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<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Molecular Medicine Reports</journal-id>
<journal-title-group>
<journal-title>Molecular Medicine Reports</journal-title>
</journal-title-group>
<issn pub-type="ppub">1791-2997</issn>
<issn pub-type="epub">1791-3004</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/mmr.2019.10267</article-id>
<article-id pub-id-type="publisher-id">mmr-20-01-0401</article-id>
<article-categories>
<subj-group>
<subject>Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Crocin protects against dexamethasone-induced osteoblast apoptosis by inhibiting the ROS/Ca<sup>2&#x002B;</sup>-mediated mitochondrial pathway</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>Nie</surname><given-names>Zhigang</given-names></name>
<xref rid="af1-mmr-20-01-0401" ref-type="aff"/>
<xref rid="fn1-mmr-20-01-0401" ref-type="author-notes">&#x002A;</xref></contrib>
<contrib contrib-type="author"><name><surname>Deng</surname><given-names>Shuang</given-names></name>
<xref rid="af1-mmr-20-01-0401" ref-type="aff"/>
<xref rid="fn1-mmr-20-01-0401" ref-type="author-notes">&#x002A;</xref></contrib>
<contrib contrib-type="author"><name><surname>Zhang</surname><given-names>Lei</given-names></name>
<xref rid="af1-mmr-20-01-0401" ref-type="aff"/>
<xref rid="fn1-mmr-20-01-0401" ref-type="author-notes">&#x002A;</xref></contrib>
<contrib contrib-type="author"><name><surname>Chen</surname><given-names>Sen</given-names></name>
<xref rid="af1-mmr-20-01-0401" ref-type="aff"/></contrib>
<contrib contrib-type="author"><name><surname>Lu</surname><given-names>Qiang</given-names></name>
<xref rid="af1-mmr-20-01-0401" ref-type="aff"/></contrib>
<contrib contrib-type="author"><name><surname>Peng</surname><given-names>Hao</given-names></name>
<xref rid="af1-mmr-20-01-0401" ref-type="aff"/>
<xref rid="c1-mmr-20-01-0401" ref-type="corresp"/></contrib>
</contrib-group>
<aff id="af1-mmr-20-01-0401">Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China</aff>
<author-notes>
<corresp id="c1-mmr-20-01-0401"><italic>Correspondence to</italic>: Professor Hao Peng, Department of Orthopedics, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, Hubei 430060, P.R. China, E-mail: <email>penghaowhu123@163.com</email></corresp>
<fn id="fn1-mmr-20-01-0401"><label>&#x002A;</label><p>Contributed equally</p></fn>
</author-notes>
<pub-date pub-type="ppub"><month>07</month><year>2019</year></pub-date>
<pub-date pub-type="epub"><day>22</day><month>05</month><year>2019</year></pub-date>
<volume>20</volume>
<issue>1</issue>
<fpage>401</fpage>
<lpage>408</lpage>
<history>
<date date-type="received"><day>01</day><month>07</month><year>2018</year></date>
<date date-type="accepted"><day>28</day><month>02</month><year>2019</year></date>
</history>
<permissions>
<copyright-statement>Copyright: &#x00A9; Nie et al.</copyright-statement>
<copyright-year>2019</copyright-year>
<license license-type="open-access">
<license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivs License</ext-link>, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.</license-p></license>
</permissions>
<abstract>
<p>Osteoblast apoptosis has been identified as an important event in the development of glucocorticoid (GC)-induced osteoporosis and osteonecrosis of the femoral head. Crocin, a bioactive ingredient of saffron, has been demonstrated to induce antiapoptotic effects on numerous types of cell <italic>in vitro</italic>; however, the effects of crocin on the dexamethasone (Dex)-induced apoptosis of osteoblasts remain unclear. In the present study, the protective effects of crocin during Dex-induced apoptosis of MC3T3-E1 osteoblasts, and the underlying mechanisms, were investigated. MTT and Annexin V-FITC/PI flow cytometry assays were performed to evaluate the viability and apoptosis of cells, respectively. The mitochondrial transmembrane potential, reactive oxygen species (ROS), intracellular Ca<sup>2&#x002B;</sup> levels and apoptosis-associated protein expression were assessed via flow cytometry, fluorescence microscopy and western blotting. It was demonstrated that crocin pretreatment inhibited Dex-induced apoptosis of osteoblasts in a dose-dependent manner. Crocin reversed Dex-induced decreases in the mitochondrial transmembrane potential, and increases in ROS and intracellular Ca<sup>2&#x002B;</sup> levels. Furthermore, crocin upregulated the expression levels of B-cell lymphoma-2 (Bcl-2) and mitochondrial cytochrome <italic>c</italic> (Cyt C), and downregulated those of cleaved caspase-9, cleaved caspase-3, Bcl-2-associated X protein and cytoplasmic Cyt C. N-acetylcysteine, a ROS inhibitor, and 1,2-bis(2-aminophenoxy)ethane-N,N,N&#x2032;,N&#x2032;-tetraacetic acid, a calcium chelator, attenuated Dex-induced osteoblast apoptosis, whereas H<sub>2</sub>O<sub>2</sub> and ionomycin, a calcium ionophore that increases intracellular calcium levels, reversed the antiapoptotic effects of crocin on Dex-treated osteoblasts. These results indicated that crocin may protect osteoblasts from Dex-induced apoptosis by inhibiting the ROS/Ca<sup>2&#x002B;</sup>-mediated mitochondrial pathway, thus suggesting that crocin has potential value as a treatment for GC-induced bone diseases.</p>
</abstract>
<kwd-group>
<kwd>crocin</kwd>
<kwd>osteoblast</kwd>
<kwd>apoptosis</kwd>
<kwd>mitochondrial pathway</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec sec-type="intro">
<title>Introduction</title>
<p>Glucocorticoids (GCs) are widely used as treatments for various diseases (<xref rid="b1-mmr-20-01-0401" ref-type="bibr">1</xref>), including systemic lupus erythematosus, idiopathic thrombocytopenic purpura and nephrotic syndrome; however, GC use can lead to numerous complications, the most serious of which are osteoporosis and osteonecrosis of the femoral head (ONFH) (<xref rid="b2-mmr-20-01-0401" ref-type="bibr">2</xref>). Osteoblast apoptosis is regarded as an important pathogenic mechanism underlying these two complications (<xref rid="b3-mmr-20-01-0401" ref-type="bibr">3</xref>&#x2013;<xref rid="b6-mmr-20-01-0401" ref-type="bibr">6</xref>). Consistent with these findings, previous studies have detected a large number of TUNEL-positive osteoblasts (apoptotic cells) in the femoral head of GC-treated rats (<xref rid="b7-mmr-20-01-0401" ref-type="bibr">7</xref>,<xref rid="b8-mmr-20-01-0401" ref-type="bibr">8</xref>). Therefore, the development of novel treatments that inhibit osteoblast apoptosis is required.</p>
<p>The role of reactive oxygen species (ROS) in osteoblast apoptosis has received considerable attention from researchers. Dai <italic>et al</italic> (<xref rid="b9-mmr-20-01-0401" ref-type="bibr">9</xref>) revealed that H<sub>2</sub>O<sub>2</sub> induces apoptosis in the Saos-2 osteoblastic cell line, which is attenuated by curcumin via increased protein kinase B-glycogen synthase kinase 3&#x03B2; signaling and preservation of mitochondrial function. Additionally, Linares <italic>et al</italic> (<xref rid="b10-mmr-20-01-0401" ref-type="bibr">10</xref>) confirmed that apoptosis is induced in MC3T3-E1 cells by H<sub>2</sub>O<sub>2</sub> and revealed that the effect is regulated by glutaredoxin 5. Li <italic>et al</italic> (<xref rid="b11-mmr-20-01-0401" ref-type="bibr">11</xref>) reported that aluminum induces osteoblast apoptosis via the oxidative stress-mediated c-Jun N-terminal kinase (JNK) pathway. ROS serve roles in promoting apoptosis by inducing cytochrome <italic>c</italic> (Cyt C) release from the mitochondria to the cytosol (<xref rid="b12-mmr-20-01-0401" ref-type="bibr">12</xref>). Furthermore, ROS have been reported to induce apoptosis of osteoblasts via activation of a protein kinase C&#x03B2;/p66<sup>shc</sup>/JNK signaling cascade (<xref rid="b13-mmr-20-01-0401" ref-type="bibr">13</xref>). Intracellular Ca<sup>2&#x002B;</sup> is also involved in inducing apoptosis of various cell types (<xref rid="b14-mmr-20-01-0401" ref-type="bibr">14</xref>,<xref rid="b15-mmr-20-01-0401" ref-type="bibr">15</xref>); however, the role of Ca<sup>2&#x002B;</sup> in osteoblasts remains unclear. At present, only Nam <italic>et al</italic> (<xref rid="b16-mmr-20-01-0401" ref-type="bibr">16</xref>) has reported that H<sub>2</sub>O<sub>2</sub> increases intracellular Ca<sup>2&#x002B;</sup> levels in osteoblasts, subsequently inducing cell death.</p>
<p>Crocin (<xref rid="f1-mmr-20-01-0401" ref-type="fig">Fig. 1A</xref>) is a major bioactive component extracted from saffron, which has been reported to possess anticancer, anti-inflammatory, antioxidant and antiapoptotic properties (<xref rid="b17-mmr-20-01-0401" ref-type="bibr">17</xref>&#x2013;<xref rid="b20-mmr-20-01-0401" ref-type="bibr">20</xref>). As revealed by Santhosh <italic>et al</italic> (<xref rid="b21-mmr-20-01-0401" ref-type="bibr">21</xref>), crocin provides notable protection against <italic>Vipera russelli</italic> venom-induced oxidative stress and neutrophil apoptosis. Additionally, Oruc <italic>et al</italic> (<xref rid="b22-mmr-20-01-0401" ref-type="bibr">22</xref>) reported that crocin exhibits antiapoptotic and antioxidant effects on ischemia-reperfusion injury induced by four-vessel occlusion. The effects of crocin on intracellular Ca<sup>2&#x002B;</sup> signaling have received limited attention, with the exception of a study by Liu <italic>et al</italic> (<xref rid="b23-mmr-20-01-0401" ref-type="bibr">23</xref>), which revealed that crocin decreases the L-type Ca<sup>2&#x002B;</sup> current and inhibits Ca<sup>2&#x002B;</sup> entry into cardiomyocytes, thereby exerting cardioprotective effects. Notably, crocin has been demonstrated to protect against ovariectomy-induced osteoporosis by inhibiting oxidative stress in a rat model (<xref rid="b24-mmr-20-01-0401" ref-type="bibr">24</xref>). Therefore, it has been suggested that crocin may serve a protective role in osteoblasts. This study hypothesized that crocin may suppress dexamethasone (Dex)-induced osteoblast apoptosis by inhibiting the ROS/Ca<sup>2&#x002B;</sup>-mediated mitochondrial pathway.</p>
<p>In the present study, the effects of crocin on Dex-induced osteoblast apoptosis and its underlying mechanisms were investigated. ROS and intracellular Ca<sup>2&#x002B;</sup> levels, and the activity of the mitochondrial apoptotic pathway, were determined following crocin administration in Dex-treated MC3T3-E1 osteoblasts.</p>
</sec>
<sec sec-type="materials|methods">
<title>Materials and methods</title>
<sec>
<title/>
<sec>
<title>Materials</title>
<p>Crocin (cat. no. 17304), MTT (cat. no. M2128), N-acetyl-L-cysteine (NAC, cat. no. A7250), 1,2-bis(2-aminophenoxy)ethane-N,N,N&#x2032;,N&#x2032;-tetraacetic acid (BAPTA-AM; cat. no. 14510), H<sub>2</sub>O<sub>2</sub> (cat. no. 88597), ionomycin (Ion; cat. no. 407952), and dimethyl sulfoxide (cat. no. 156914) were purchased from Sigma-Aldrich (Merck KGaA, Darmstadt, Germany). The purity of crocin was determined to be 98.06&#x0025; via high-performance liquid chromatography conducted by the Department of Pharmacology of Wuhan University (Wuhan, China). Dex was acquired from Shanghai Aladdin Bio-Chem Technology Co., Ltd. (Shanghai, China, cat. no. D137736). An Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) kit was purchased from Nanjing KeyGen Biotech Co., Ltd. (Nanjing, China; cat. no. KGA108). JC-1 Assay (cat. no. C2006), ROS Assay (cat. no. S0033), Mitochondria Isolation (cat. no. C3601), Bicinchoninic Acid (BCA; cat. no. P0010) Assay and Caspase-3 Activity Assay kits (cat. no. C1116), and phenylmethylsulfonyl fluoride (PMSF; cat. no. ST506) were acquired from Beyotime Institute of Biotechnology (Shanghai, China). A Fluo-3 AM kit was purchased from Dojindo Molecular Technologies, Inc. (Kumamoto, Japan; cat. no. F026). B-cell lymphoma-2 (Bcl-2; cat. no. 4223S), Bcl-2-associated X protein (Bax; cat. no. 2772T), cleaved caspase-3 (cat. no. 9664T), &#x2212;8 (cat. no. 8592) and &#x2212;9 (cat. no. 9509) antibodies were purchased from Cell Signaling Technology, Inc. (Danvers, MA, USA). Cyt C antibody was obtained from Wuhan Sanying Biotechnology (Wuhan, China; cat. no. 10993-1-AP). GAPDH antibody was acquired from Hangzhou Goodhere Biotechnology Co., Ltd. (Hangzhou, China; cat. no. AB-P-R 001). Cyt C oxidase IV (COX IV; cat. no. ab16056) antibody was purchased from Abcam (Cambridge, UK). Horseradish peroxidase-conjugated secondary antibodies were acquired from Boster Biological Technology (Pleasanton, CA, USA; cat. no. BA1054).</p>
</sec>
<sec>
<title>Cell culture</title>
<p>MC3T3-E1 osteoblasts were obtained from Wuhan Biofavor Biotech Services Co., Ltd. (Wuhan, China). Cells were cultured in &#x03B1;-minimal essential medium (Gibco; Thermo Fisher Scientific, Inc., Waltham, MA, USA) supplemented with 10&#x0025; fetal bovine serum (Gibco; Thermo Fisher Scientific, Inc.), 100 U/ml penicillin and 100 &#x00B5;g/ml streptomycin at 37&#x00B0;C in an atmosphere containing 5&#x0025; CO<sub>2</sub>.</p>
</sec>
<sec>
<title>Cell viability assay</title>
<p>Cells were cultured in 96-well plates at a density of 5&#x00D7;10<sup>3</sup> cells/well. Increasing concentrations of crocin (0, 5, 25, 100, 400, 1,000 and 4,000 &#x00B5;M) were added to the wells, and cells were incubated at 37&#x00B0;C for 24 or 48 h. Then, nontoxic concentrations of crocin were determined using an MTT assay and were selected for subsequent experiments. Three concentrations (5, 25 and 100 &#x00B5;M) were then used to investigate the protective effects of crocin against 1 &#x00B5;M Dex-induced cytotoxicity using an MTT assay. Cells were pretreated with 5, 25 and 100 &#x00B5;M crocin for 1 h, and then treated with 1 &#x00B5;M Dex for a further 24 or 48 h. Cells were incubated at 37&#x00B0;C. The MTT assay was conducted as follows: Following aforementioned treatment and incubation, MTT reagent (10 &#x00B5;l) was added to wells, and the plates were incubated at 37&#x00B0;C for 4 h. The medium was then discarded, and 150 &#x00B5;l dimethyl sulfoxide was added to the wells to dissolve the formazan crystals. The absorbance was detected at 568 nm using a microplate reader (Thermo Fisher Scientific, Inc.).</p>
</sec>
<sec>
<title>Apoptosis assay</title>
<p>An Annexin V-FITC/PI assay was used to determine the apoptosis of osteoblasts. Cells were pretreated with 5, 25 and 100 &#x00B5;M crocin for 1 h, and then treated with 1 &#x00B5;M Dex for a further 24 h. Cells were incubated at 37&#x00B0;C. Following treatment, cells were washed twice with PBS, and were then incubated with 5 &#x00B5;l Annexin V and 5 &#x00B5;l PI in the dark at room temperature for 15 min. Subsequently, the cells were subjected to flow cytometry (Beckmancoulter, Brea, CA, USA), and CytExpert 2.0 software (Beckmancoulter) was used to determine the percentage of apoptotic cells. Annexin V<sup>&#x002B;</sup>/PI<sup>&#x2212;</sup> cells were designated as early apoptotic cells, whereas Annexin V<sup>&#x002B;</sup>/PI<sup>&#x002B;</sup> cells were identified as late apoptotic cells. The total percentage of apoptotic cells was calculated by adding the percentage of early apoptotic cells to the percentage of late apoptotic cells.</p>
</sec>
<sec>
<title>Effects of increase and decrease of ROS and Ca<sup>2&#x002B;</sup></title>
<p>NAC, H<sub>2</sub>O<sub>2,</sub> BAPTA-AM, and Ion were added to cells to observe the effects of increases and decreases in ROS and Ca<sup>2&#x002B;</sup> on the mitochondrial transmembrane potential (&#x0394;&#x03C8;m), caspase-3 activity, ROS levels, Ca<sup>2&#x002B;</sup> levels and apoptotic rate of osteoblasts. Cells were pretreated with 100 &#x00B5;M Cro, 2 mM NAC, 20 &#x00B5;M BAP, 100 &#x00B5;M H<sub>2</sub>O<sub>2</sub> or 0.5 &#x00B5;M Ion for 1 h at 37&#x00B0;C prior to treatment with 1 &#x00B5;M Dex for 24 h at 37&#x00B0;C. The effects of NAC and BAP on Dex-induced mitochondrial membrane potential (&#x0394;&#x03C8;m) changes, caspase-3 activation, osteoblast apoptosis, and ROS and Ca<sup>2&#x002B;</sup> levels were evaluated. The effects of H<sub>2</sub>O<sub>2</sub> and Ion on the protective effects of Cro against Dex-induced &#x0394;&#x03C8;m changes, caspase-3 activation, osteoblast apoptosis, and ROS and Ca<sup>2&#x002B;</sup> levels were also evaluated.</p>
</sec>
<sec>
<title>Measurement of the &#x0394;&#x03C8;m</title>
<p>The &#x0394;&#x03C8;m was measured using the JC-1 Assay kit, according to the manufacturer&#x0027;s protocol. Briefly, following treatment, cells were incubated with JC-1 solution (500 &#x00B5;l) at 37&#x00B0;C for 20 min and were then centrifuged at 13,500 &#x00D7; g for 3 min at 4&#x00B0;C. Subsequently, the cells were washed and resuspended in 1X incubation buffer (provided in the assay kit) three times. Finally, the &#x0394;&#x03C8;m was determined by flow cytometry. The JC-1 polymer/monomer fluorescence ratio was used to quantify the &#x0394;&#x03C8;m.</p>
</sec>
<sec>
<title>ROS detection</title>
<p>ROS levels were determined via two methods using the ROS Assay kit: Flow cytometry and fluorescence microscopy. Briefly, following treatment, cells were incubated with dichlorodihydrofluorescein diacetate solution (10 &#x00B5;M) at 37&#x00B0;C for 20 min. Cells were then washed three times with serum-free medium and washed twice with PBS. Finally, a flow cytometer was used to quantify the fluorescence intensity as a measure of ROS production, and data were analyzed using CytExpert 2.0 software. A fluorescence microscope (Olympus Corporation, Tokyo, Japan) and cellSens Entry 1.17 software (Olympus Corporation) was used to observe intracellular ROS fluorescence.</p>
</sec>
<sec>
<title>Intracellular Ca<sup>2&#x002B;</sup> detection</title>
<p>The Ca<sup>2&#x002B;</sup> dye Fluo-3 AM was used to determine intracellular Ca<sup>2&#x002B;</sup> levels. Two methods, flow cytometry and fluorescence microscopy, were employed. Following treatment, cells were incubated with Fluo-3 AM solution (final concentration, 5 &#x00B5;M) at 37&#x00B0;C for 30 min. The cells were then washed twice with PBS, and the Ca<sup>2&#x002B;</sup>-dependent fluorescence intensity was determined using a flow cytometer and CytExpert 2.0 software. Fluorescence images were visualized under a fluorescence microscope (Olympus Corporation, Tokyo, Japan) using cellSens Entry 1.17 software.</p>
</sec>
<sec>
<title>Caspase-3 activity assay</title>
<p>Caspase-3 activity in cells was determined using a Caspase-3 Activity Assay kit, according to the manufacturer&#x0027;s protocols. Luminescence was measured at 405 nm using a microplate reader (Thermo Fisher Scientific, Inc.).</p>
</sec>
<sec>
<title>Western blotting</title>
<p>A Mitochondria Isolation kit was used to isolate mitochondria for analysis of mitochondrial Cyt C expression, according to the manufacturer&#x0027;s protocol. Following treatment, cells were homogenized on ice in cell lysis buffer (RIPA buffer; Beyotime Institute of Biotechnology) containing PMSF and centrifuged at 13,500 &#x00D7; g for 15 min at 4&#x00B0;C. Subsequently, protein concentrations were determined using a BCA kit. Equal quantities of total protein (50 &#x00B5;g/lane) were separated by SDS-PAGE (separation gel, 15&#x0025;; stacking gel, 5&#x0025;) and transferred to polyvinylidene fluoride membranes. Membranes were blocked with 5&#x0025; non-fat dried milk in TBS-0.1&#x0025; Tween-20 at room temperature for 2 h. incubated with primary antibodies against Bax (1:1,000), Bcl-2 (1:1,000), cleaved caspase-3 (1:1,000), cleaved caspase-8 (1:1,000), cleaved caspase-9 (1:1,000), Cyt C (1:1,000), COX IV (1:2,000) and GAPDH (1:1,000) overnight at 4&#x00B0;C. Subsequently, membranes were incubated with horseradish peroxidas-conjugated secondary antibodies (1:50,000) at 37&#x00B0;C for 2 h. Protein bands were visualized using enhanced chemiluminescence (Thermo Fisher Scientific, Inc.) and the optical density of protein bands was detected using BandScan 5.0 software (Glyko, Inc.; BioMarin Pharmaceutical, Inc., Novato, CA, USA).</p>
</sec>
<sec>
<title>Statistical analysis</title>
<p>Data are presented as the means &#x00B1; standard deviation of three independent experiments. Data were analyzed using GraphPad Prism 5.0 software (GraphPad Software, Inc., La Jolla, CA, USA). Statistical significance was evaluated by one-way analysis of variance followed by a Tukey-Kramer test for post hoc comparisons. P&#x003C;0.05 was considered to indicate a statistically significant difference.</p>
</sec>
</sec>
</sec>
<sec sec-type="results">
<title>Results</title>
<sec>
<title/>
<sec>
<title>Crocin protects osteoblasts against Dex-induced cytotoxicity and apoptosis</title>
<p>The viability of MC3T3-E1 osteoblasts following treatment with various concentrations of crocin was investigated to determine a nontoxic concentration range. As presented in <xref rid="f1-mmr-20-01-0401" ref-type="fig">Fig. 1B</xref>, crocin did not exhibit cytotoxic effects on osteoblasts at concentrations &#x2264;400 &#x00B5;M. Subsequently, the protective effects of crocin against Dex-treated MC3T3-E1 osteoblasts were determined. As presented in <xref rid="f1-mmr-20-01-0401" ref-type="fig">Fig. 1C</xref>, the viability of osteoblasts at 24 h was increased from 59.9&#x00B1;1.6&#x0025; following treatment with 1 &#x00B5;M Dex alone, to 65.1&#x00B1;6.7, 76.2&#x00B1;5.0 and 85.8&#x00B1;4.9&#x0025; following treatment with Dex &#x002B; 5, 25 and 100 &#x00B5;M crocin, respectively (P&#x003C;0.05). There was no notable difference in cell viability following incubation for 24 or 48 h. Similarly, it was revealed that the percentage of apoptotic cells at 24 h was significantly decreased from 27.0&#x00B1;2.9&#x0025; following incubation with 1 &#x00B5;M Dex alone, to 17.6&#x00B1;1.6, 11.6&#x00B1;1.4 and 8.97&#x00B1;0.9&#x0025; following treatment with Dex &#x002B; 5, 25 and 100 &#x00B5;M crocin, respectively (<xref rid="f1-mmr-20-01-0401" ref-type="fig">Fig. 1D</xref>; P&#x003C;0.05).</p>
</sec>
<sec>
<title>Crocin protects osteoblasts against Dex-induced apoptosis by inhibiting the mitochondrial apoptotic pathway</title>
<p>The &#x0394;&#x03C8;m and expression of mitochondrial apoptotic pathway-associated proteins were investigated. As presented in <xref rid="f2-mmr-20-01-0401" ref-type="fig">Fig. 2A and B</xref>, Dex significantly reduced the &#x0394;&#x03C8;m (JC-1 polymer/monomer fluorescence ratio) compared with in the control group; however, crocin pretreatment reversed the effects of Dex in a dose-dependent manner. Additionally, Dex significantly increased the expression levels of cleaved caspase-9 and cleaved caspase-3 compared with in the control groups; these effects were significantly attenuated by crocin pretreatment. Conversely, Dex and crocin did not induce a significant effect on cleaved caspase-8 expression (<xref rid="f2-mmr-20-01-0401" ref-type="fig">Fig. 2C and D</xref>). Mitochondrial Cyt C levels were significantly decreased and Cyt C levels were significantly increased following Dex treatment compared with in the control group (<xref rid="f2-mmr-20-01-0401" ref-type="fig">Fig. 2E and F</xref>); crocin significantly reversed these effects. The relative expression levels of Bax and Bcl-2 exhibited similar alterations; Bax expression was increased and Bcl-2 expression was decreased by Dex, whereas these effects were reversed by crocin.</p>
</sec>
<sec>
<title>ROS and intracellular Ca<sup>2&#x002B;</sup> are involved in the protective effects of crocin on Dex-treated osteoblasts</title>
<p>The roles of ROS and intracellular Ca<sup>2&#x002B;</sup> in the protective effects of crocin on Dex-treated osteoblasts were investigated. It was demonstrated that Dex significantly increased ROS and intracellular Ca<sup>2&#x002B;</sup> levels compared with in the control group, whereas crocin pretreatment significantly inhibited these effects in a dose-dependent manner (<xref rid="f3-mmr-20-01-0401" ref-type="fig">Fig. 3</xref>).</p>
</sec>
<sec>
<title>Crocin induces antiapoptotic effects on Dex-treated osteoblasts via ROS/Ca<sup>2&#x002B;</sup> signaling</title>
<p>As presented in <xref rid="f4-mmr-20-01-0401" ref-type="fig">Fig. 4A-C</xref>, treatment with NAC or BAPTA-AM attenuated Dex-induced apoptosis, loss of the &#x0394;&#x03C8;m and activation of caspase-3 in osteoblasts. Furthermore, it was demonstrated that H<sub>2</sub>O<sub>2</sub> and Ion attenuated the protective effects of crocin on Dex-induced apoptosis, alterations in the &#x0394;&#x03C8;m and caspase-3 activation (<xref rid="f4-mmr-20-01-0401" ref-type="fig">Fig. 4D-F</xref>). The results indicated that the protective effects of crocin were mediated via alterations in intracellular Ca<sup>2&#x002B;</sup> and ROS levels.</p>
</sec>
<sec>
<title>Association between ROS and intracellular Ca<sup>2&#x002B;</sup> in Dex- and crocin-treated osteoblasts</title>
<p>The association between ROS and intracellular Ca<sup>2&#x002B;</sup> in Dex- and crocin-treated osteoblasts was further investigated. As presented in <xref rid="f5-mmr-20-01-0401" ref-type="fig">Fig. 5A-C</xref>, NAC and BAPTA-AM significantly decreased Dex-induced ROS generation and intracellular Ca<sup>2&#x002B;</sup> accumulation compared with Dex treatment alone. Additionally, as presented in <xref rid="f5-mmr-20-01-0401" ref-type="fig">Fig. 5D-F</xref>, H<sub>2</sub>O<sub>2</sub> and Ion treatment significantly attenuated the protective effects of crocin on Dex-induced ROS generation and intracellular Ca<sup>2&#x002B;</sup> accumulation. The results suggested that ROS and intracellular Ca<sup>2&#x002B;</sup> levels may be associated and collectively contribute to apoptosis.</p>
</sec>
</sec>
</sec>
<sec sec-type="discussion">
<title>Discussion</title>
<p>Osteoblast apoptosis remains a significant cause of GC-induced osteoporosis and ONFH (<xref rid="b25-mmr-20-01-0401" ref-type="bibr">25</xref>,<xref rid="b26-mmr-20-01-0401" ref-type="bibr">26</xref>). Crocin has been reported to exert antioxidative and antiapoptotic effects (<xref rid="b27-mmr-20-01-0401" ref-type="bibr">27</xref>,<xref rid="b28-mmr-20-01-0401" ref-type="bibr">28</xref>). Cao <italic>et al</italic> (<xref rid="b24-mmr-20-01-0401" ref-type="bibr">24</xref>) revealed that crocin ameliorates ovariectomy-induced osteoporosis in rats by inhibiting oxidative stress; however, it is yet to be determined whether crocin exerts protective effects against Dex-induced osteoblast apoptosis. In the present study, it was observed that crocin significantly inhibited Dex-induced osteoblast apoptosis in a dose-dependent manner, thus suggesting that crocin may be considered a potential natural treatment for GC-induced bone diseases.</p>
<p>Numerous studies have reported that the antiapoptotic effects of crocin protect various tissues and organs (<xref rid="b19-mmr-20-01-0401" ref-type="bibr">19</xref>,<xref rid="b29-mmr-20-01-0401" ref-type="bibr">29</xref>&#x2013;<xref rid="b31-mmr-20-01-0401" ref-type="bibr">31</xref>), whereas others have observed that its proapoptotic effects promote apoptosis in tumor cells (<xref rid="b32-mmr-20-01-0401" ref-type="bibr">32</xref>&#x2013;<xref rid="b34-mmr-20-01-0401" ref-type="bibr">34</xref>). Therefore, crocin appears to exhibit antiapoptotic and proapoptotic properties; however, the dose ranges of crocin used in these studies may be responsible for these varied effects, as doses &#x003C;500 &#x00B5;M tend to induce antiapoptotic effects, whereas those &#x003E;500 &#x00B5;M induce proapoptotic effects. The present findings were similar; concentrations &#x2264;400 &#x00B5;M did not exhibit toxicity, whereas those &#x003E;1,000 &#x00B5;M significantly reduced osteoblast viability.</p>
<p>To identify the mechanisms underlying the antiapoptotic effects of crocin on Dex-induced apoptosis of osteoblasts, the mitochondrial apoptotic pathway was investigated. The results revealed that Dex exposure decreased the &#x0394;&#x03C8;m, whereas crocin treatment reversed this effect in a dose-dependent manner. In addition, Dex activated caspase-9, but did not alter caspase-8 activity, suggesting that the mitochondrial pathway, but not the death receptor-mediated pathway, contributed to Dex-induced osteoblast apoptosis. These results were consistent with the findings of Li <italic>et al</italic> (<xref rid="b35-mmr-20-01-0401" ref-type="bibr">35</xref>). Furthermore, it was demonstrated that crocin treatment attenuated Dex-induced caspase-9 activation, suggesting that crocin inhibited the mitochondrial apoptotic pathway. Loss of the &#x0394;&#x03C8;m is associated with release of Cyt C from the mitochondria to the cytosol, subsequently leading to the activation of caspase-3 and apoptosis (<xref rid="b36-mmr-20-01-0401" ref-type="bibr">36</xref>). A decrease in the Bcl-2/Bax ratio can induce loss of the &#x0394;&#x03C8;m (<xref rid="b37-mmr-20-01-0401" ref-type="bibr">37</xref>,<xref rid="b38-mmr-20-01-0401" ref-type="bibr">38</xref>). Consistent with these findings, the results of the present study indicated that Cyt C translocated from the mitochondria to the cytosol following Dex treatment, and that crocin attenuated this effect. The expression levels of Bcl-2, Bax and cleaved caspase-3 in the present study also supported the hypothesis that crocin may suppress the mitochondrial apoptosis pathway in Dex-treated osteoblasts.</p>
<p>ROS, which are primarily generated in the mitochondria, induce loss of the &#x0394;&#x03C8;m and serve an important role in osteoblast apoptosis (<xref rid="b11-mmr-20-01-0401" ref-type="bibr">11</xref>,<xref rid="b39-mmr-20-01-0401" ref-type="bibr">39</xref>). Almeida <italic>et al</italic> (<xref rid="b13-mmr-20-01-0401" ref-type="bibr">13</xref>) observed elevated ROS levels and increased apoptosis in Dex-treated UAMS-32 osteoblasts; however, these effects are inhibited by the antioxidant NAC. The present study also revealed that ROS was involved in Dex-induced osteoblast apoptosis, and that crocin attenuated ROS generation. Inhibition of ROS with NAC suppressed Dex-induced apoptosis. Furthermore, H<sub>2</sub>O<sub>2</sub> suppressed the antiapoptotic effects of crocin on Dex-treated osteoblasts. Intracellular Ca<sup>2&#x002B;</sup> overload has also been reported to lead to loss of the &#x0394;&#x03C8;m and the induction of apoptosis (<xref rid="b40-mmr-20-01-0401" ref-type="bibr">40</xref>,<xref rid="b41-mmr-20-01-0401" ref-type="bibr">41</xref>). Pretreatment with the calcium chelator BAPTA-AM partially suppresses apoptosis (<xref rid="b42-mmr-20-01-0401" ref-type="bibr">42</xref>). Similarly, it was observed in the present study that Dex increased intracellular Ca<sup>2&#x002B;</sup> concentrations, and that crocin reversed the effect. Notably, BAPTA-AM also suppressed Dex-induced apoptosis, whereas the calcium ionophore Ion reversed the antiapoptotic effects of crocin on Dex-treated osteoblasts. Zhang <italic>et al</italic> (<xref rid="b43-mmr-20-01-0401" ref-type="bibr">43</xref>) reported that NAC and BAPTA-AM suppress the eicosapentaenoic acid-induced apoptosis of HepG2 cells, and suggested the involvement of the ROS-Ca<sup>2&#x002B;</sup>-JNK mitochondrial pathways. Based on the present findings, it was hypothesized that crocin may induce antiapoptotic effects on Dex-induced osteoblasts by inhibiting the ROS/Ca<sup>2&#x002B;</sup>-mediated mitochondrial pathway.</p>
<p>The results of the present study suggested that ROS and intracellular Ca<sup>2&#x002B;</sup> levels are associated in Dex-treated cells or Dex- and crocin-treated cells. Notably, treatment with H<sub>2</sub>O<sub>2</sub> or NAC also affected intracellular Ca<sup>2&#x002B;</sup> levels, whereas treatment with Ion or BAPTA-AM also affected ROS levels. Furthermore, a number of studies have reported that ROS contributes to intracellular Ca<sup>2&#x002B;</sup> overload (<xref rid="b16-mmr-20-01-0401" ref-type="bibr">16</xref>,<xref rid="b44-mmr-20-01-0401" ref-type="bibr">44</xref>), and other studies have demonstrated that intracellular Ca<sup>2&#x002B;</sup> overload leads to increased ROS production (<xref rid="b45-mmr-20-01-0401" ref-type="bibr">45</xref>,<xref rid="b46-mmr-20-01-0401" ref-type="bibr">46</xref>). Wang <italic>et al</italic> (<xref rid="b44-mmr-20-01-0401" ref-type="bibr">44</xref>) suggested that oxidative stress decreases the efficiency of ATPase, thus contributing to voltage-gated calcium ion influx and subsequently apoptosis. Lipton and Nicotera (<xref rid="b45-mmr-20-01-0401" ref-type="bibr">45</xref>) suggested that cytosolic Ca<sup>2&#x002B;</sup> overload leads to depolarization of the mitochondria, subsequently contributing to the accumulation of ROS; however, the potential mechanisms are complex and requires further investigation.</p>
<p>In conclusion, crocin exerted protective effects against apoptosis in Dex-induced MC3T3-E1 osteoblasts. Inactivation of the ROS/Ca<sup>2&#x002B;</sup>-mediated mitochondrial pathway may be involved in the inhibitory effects of crocin on osteoblast apoptosis. The present study may promote further investigation into the application of crocin as a treatment for GC-induced osteoporosis and ONFH.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgements</title>
<p>Not applicable.</p>
</ack>
<sec>
<title>Funding</title>
<p>The present study was supported by a grant from the National Natural Science Foundation of China (grant no. 81672154).</p>
</sec>
<sec>
<title>Availability of data and materials</title>
<p>All data generated and/or analyzed during this study are included in this published article.</p>
</sec>
<sec>
<title>Author&#x0027;s contributions</title>
<p>ZN, SD and HP designed the study. ZN, SD, LZ, QL and SC performed the experiments. ZN, SD and LZ performed data analysis. ZN drafted the manuscript. ZN, SD, LZ and HP revised the manuscript. All authors reviewed the manuscript.</p>
</sec>
<sec>
<title>Ethics approval and consent to participate</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Patient consent for publication</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Competing interests</title>
<p>The authors declare that they have no competing interests.</p>
</sec>
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<floats-group>
<fig id="f1-mmr-20-01-0401" position="float">
<label>Figure 1.</label>
<caption><p>Effects of Cro on the viability and apoptosis of Dex-treated MC3T3-E1 osteoblasts. (A) Molecular structure of Cro. (B) Cell viability was examined to detect the nontoxic concentrations of Cro using an MTT assay. MC3T3-E1 osteoblasts were incubated with Cro (5, 25, 100, 400, 1,000, and 4,000 &#x00B5;M) for 24 and 48 h, as determined by an MTT assay. (C) Viability of osteoblasts pretreated with Cro (5, 25 and 100 &#x00B5;M) for 1 h and then treated with 1 &#x00B5;M Dex for 24 and 48 h, as determined by an MTT assay. (D) Apoptosis of osteoblasts pretreated with Cro (5, 25 and 100 &#x00B5;M) for 1 h and then treated with 1 &#x00B5;M Dex for 24 h, as determined by flow cytometry using an Annexin V-FITC/PI kit. (E) Quantitative analysis of apoptotic cells. Data are presented as the means &#x00B1; standard deviation of three independent experiments. &#x002A;&#x002A;P&#x003C;0.01 and &#x002A;&#x002A;&#x002A;P&#x003C;0.001 vs. Ctrl; <sup>#</sup>P&#x003C;0.05, <sup>###</sup>P&#x003C;0.001 vs. Dex. Cro, crocin; Ctrl, control; Dex, dexamethasone; FITC, fluorescein isothiocyanate; PI, propidium iodide.</p></caption>
<graphic xlink:href="MMR-20-01-0401-g00.tif"/>
</fig>
<fig id="f2-mmr-20-01-0401" position="float">
<label>Figure 2.</label>
<caption><p>Effects of Cro on the mitochondrial apoptotic pathway in Dex-treated MC3T3-E1 osteoblasts. Cells were pretreated with Cro (5, 25 and 100 &#x00B5;M) for 1 h and were then treated with 1 &#x00B5;M Dex for 24 h. (A) &#x0394;&#x03C8;m of osteoblasts, as determined using a JC-1 Assay kit. (B) Quantitative analysis of the &#x0394;&#x03C8;m, as determined by calculating the JC-1 polymer/monomer fluorescence ratio. (C) Western blot analysis of cleaved caspase-9, cleaved caspase-8 and cleaved caspase-3 protein expression. (D) Semi-quantitative analysis of the protein expression levels of cleaved caspase-9, cleaved caspase-8 and cleaved caspase-3. (E) Western blot analysis and semi-quantitative analysis of Bcl-2 and Bax protein expression. (F) Western blot analysis and semi-quantitative analysis of Mito Cyt C protein expression. (G) Western blot analysis and semi-quantitative analysis of Cyto Cyt C protein expression. Data are presented as the means &#x00B1; standard deviation of three independent experiments. &#x002A;&#x002A;&#x002A;P&#x003C;0.001 vs. Ctrl; <sup>#</sup>P&#x003C;0.05, <sup>##</sup>P&#x003C;0.01 and <sup>###</sup>P&#x003C;0.001 vs. Dex. &#x0394;&#x03C8;m, mitochondrial transmembrane potential; Bcl-2, B-cell lymphoma-2; Bax, Bcl-2-associated X protein; Cro, crocin; Ctrl, control; Cyt C, cytochrome <italic>c</italic>; COX IV, Cyt C oxidase IV; Cyto, cytosolic; Dex, dexamethasone; Mito, mitochondrial.</p></caption>
<graphic xlink:href="MMR-20-01-0401-g01.tif"/>
</fig>
<fig id="f3-mmr-20-01-0401" position="float">
<label>Figure 3.</label>
<caption><p>Effects of Cro on ROS and intracellular Ca<sup>2&#x002B;</sup> levels in Dex-treated MC3T3-E1 osteoblasts. Cells were pretreated with Cro (5, 25 and 100 &#x00B5;M) for 1 h and were then treated with 1 &#x00B5;M Dex for 24 h. (A) ROS levels, as determined by flow cytometry. (B) Quantitative analysis of ROS. (C) Intracellular Ca<sup>2&#x002B;</sup> levels, as determined by flow cytometry. (D) Quantitative analysis of intracellular Ca<sup>2&#x002B;</sup> levels. Data are presented as the means &#x00B1; standard deviation of three independent experiments. &#x002A;&#x002A;&#x002A;P&#x003C;0.001 vs. Ctrl; <sup>###</sup>P&#x003C;0.001 vs. Dex. Cro, crocin; DCFH-DA, dichlorodihydrofluorescein diacetate; Dex, dexamethasone; ROS, reactive oxygen species.</p></caption>
<graphic xlink:href="MMR-20-01-0401-g02.tif"/>
</fig>
<fig id="f4-mmr-20-01-0401" position="float">
<label>Figure 4.</label>
<caption><p>Effects of ROS and Ca<sup>2&#x002B;</sup> signaling on Dex- and Cro-treated MC3T3-E1 osteoblasts. Cells were pretreated with 100 &#x00B5;M Cro, 2 mM NAC, 20 &#x00B5;M BAP, 100 &#x00B5;M H<sub>2</sub>O<sub>2</sub> or 0.5 &#x00B5;M Ion for 1 h prior to treatment with 1 &#x00B5;M Dex for 24 h. Effects of NAC and BAP on Dex-induced (A) &#x0394;&#x03C8;m loss, (B) caspase-3 activation and (C) apoptosis of osteoblasts. Effects of H<sub>2</sub>O<sub>2</sub> and Ion on the protective effects of Cro against Dex-induced (D) loss of the &#x0394;&#x03C8;m, (E) caspase-3 activation and (F) apoptosis. Data are presented as the means &#x00B1; standard deviation of three independent experiments. &#x002A;&#x002A;&#x002A;P&#x003C;0.001 vs. control; <sup>#</sup>P&#x003C;0.05, <sup>##</sup>P&#x003C;0.01 and <sup>###</sup>P&#x003C;0.001 vs. Dex; <sup>&#x0026;</sup>P&#x003C;0.05, <sup>&#x0026;&#x0026;</sup>P&#x003C;0.01 and <sup>&#x0026;&#x0026;&#x0026;</sup>P&#x003C;0.001 vs. Dex &#x002B; Cro. &#x0394;&#x03C8;m, mitochondrial transmembrane potential; BAP, 1,2-bis(2-aminophenoxy)ethane-N,N,N&#x2032;,N&#x2032;-tetraacetic acid; Cro, crocin; Dex, dexamethasone; Ion, ionomycin; NAC, N-acetyl-L-cysteine.</p></caption>
<graphic xlink:href="MMR-20-01-0401-g03.tif"/>
</fig>
<fig id="f5-mmr-20-01-0401" position="float">
<label>Figure 5.</label>
<caption><p>Association between ROS and intracellular Ca<sup>2&#x002B;</sup> in Dex- and Cro-treated MC3T3-E1 osteoblasts. Cells were pretreated with 100 &#x00B5;M Cro, 2 mM NAC, 20 &#x00B5;M BAP, 100 &#x00B5;M H<sub>2</sub>O<sub>2</sub> or 0.5 &#x00B5;M Ion for 1 h prior to treatment with 1 &#x00B5;M Dex for 24 h. (A) Visualization of ROS generation and intracellular Ca<sup>2&#x002B;</sup> by fluorescence microscopy (magnification, &#x00D7;100). Quantitative analysis of (B) ROS production and (C) intracellular Ca<sup>2&#x002B;</sup> levels following pretreatment with NAC or BAP, and treatment with Dex, as determined via flow cytometry. (D) Visualization of ROS generation and intracellular Ca<sup>2&#x002B;</sup> by fluorescence microscopy (magnification, &#x00D7;100). Quantitative analysis of (E) ROS production and (F) intracellular Ca<sup>2&#x002B;</sup> levels following pretreatment with Cro with or without H<sub>2</sub>O<sub>2</sub> and Ion, and treatment with Dex, as determined via flow cytometry. Data are presented as the means &#x00B1; standard deviation of three independent experiments. &#x002A;&#x002A;&#x002A;P&#x003C;0.001 vs. Ctrl; <sup>###</sup>P&#x003C;0.001 vs. Dex; <sup>&#x0026;&#x0026;&#x0026;</sup>P&#x003C;0.001 vs. Dex &#x002B; Cro. BAP, 1,2-bis(2-aminophenoxy)ethane-N,N,N&#x2032;,N&#x2032;-tetraacetic acid; Cro, crocin; Dex, dexamethasone; Ion, ionomycin; NAC, N-acetyl-L-cysteine; ROS, reactive oxygen species.</p></caption>
<graphic xlink:href="MMR-20-01-0401-g04.tif"/>
</fig>
</floats-group>
</article>