Pathogenesis of Osteoarthritis: Mechanisms of Action of Disulfidptosis and Targeted Therapeutic Strategies.

The onset of osteoarthritis (OA) involves the interplay of mechanical stress, inflammatory responses, and metabolic disorders. Pro-inflammatory cytokines, including IL-1β, TNF-α, and IL-6, drive cartilage degradation, synovitis, and subchondral bone remodeling through activation of NF-κB and MAPK signaling pathways. Recent studies have identified disulfidptosis, a novel form of programmed cell death, and suggest its potential involvement in OA pathogenesis. This death modality is triggered by abnormal intracellular accumulation of disulfide bonds, dependent on high SLC7A11 expression and NADPH depletion, leading to cytoskeletal protein cross-linking and cellular collapse. In the OA microenvironment, chondrocytes and synovial cells are hypothesized to exhibit increased susceptibility to disulfidptosis owing to metabolic imbalance, impaired glucose uptake, and oxidative stress. This process may not only cause direct loss of cellular function but also potentially amplify inflammatory responses through the release of damage-associated molecular patterns (DAMPs) and senescence-associated secretory phenotype (SASP) factors, thereby theoretically contributing to a vicious cycle of inflammation and M1 macrophage polarization that exacerbates cartilage destruction. Potential therapeutic strategies targeting this pathway include: phytochemicals (eg, curcumin, resveratrol) that modulate redox balance; traditional Chinese medicines (eg, Duhuo Jisheng Decoction) with multi-target anti-inflammatory properties; specific inhibitors such as SLC7A11 antagonists or G6PD activators; hydrogel-based drug delivery systems for localized sustained release; and bone transport technology that activates Piezo1 mechanoreceptors to enhance antioxidant defense. While these approaches represent promising investigational directions, direct evidence validating their efficacy against disulfidptosis in OA remains limited. Future studies must clarify the functional significance of disulfidptosis in OA and rigorously evaluate targeted therapies in preclinical models before clinical translation can be considered.