Anthocyanins and Musculoskeletal Diseases: Mechanisms and Therapeutic Potential

Xing Lv¹Xiaopeng Zhao^2,3Wen-Cong Li⁴Nai-Fei Xing¹Ke-Qiang Zong^5,6Yi Zhai⁷Yang Shenglei⁶Jiyao Zhang¹Xia Liu^1,7,8*

• ¹Department of Rehabilitation, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
• ²Sport Science College, Beijing Sport University, Beijing, China
• ³College of Exercise and Health, Shenyang Sport University, Shenyang, China
• ⁴Department of Neurology, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
• ⁵College of Physical Education, Qiqihar University, Qiqihar, China
• ⁶School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, Beijing Municipality, China
• ⁷Shandong Boaoke Biotechnology Co., Ltd, Liaocheng, Shandong Province, China
• ⁸Medical Integration and Practice Center, Shandong University, Jinan, China

Background: Musculoskeletal diseases (MSDs) are a common group of conditions involving bones, muscles, cartilage, ligaments, and nerves, which significantly impact patients' quality of life and ability to participate in society. Anthocyanins (ACNs), as phytochemicals, possess various pharmacological and biological activities, including anti-apoptotic, antioxidant, anti-inflammatory, and immunosuppressive properties. In recent years, ACNs have shown remarkable potential in improving MSDs. This review article aims to recapitulate the therapeutic potential of ACNs and its mechanism of action in treating MSDs. Methods: Extensive literature was searched and reviewed through online electronic databases (PubMed, Embase and Web of Science), focusing on analysing the specific roles and molecular mechanisms of ACNs in in vivo and in vitro studies. Results: ACNs exert protective effects on MSDs by targeting multiple key signaling pathways, including mitogen-activated protein kinase (MAPK), nuclear factor-kappaΒ (NF-κB), Wingless-related integration site (Wnt)/β-catenin, phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt), adenosyl monophosphate-dependent protein kinase (AMPK), receptor activator of nuclear factor-kappaΒ/receptor activator of nuclear factor-kappaΒ ligand/osteoprotegerin (RANK/RANKL/OPG) and oxidative stress signaling. In addition, ACNs exhibited anti-inflammatory, anti-apoptotic, and immunosuppressive properties. This article reviews the mechanisms and potential therapeutic applications of ACNs in the prevention and alleviation of MSDs, providing valuable reference points for further research and development of ACNs. Conclusion: ACNs improve the prevention of MSDs through multiple actions such as antioxidant, anti-inflammatory, immunomodulatory and bone metabolism homeostasis regulation. However, results from in vitro and in vivo studies still need to be further validated by human clinical trials.