Atherosclerosis is a chronic inflammatory disorder characterized by the gradual buildup of plaques within the vessel wall of middle-sized and large arteries. The occurrence and development of atherosclerosis and the rupture of plaques are related to the injury of vascular cells, including endothelial cells, smooth muscle cells, and macrophages. Autophagy is a subcellular process that plays an important role in the degradation of proteins and damaged organelles, and the autophagy disorder of vascular cells is closely related to atherosclerosis. Pyroptosis is a proinflammatory form of regulated cell death, while ferroptosis is a form of regulated nonapoptotic cell death involving overwhelming iron-dependent lipid peroxidation. Both of them exhibit distinct features from apoptosis, necrosis, and autophagy in morphology, biochemistry, and genetics. However, a growing body of evidence suggests that pyroptosis and ferroptosis interact with autophagy and participate in the development of cancers, degenerative brain diseases and cardiovascular diseases. This review updated the current understanding of autophagy, pyroptosis, and ferroptosis, finding potential links and their effects on atherogenesis and plaque stability, thus providing ways to develop new pharmacological strategies to address atherosclerosis and stabilize vulnerable, ruptured plaques.

Vascular endothelial injury is the initial stage of atherosclerosis (AS). Stimulating and activating the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway can regulate the expression of vascular endothelial cytokines, thus affecting the occurrence and development of AS. In addition, the PI3K/Akt signaling pathway can regulate the polarization and survival of macrophages and the expression of inflammatory factors and platelet function, thus influencing the progression of AS. In recent years, traditional Chinese medicine (TCM) has been widely recognized for its advantages of fewer side effects, multiple pathways, and multiple targets. Also, the research of TCM regulation of AS via the PI3K/Akt signaling pathway has achieved certain results. This study aimed to analyze the characteristics of the PI3K/Akt signaling pathway and its role in the pathogenesis of AS, as well as the role of Chinese medicine in regulating the PI3K/Akt signaling pathway. The findings are expected to provide a theoretical basis for the clinical treatment and pathological mechanism research of AS.

Autophagy is closely associated with atherosclerosis and other cardiovascular diseases (CVD). Compound Danshen prescription is widely used as a clinical antiatherosclerotic drug. In our previous studies, we have shown that the combined active component, ginsenoside Rg1-notoginsenoside R1-protocatechualdehyde (RRP), can effectively alleviate endothelial dysfunction and reduce atherosclerotic plaques. However, the association between cellular senescence, caused by reduced autophagy, and atherosclerosis remains unclear. In this study, we investigated whether RRP can enhance autophagy and alleviate cell senescence through the AMPK pathway. Our results showed that RRP reduced the secretion of inflammatory factors in the serum of atherosclerotic mice, enhanced autophagy, and alleviated aortic aging in mice, thus reducing atherosclerotic plaques. In human aortic endothelial cells (HAECs), RRP effectively enhanced autophagy and inhibited senescence by activating the AMPK pathway. When AMPKα was silenced, the effect of RRP was inhibited, thus reversing its antiaging effect. Overall, our results show that RRP regulates autophagy through the AMPK pathway, thereby inhibiting cell senescence and alleviating the progression of atherosclerosis, suggesting that RRP may be a potential candidate drug for the treatment of atherosclerosis.

细胞衰老是一种与细胞结构和功能退化相关的生物过程，与年龄相关的疾病有着复杂的联系。动脉粥样硬化是一种慢性炎症性疾病，可引起多种心血管疾病。本文就细胞衰老过程中，多种衰老细胞产生不同的生理病理变化对动脉粥样硬化的影响，衰老细胞器的改变和衰老细胞分泌的衰老相关分泌表型（SASP）的增多促进动脉粥样硬化的进展，以及针对清除衰老细胞和减少SASP以减轻动脉粥样硬化的相关治疗方法等研究进展进行综述，以期为动脉粥样硬化的治疗提供新的思路。

Protocatechuic aldehyde (PCA) is a natural phenolic acid compound with pharmacological effects such as anti-oxidative stress, antibacterial, anti-apoptotic, anti-inflammatory, anti-platelet aggregation, and anti-tumor. Despite the favorable therapeutic effects of PCA, it is imperative to recognize that adverse drug reactions can arise even with satisfactory quality assurance measures and during standard clinical application and dosing. Additionally, the acute toxicity and cardiotoxic sequelae of PCA are frequently under reported in the available documentation. To investigate the acute toxicity and cardiotoxic effects of PCA, the present study comprehensively assessed the acute toxicity and cardiotoxic effects of PCA by administering different concentrations of PCA and by monitoring the phenotypic changes in zebrafish, using AB wild-type Tg(cmlc2:EGFP) zebrafish as the experimental model organism. Meanwhile, the target genes of PCA that may cause cardiotoxicity were predicted and validated using a network pharmacology approach. Our findings indicated that PCA exhibited severe acute toxicity and cardiotoxic effects in zebrafish at 70 μg/mL and 80 μg/mL. Furthermore, PIK3CA, PARP1, and GSK3β may be involved in the mechanism of action of the cardiotoxicity-inducing effects of this compound. The present investigation has afforded a deeper insight into the acute toxicity and cardiotoxic impacts of PCA on zebrafish and has established a significant theoretical foundation for the evaluation of toxicity in pharmaceuticals incorporating PCA.

The global population is aging at an unprecedented rate, leading to a sharp rise in late-life diseases such as sarcopenia. Despite its increasing prevalence, effective pharmacological treatments, exercise regimens, and dietary recommendations for sarcopenia remain limited. Acupuncture has demonstrated potential in improving quality of life for individuals with sarcopenia. However, whether acupuncture is effective for treating sarcopenia remains unclear. This systematic review and meta-analysis aim to assess the therapeutic effectiveness of acupuncture in treating sarcopenia. We conducted a comprehensive search across nine major English and Chinese electronic databases, covering all available studies up to May 2024. We compared sarcopenia outcomes between patients who received acupuncture and those who did not. The retrieved literature was systematically organized and categorized using EndNote 21. We performed data analysis using Review Manager 5.3 and STATA 18.0. Our comprehensive search identified 1,106 publications, including 384 basic research, 324 systematic reviews and meta-analyses, 281 unrelated studies, 109 randomized controlled trials, and 8 case reports. Finally we analyzed 10 RCTs. Compared to conventional treatment, acupuncture significantly improved total treatment efficiency (RR = 1.40, 95% CI: 1.13–1.73), muscle mass (SMD = 1.31, 95% CI: 0.19–2.43), grip strength (SMD = 0.66, 95% CI: 0.49–0.83), and usual gait speed (SMD = 2.53, 95% CI: 0.78–4.28). Additionally, acupuncture reducing C-reactive protein levels (SMD = −0.99, 95% CI: −1.42–−0.56). Among the results, acupuncture-based therapies demonstrated therapeutic potential on muscle mass and some physical function in patients with sarcopenia. Moreover, acupuncture constitutes an essential complementary modality for frail older adults unable to tolerate conventional treatments. However, the limited number and quality of RCTs necessitates further research to confirm these findings and fully elucidate acupuncture’s potential in sarcopenia management. Further validation through multicenter, high-quality RCTs with larger sample sizes is essential to ensure the robustness and generalizability of these findings. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251040930 , Identifier, CRD420251040930.