapy. This paper describes in detail the operating procedures and precautions to be taken during du-moxibustion in treating ankylosing spondylitis in experimental mice. Our study found that du-moxibustion could improve motor coordination and autonomic movement, reduce ankle swelling, and alleviate inflammation in mice with AS.The traditional Chinese medicine external treatment of du-moxibustion was introduced for the first time in detail and more experiments, laying the foundation for future treatment of AS mechanism research.As a external therapeutic technique used in traditional Chinese medicine, du-moxibustion skillfully combines the compatible technicals of TCM to integrate meridians, acupoints, Chinese herbal medicine, and moxibustion, which directly acts on the spine area and makes overall adjustment to related site. In future studies, we will pay attention to the evaluation of different parameters, such as placebo moxibustion dose range and treatment time to obtain the most effective combination schemes. In later studies, imaging methods can be used to evaluate the treatment results in a more intuitive way.

Watch this Scientific Journal Video about Du-Moxibustion in the Treatment of Ankylosing Spondylitis AS in an AS Mouse Model at JoVE.com

Du-Moxibustion in the Treatment of Ankylosing Spondylitis (AS) in an AS Mouse Model  

To begin, take a piece of velvet and twist it into a spindle shape to make moxa cones. Now, cut ginger into small pieces and puree it in a juicer. Filter the ginger puree through cotton gauze to separate the ginger juice and mud from the puree.Take 10 grams of ginger mud and 20 milliliters of ginger juice in paper cups for later use. Then, take 0.1 grams of traditional Chinese medicine powder, and grind it in a mortar. After administering anesthesia to the mouse and confirming the appropriate surgical depth, remove it from the anesthesia induction box.Secure the mouse on the operating table in a prone position. Align the mouse's mouth and nose with the outlet of the anesthetic. Maintain the anesthesia and place the mouse on a 37 degrees Celsius heating pad during the operational procedure.Apply lubricant to the mouse's eyes to prevent desiccation. Now, locate the acupoints on the mouse, and identify the stimulation area. Shave the hair on the back of the mouse until the flesh-colored skin on the back of the mouse is seen.Ensure the hair removal is 1.5 centimeter wide and extends from C7 to the tail vertebra. Using cotton gauze, apply the prepared ginger juice to the shaved area of the mouse's back. Then, with a writing brush, sprinkle the traditional Chinese medicine powder evenly on the median line of the mouse's back, and cover the area with mulberry paper.Next, use ginger mud to make a trapezoidal ginger column, and fill it down the mulberry paper. Create a groove above the midline of the ginger column, and place the prepared moxa cone in the groove. Then, light the moxa cone, and replace it with a new one once it burns out.Wipe off the ginger and traditional Chinese medicine powder from the mouse's back. Clean the back of the mouse, discontinue the anesthesia and allow the mouse to recover.

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Research

JoVE Journal

Immunology and Infection

60 Views.  Shandong University of Traditional Chinese Medicine. To begin, take a piece of velvet and twist it into a spindle shape to make moxa cones. Now, cut ginger into small pieces and puree it in a juicer. Filter the ginger puree through cotton gauze to separate the ginger juice and mud from the puree.Take 10 grams of ginger mud and 20 milliliters of ginger juice in paper cups for later use. Then, take 0.1 grams of traditional Chinese medicine powder, and grind it in a mortar. After administering anesthesia to the mouse and confirming the appr...