Article Abstract

Volume 35, No. (6), 2025 (December)
Mechanism of Huoxue Huayu Decoction Promoting Tibial Fracture Healing in Rats via Notch1/PPARγ/CD36 Signaling Pathway
Nuning Rahmawati, Yuli Widiyastuti, Agung Endro Nugroho, Abdul Rohman

N. Rahmawati¹, Y. Widiyastuti², A. E. Nugroho³, A. Rohman⁴*

¹ Research Center for Pharmaceutical Science and Traditional Medicine, National Research and Innovation Agency, Cibinong, West Java 16911, Indonesia,
² Research Center for Pharmaceutical Science and Traditional Medicine, National Research and Innovation Agency, Cibinong, West Java 16911, Indonesia,
³ Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia,
⁴ Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia,

Corresponding Author: abdul_kimfar@ugm.ac.id
Page Number(s): 1691-1701
Published Online First: October 08, 2025
Publication Date: November 30, 2025
ABSTRACT

Tibial fractures are a common type of traumatic injury, typically treated through surgical reduction and fixation; however, the healing outcomes are often suboptimal. This work aimed to investigate the mechanism of Huoxue Huayu Decoction (HXHYD, a traditional Chinese herbal formula composed of Bupleuri RadixPaeoniae Radix Alba, and Leonuri Herba known for promoting blood circulation and resolving stasis) promoting tibial fracture healing in rats via Notch1/PPARγ/CD36 pathway. Forty-eight male Sprague-Dawley rats of clean grade were randomly allocated into a control group (sham surgery, 10 mL/kg/d saline gavage, n=12), a model group (fracture model, 10 mL/kg/d saline gavage, n=12), a positive group (fracture model, 0.27 g/kg/d Xianling Gubao capsule gavage (standardized extract equivalent to human dose of 3 g/d, calculated by body surface area, n=12), and a HXHYD group (fracture model, 13.45 mL/kg/d HXHYD gavage, n=12). Rats in each group were administered gavage once daily for 28 consecutive days. X-ray imaging outcomes and Lane-Sandhu scores were employed to assess tibial fracture healing. Enzyme-linked immunosorbent assay (ELISA) measured serum inflammatory cytokine levels and bone formation markers. Tibial tissue from rats was collected to measure biomechanical parameters. Western blot analysis quantified bone-regulatory factors’ expression. Relative to control group, model group showed a reduced Lane-Sandhu score, elevated serum TNF-α, IL-1β, IL-6, and bone formation markers ALP, BGP, and IGF-1, and a decrease in tibial maximum load, elastic load, and maximum deflection. Additionally, tibial BMP-2, RUNX2, VEGF, Notch1, and CD36 protein levels were increased, while tibial PPARγ protein expression was decreased (P<0.05). HXHYD group showed the most prominent improvements, including a 45% increase in Lane-Sandhu score, 30% reduction in TNF-α levels, and 50% elevation in BMP-2 expression versus model group (P<0.05). HXHYD also enhanced maximum tibial load (25.3±2.1 N vs. 18.5±1.8 N in model group) and suppressed PPARγ expression by 40%, while upregulating Notch1 and CD36 (P<0.05). Relative to positive group, HXHYD group showed more pronounced improvements in all indicators (P<0.05). HXHYD promotes tibial fracture healing by alleviating inflammation, enhancing osteogenesis, and modulating Notch1/PPARγ/CD36 pathway. Hence, HXHYD can serve as a complementary therapy to surgery, optimizing the bone repair microenvironment and accelerating functional recovery.

Keywords: tibial fracture; Huoxue Huayu Decoction; inflammation; biomechanics; Notch1/PPARγ/CD36 pathway

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Journal Impact Factor: 0.5 | (JCR Year: 2025) | Cite Score: 1.3

HEC Category: W

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Print ISSN: 1018-7081

Electronic ISSN: 2309-8694

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