Guilu Erxian glue reduces endoplasmic reticulum stress-mediated apoptosis and restores the balance of extracellular matrix synthesis and degradation in chondrocytes by inhibiting the ATF6/GRP78/CHOP signaling pathway.

Knee Osteoarthritis (KOA) is characterized by phenotypic alterations, apoptosis, and the breakdown of the extracellular matrix (ECM) in the superficial articular cartilage cells. The inflammatory response activates the Endoplasmic Reticulum Stress (ERS) signaling pathway, which plays a critical role in the pathophysiology and progression of KOA. Chondrocytes stimulated by thapsigargin(TG)exhibit heightened ERS and significantly increase the expression of ERS-associated proteins. Key mediators of ERS-induced apoptosis include X-box-binding protein 1(XBP1), elevated levels of the protein transport protein Sec61 subunit (SEC61), and C/EBP homologous protein (CHOP). While the precise mechanism of action of Guilu Erxian Glue (GEG), a medication commonly used in the clinical treatment of KOA, remains to be fully elucidated, our research has shown that GEG mitigates the imbalance between ECM synthesis and degradation, as well as chondrocyte apoptosis resulting from ERS. This effect is likely achieved through the suppression of the Activating Transcription Factor 6 (ATF6)/Glucose-Regulatory Protein 78 (GRP78)/CHOP signaling pathway. In summary,our research results indicate that GEG can activate the ATF6/GRP78/CHOP signaling pathway to restore endoplasmic reticulum (ER) homeostasis in chondrocytes, thereby reducing chondrocyte apoptosis and ultimately promoting the balance between ECM synthesis and degradation.