Advanced Search

Journal of Traditional Chinese Medicine >

2026 , Vol. 46 >Issue 2: 339 - 349

DOI: https://doi.org/10.19852/j.cnki.jtcm.2026.02.007

Original Articles

Moxibustion alleviates autophagy and inhibits ferroptosis to improve cardiac function in rats with post-myocardial infarction heart failure

  • GAO Bing ,
  • LIU Pan ,
  • LI Lan ,
  • GONG Tiantian ,
  • ZHU Ling ,
  • LI Lingji ,
  • XIA Ran ,
  • MA Qiang ,
  • HU Jing ,
  • WANG Jing
Expand
  • 1 College of Traditional Chinese Medicine, Anhui University of Chinese Medicine, Hefei 230012, China
    2 Acupuncture and moxibustion and Massage College, Anhui University of Chinese Medicine, Hefei 230012, China
    3 Key Laboratory of Xin’an Medical Ministry of Education, Anhui University of Chinese Medicine, Hefei 230012, China
    4 Center for Xin’an Medicine and Modernization of Traditional Chinese Medicine of IHM, Hefei 230012, China
Dr. WANG Jing, College of Traditional Chinese Medicine, Anhui University of Chinese Medicine, Hefei 230012, China. Wangjing2161@126.com; Telephone: +86-13865912237

Received date: 2024-11-03

  Accepted date: 2025-05-15

  Online published: 2026-04-04

Supported by

National Natural Science Foundation of China: Research on the Cardiomyoprotective Effect Mechanism of Moxibustion Regulating the Mammalian Target of Rapamycin Signaling Pathway to Inhibit Autophagy(81574084);Natural Science Research Project of Colleges and Universities in Anhui Province, China: Exploring the Mechanism of Moxibustion Anti-chronic Heart Failure Fibrosis Based on MicroRNA-21/Phosphatase and Tensin Homolog/mTOR Signaling Pathway-mediated Circular RNA PAN3 Regulation of Cardiomyocyte Autophagy, and Investigating the Mechanism of Moxibustion in Preventing and Treating Chronic Heart Failure Myocardial Fibrosis Based on Transient Receptor Potential Vanilloid 1-regulated Calcitonin Gene-Related Peptide-mediated Vascular Endothelial Growth Factor Endothelial Nitric Oxide Synthase Signaling Pathway(kj2021a0570);Natural Science Research Project of Colleges and Universities in Anhui Province, China: Exploring the Mechanism of Moxibustion Anti-chronic Heart Failure Fibrosis Based on MicroRNA-21/Phosphatase and Tensin Homolog/mTOR Signaling Pathway-mediated Circular RNA PAN3 Regulation of Cardiomyocyte Autophagy, and Investigating the Mechanism of Moxibustion in Preventing and Treating Chronic Heart Failure Myocardial Fibrosis Based on Transient Receptor Potential Vanilloid 1-regulated Calcitonin Gene-Related Peptide-mediated Vascular Endothelial Growth Factor Endothelial Nitric Oxide Synthase Signaling Pathway(2023AH050796);Special Project of Xin'an Medical and Traditional Chinese Medicine Modernization Research Institute of Great Health Research Institute: Research on the Academic Thoughts of Xin'an Medical Expert Wu Yiding in Treating Fever with Moxibustion and the Application of Moxibustion in the Treatment of Epidemic Viral Pneumonia(2023CXMMTCM022)

Fold

Abstract

OBJECTIVE: To explore the mechanism by which moxibustion alleviates autophagy and inhibits ferroptosis, thereby improving myocardial fibrosis in rats with post-myocardial infarction heart failure (post-MI HF).

METHODS: We used a rat model of post-MI HF rats. Interventions included moxibustion and intraperitoneal injection of rapamycin (RAPA) along with assessing echocardiography, cardiac pathology, myocardial mitochondrial morphology, co-immunofluorescence, transmission electron microscope, Western blotting, and reverse transcriptase-quantitative polymerase chain reaction.

RESULTS: Moxibustion improves the left ventricular ejection fraction and fractional shortening, myocardial cell morphology, and myocardial fibrosis levels induced by post-MI HF. In addition, it reduces the immunofluorescence co-localization intensity of nuclear receptor coactivator 4 (NCOA4) and microtubule-associated protein 1A/1B light chain 3 and decreases the level of intracellular free iron. It suppresses autophagy and ferroptosis-related indicators, downregulates NCOA4 expression, upregulates glutathione peroxidase 4 expression, and decreases lipid peroxidation levels. The activation of autophagy increases NCOA4 expression and promotes ferroptosis. Furthermore, moxibustion counteracts the effects of RAPA.

CONCLUSIONS: Moxibustion can alleviate myocardial fibrosis and exert cardioprotective effects by regulating autophagy and inhibiting ferroptosis. Our findings indicate that targeting autophagy-induced ferroptosis may serve as a novel therapeutic approach for the treatment of post-MI HF.

Key words： moxibustion; nuclear receptor coactivator 4; ferroptosis; autophagy; heart failure; myocardial fibrosis

Cite this article

GAO Bing , LIU Pan , LI Lan , GONG Tiantian , ZHU Ling , LI Lingji , XIA Ran , MA Qiang , HU Jing , WANG Jing . Moxibustion alleviates autophagy and inhibits ferroptosis to improve cardiac function in rats with post-myocardial infarction heart failure[J]. Journal of Traditional Chinese Medicine, 2026 , 46(2) : 339 -349 . DOI: 10.19852/j.cnki.jtcm.2026.02.007

References

1. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation 2022; 145: e895-1032.
2. Branch of Cardiovascular Physicians, Chinese Medical Doctor Association, China Cardiovascular Health Alliance, The Expert Consensus Working Group on the Prevention and Treatment of Heart Failure After Myocardial Infarction. 2020 Expert consensus on the prevention and treatment of heart failure after myocardial infarction. Zhong Guo Xun Huan Za Zhi 2020; 35: 1166-80.
3. Gerber Y, Weston SA, Enriquez-Sarano M, et al. Atherosclerotic burden and heart failure after myocardial infarction. JAMA Cardiol 2016; 1: 156-62.
4. Zhang ZY, Jia ZZ, Song YW, et al. Optimized new Shengmai powder inhibits myocardial fibrosis in heart failure by regulating the rat sarcoma/rapidly accelerated fibrosarcoma/mitogen-activated protein kinase kinase/extracellular regulated protein kinases signaling pathway. J Tradit Chin Med 2024; 44: 448-57.
5. Emmons-Bell S, Johnson C, Roth G. Prevalence, incidence and survival of heart failure: a systematic review. Heart 2022; 108: 1351-60.
6. Zhang Q, Li Z, Li Q, et al. Control of NAD+ homeostasis by autophagic flux modulates mitochondrial and cardiac function. EMBO J 2024; 43: 362-90.
7. Qin W, Cao L, Massey IY. Role of PI3K/Akt signaling pathway in cardiac fibrosis. Mol Cell Biochem 2021; 476: 4045-59.
8. Mancias JD, Wang X, Gygi SP, Harper JW, Kimmelman AC. Quantitative proteomics identifies NCOA4 as the cargo receptor mediating ferritinophagy. Nature 2014; 509: 105-9.
9. He JH, Li ZW, Xia PP, et al. Ferroptosis and ferritinophagy in diabetes complications. Mol Metab 2022; 60: 101470.
10. Zheng HY, Shi L, Tong CC, Liu YN, Hou MX. circSnx 12 is involved in ferroptosis during heart failure by targeting miR-224-5p. Front Cardiovasc Med 2021; 8: 656093.
11. Chen X, Yu C, Kang R, Kroemer G, Tang DL. Cellular degradation systems in ferroptosis. Cell Death Differ 2021; 28: 1135-48.
12. Zhang YX, Qu YY, Cai RP, et al. Atorvastatin ameliorates diabetic nephropathy through inhibiting oxidative stress and ferroptosis signaling. Eur J Pharmacol 2024; 976: 176699.
13. Tian Y, Lu J, Hao XQ, et al. FTH1 inhibits ferroptosis through ferritinophagy in the 6-OHDA model of Parkinson’s disease. Neurotherapeutics 2020; 17: 1796-812.
14. Rui TY, Wang HC, Li QQ, et al. Deletion of ferritin H in neurons counteracts the protective effect of melatonin against traumatic brain injury-induced ferroptosis. J Pineal Res 2021; 70: 12704.
15. Jaladat AM, Alizadeh Vaghasloo M, Atarzadeh F, et al. Similarities and differences between kaiy in persian medicine and moxibustion in Chinese medicine. J Integr Med 2023; 21: 354-60.
16. Yang WX, Liang MZ, Xu RM. Clinical efficacy of Fuling Sini decoction combined with moxibustion therapy in the treatment of heart-Yang deficiency type chronic heart failure in the elderly. Zhong Guo Lao Nian Xue Za Zhi 2023; 43: 3077-81.
17. Wang Z, Xia R, Gao B, et al. Efficacy observation of moxibustion plus medication for chronic heart failure of blood stasis due to Qi deficiency syndrome. Shanghai Zhen Jiu Za Zhi 2023; 42: 797-801.
18. Guo Yi. Experimental acupuncture and moxibustion. Beijing: China Traditional Chinese Medicine Press, 2021: 189.
19. Li QL, Ma Q, Li Y, et al. Effect of moxibustion on cardiac function and expression of autophagy-related proteins of cardiomyocytes in chronic heart failure rats. Zhen Ci Yan Jiu 2020; 45: 259-63+74.
20. Xia R, Wang W, Gao B, et al. Moxibustion alleviates chronic heart failure by regulating mitochondrial dynamics and inhibiting autophagy. Exp Ther Med 2022; 23: 359.
21. National Research Council (US) Committee for the Update of the Guide for the Care and Use of Laboratory Animals. Guide for the care and use of laboratory animals. 8th ed. Washington (DC): National Academies Press (US), 2011: 4-6.
22. Zhang L, Gan ZK, Han LN, et al. Protective effect of heme oxygenase-1 on wistar rats with heart failure through the inhibition of inflammation and amelioration of intestinal microcirculation. J Geriatr Cardiol 2015; 12: 353-65.
23. Xu L. Experimental study about prevention of anthracycline-induced myocardial injury by ginger moxibustion. Zhong Guo Xian Dai Yi Sheng 2016; 54: 139-41.
24. Liu SS, Li YB, Shi H, et al. Observation on the clinical effect of heat sensitive moxibustion on patients with heart failure and diuretic resistance. Jiangxi Zhong Yi Yao Da Xue Xue Bao 2023; 35: 65-8.
25. Li Q, Wang W, Ma Q, et al. Moxibustion improves chronic heart failure by inhibiting autophagy and inflammation via upregulation of mTOR expression. Evid Based Complement Alternat Med 2021; 2021: 6635876.
26. Wang W, Li QL, Ma Q, et al. Effects of moxibustion at bilateral Feishu (BL13) and Xinshu (BL15) combined with benazepril on myocardial cells apoptosis index and apoptosis-related proteins cytochrome C and apoptosis-inducing factor in rats with chronic heart failure. J Tradit Chin Med 2022; 42: 227-33.
27. Zhang H, Zhabyeyev P, Wang S, Oudit GY. Role of iron metabolism in heart failure: from iron deficiency to iron overload. Biochim Biophys Acta Mol Basis Dis 2019; 1865: 1925-37.
28. Gao MH, Monian P, Pan QH, Zhang W, Xiang J, Jiang XJ. Ferroptosis is an autophagic cell death process. Cell Res 2016; 26: 1021-32.
29. Fan ZY, Cai LL, Wang SN, Wang J, Chen BH. Baicalin prevents myocardial ischemia/reperfusion injury through inhibiting ACSL4 mediated ferroptosis. Front Pharmacol 2021; 4: 628988.
30. Hou W, Xie Y, Song X, et al. Autophagy promotes ferroptosis by degradation of ferritin. Autophagy 2016; 12: 1425-8.
31. Xiao Y, Ding L, Chen H, et al. Grain-moxibustion may protect myocardium by reducing oxidative stress in doxorubicin-induced cardiomyopathy rats. Zhen Ci Yan Jiu 2016; 41: 502-8.
32. Hajri T, Gharib M, Fungwe T, M’Koma A. Very low-density lipoprotein receptor mediates triglyceride-rich lipoprotein-induced oxidative stress and insulin resistance. Am J Physiol Heart Circ Physiol 2024; 327: H733-48.
33. Sahebkar A, Foroutan Z, Katsiki N, Jamialahmadi T, Mantzoros CS. Ferroptosis, a new pathogenetic mechanism in cardiometabolic diseases and cancer: is there a role for statin therapy? Metabolism 2023; 146: 155659.
34. Fang YY, Chen XC, Tan QY, Zhou HH, Xu J, Gu Q. Inhibiting ferroptosis through disrupting the NCOA4-FTH1 interaction: a new mechanism of action. ACS Cent Sci 2021; 7: 980-9.
35. Zeidan RS, Han SM, Leeuwenburgh C, Xiao R. Iron homeostasis and organismal aging. Ageing Res Rev 2021; 72: 101510.
36. Zeng Z, Huang H, Zhang J, et al. HDM induce airway epithelial cell ferroptosis and promote inflammation by activating ferritinophagy in asthma. FASEB J 2022; 36: e22359.
37. Laukaitiene J, Gujyte G, Kadusevicius E. Cardiomyocyte damage: ferroptosis relation to ischemia-reperfusion injury and future treatment options. Int J Mol Sci 2023; 24: 12846.
38. Sumneang N, Siri-Angkul N, Kumfu S, Chattipakorn SC, Chattipakorn N. The effects of iron overload on mitochondrial function, mitochondrial dynamics, and ferroptosis in cardiomyocytes. Arch Biochem Biophys 2020; 680: 108241.
39. Wang XC, Wei TT, Luo JL, et al. Iron overload-dependent ferroptosis aggravates LPS-induced acute lung injury by impairing mitochondrial function. Inflammation 2024; 47: 2013-26.
40. Huang FZ, Liu XM, Liu JJ, et al. Phosphatidylethanolamine aggravates angiotensin II-induced atrial fibrosis by triggering ferroptosis in mice. Front Pharmacol 2023; 14: 1148410.
Options
Outlines

/

〈 〉