The role of reactive oxygen species-mitophagy regulation in the treatment of osteoarthritis by active Chinese herbal medicine monomers: a review

The primary pathological features of osteoarthritis (OA) involve articular cartilage degradation and structural damage, coupled with osteophyte formation and inflammatory responses. As aging populations expand, the prevalence of knee osteoarthritis has risen substantially, severely compromising patients’ quality of life. Current therapeutic strategies for knee osteoarthritis remain limited in clinical efficacy, creating an urgent need for novel treatments that are both effective and safe. Chinese herbal medicine monomers have demonstrated significant potential in OA management, offering multi-pathway therapeutic effects, multi-target modulation, and favorable safety profiles. However, its underlying mechanisms require further elucidation. Mitophagy, a selective mitochondrial quality control mechanism that eliminates reactive oxygen species-damaged organelles, plays a crucial role in maintaining chondrocyte homeostasis and function. Emerging evidence highlights the regulatory significance of mitophagy in OA progression, presenting novel therapeutic perspectives. This review comprehensively analyzes the molecular mechanisms and physiological roles of the oxidative stress-mitophagy axis in knee osteoarthritis pathogenesis, while summarizing recent advances in herbal monomer-mediated regulation of this pathway. Future research directions are proposed to facilitate the systematic exploration and clinical translation of Chinese herbal medicine in OA therapeutics.