{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T07:35:15Z","timestamp":1774596915187,"version":"3.50.1"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Background<\/jats:title>\n Ankylosing spondylitis (AS) is a chronic autoimmune disorder, accompanied by a notably high disability rate and limited treatment options. White peony root is a classic nourishing Chinese medicinal herb with immune-modulating effects. Its glycoside components-Total glucosides of paeony (TGP), a natural compound, exhibits anti-inflammatory and immunomodulatory effects. However, little is currently known about the efficacy and safety of TGP therapy for treating AS.<\/jats:p>\n <\/jats:sec>\n \n Purpose<\/jats:title>\n This study aimed to provide evidence-based support for the efficacy and safety of TGP in treating ankylosing spondylitis and to explore the potential mechanisms underlying TGP therapy for this disease.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A search strategy combining keywords and free-text terms was employed to retrieve studies from eight databases: CBM, CNKI, VIP, Wanfang, Embase, PubMed, Cochrane Library, and Web of Science. Statistical analysis was conducted using RevMan 5.4 software, with evidence quality assessed via the GRADE system. Additionally, network pharmacology, molecular docking, and molecular dynamics simulations (constant pressure for 100\u202fns) were utilized to further analyze the potential targets and pathways involved in TGP\u2019s therapeutic effects on AS.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The meta-analysis ultimately included 28 studies involving 2,130 patients, with results indicating that the TGP combination therapy group significantly improved spinal function in AS patients, reduced inflammatory responses, enhanced quality of life, and played a crucial role in anti-inflammatory and immune modulation with favorable safety profiles. The therapeutic targets of TGP in AS include TLR4, NFKB1, HSP90AA1, HIF1A, MTOR, ITGB1, and CXCR4, with its mechanism of action linked to TLR and NF-\u03baB pathways. Molecular docking and MD simulations revealed benzoylpaeoniflorin exhibits the strongest binding affinity, suggesting TGP may regulate AS pathogenesis by interacting with TLR4.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n TGP demonstrates favorable clinical efficacy in treating AS, with a multi-targeted intervention mechanism that holds therapeutic promise.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n The study was prospectively registered in PROSPERO (Registration No. CRD: 420251111863, URL:\n https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n ).\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1738150","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:37:43Z","timestamp":1774593463000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and potential pharmacological mechanisms of total glucosides of paeony in treating ankylosing spondylitis in Asian populations: a meta-analysis, network pharmacology, and molecular dynamics simulation"],"prefix":"10.3389","volume":"13","author":[{"given":"Wenjun","family":"Mu","sequence":"first","affiliation":[{"name":"Guizhou University of Traditional Chinese Medicine","place":["Guiyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianhui","family":"Ma","sequence":"additional","affiliation":[{"name":"Guizhou University of Traditional Chinese Medicine","place":["Guiyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xudong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Guizhou University of Traditional Chinese Medicine","place":["Guiyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Su","sequence":"additional","affiliation":[{"name":"Anshun Hospital of Traditional Chinese Medicine","place":["Anshun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Anshun Hospital of Traditional Chinese Medicine","place":["Anshun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cong","family":"Huang","sequence":"additional","affiliation":[{"name":"Guizhou University of Traditional Chinese Medicine","place":["Guiyang, China"]},{"name":"Anshun Hospital of Traditional Chinese Medicine","place":["Anshun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/S0140-6736(16)31591-4","article-title":"Axial spondyloarthritis","volume":"390","author":"Sieper","year":"2017","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"469","DOI":"10.2147\/ORR.S540714","article-title":"Research review on the mechanisms of pathological new bone formation in ankylosing spondylitis","volume":"17","author":"Zhou","year":"2025","journal-title":"Orthop Res Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"210","DOI":"10.15698\/mic2025.08.857","article-title":"Gut microbiota and ankylosing spondylitis: current insights and future challenges","volume":"12","author":"Lobiuc","year":"2025","journal-title":"Microb Cell"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"117677","DOI":"10.1016\/j.jep.2023.117677","article-title":"Xinfeng capsule inhibits lncRNA NONHSAT227927.1\/TRAF2 to alleviate NF-\u03baB-p65-induced immuno-inflammation in ankylosing spondylitis","volume":"323","author":"Fang","year":"2024","journal-title":"J Ethnopharmacol"},{"key":"ref5","first-page":"111","article-title":"Progress in pharmacological activity and clinical immune application of total glucosides of Paeoniae Radix Alba","volume":"26","author":"Yang","year":"2024","journal-title":"Food and Drug"},{"key":"ref6","first-page":"1627","article-title":"Chinese journal of modern applied pharmacy","volume":"38","author":"Yang","year":"2021","journal-title":"Chinese J Modern Applied Pharmacy"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. Rating the quality of evidence","volume":"64","author":"Balshem","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"9954","DOI":"10.1021\/jp003020w","article-title":"Structure and dynamics of the TIP3P, SPC, and SPC\/E water models at 298 K","volume":"105","author":"Mark","year":"2001","journal-title":"J Phys Chem A"},{"key":"ref10","first-page":"13","article-title":"Clinical curative effect investigation on integrated total glucosides of peony and sulfasalazine in treating ankylosing spondylitis","volume":"10","author":"Chen","year":"2004","journal-title":"Zhejiang J Integrated Traditional Chinese Western Med"},{"key":"ref11","first-page":"79","article-title":"Clinical observation on the treatment of ankylosing spondylitis with combined total ginsenosides of total glucosides of paeony","volume":"6","author":"Liu","year":"2004","journal-title":"Xinjiang Med J"},{"key":"ref12","first-page":"236","article-title":"Effect and superiority of the application of total glucosides of white peony,combined with methotrexate and sulfasalazine in the treatment of ankylosing spondylitis","volume":"27","author":"Deng","year":"2005","journal-title":"Chinese J Tissue Eng Res"},{"key":"ref13","first-page":"318","article-title":"The combined treatment of total glucosides of paeon, sulfapyridine, methotrexate for ankylosing spondylitis","volume":"4","author":"Li","year":"2006","journal-title":"Chinese Remed Clinics"},{"key":"ref14","first-page":"217","article-title":"Clinical observation on total glucosides of Paeony combined with Suifasalazine in treatment of ankylosing spondylitis","volume":"3","author":"Wang","year":"2007","journal-title":"Zhong Xi Yi Jie He Xue Bao"},{"key":"ref15","first-page":"2660","article-title":"Clinical study on the combined treatment of ankylosing spondylitis","volume":"23","author":"Zhang","year":"2007","journal-title":"J Practical Med"},{"key":"ref16","first-page":"656","article-title":"Clinical analysis of the treatment of ankylosing spondylitis with total saponins of white Peony root combined with Mesalazine Sulfapyridine","volume":"7","author":"Wang","year":"2008","journal-title":"Zhong Xi Yi Jie He Xue Bao"},{"key":"ref17","first-page":"68","article-title":"Evaluate the efficacy of TGP in the treatment of ankylosing spondylitis and investigate the mechanism of the efficacy","volume":"25","author":"Li","year":"2009","journal-title":"Zhongguo Zhong Yao Yao Li Yu Lin Chuang"},{"key":"ref18","first-page":"58","article-title":"Total glycosides of white peony root in the treatment of ankylosing spondylitis","volume":"36","author":"Wang","year":"2009","journal-title":"Zhongguo Shi Yong Yi Xue Za Zhi"},{"key":"ref19","first-page":"892","article-title":"Clinical observation of Total glycosides of Wite Paeony combined with methotrexate and sulfasalazine on the treatment of ankylosing spondylitis","volume":"24","author":"Xiong","year":"2009","journal-title":"Hua Xi Yi Xue Za Zhi"},{"key":"ref20","first-page":"7064","article-title":"Observation of effect of Total glycosides of paeony combined with sulfasalazine in treatment of ankylosing spondylitis","volume":"10","author":"Xia","year":"2010","journal-title":"Zhongguo Yi Yuan Wu Zhen Xue Za Zhi"},{"key":"ref21","first-page":"60","article-title":"The curative effect on Leflunomide combined with total glucosides of peony in the treatment of ankylosing spondylitis","volume":"50","author":"Jiang","year":"2012","journal-title":"Zhongguo Dang Dai Yi Sheng"},{"key":"ref22","first-page":"105","article-title":"Observation on the therapeutic effect of Total Ginsenosides of Totalglycosidesofpaeony combined with Mesalazine Sulphonic acid in the treatment of ankylosing spondylitis","volume":"19","author":"Su","year":"2012","journal-title":"Zhongguo Xian Dai Yi Yao"},{"key":"ref23","first-page":"149","article-title":"Clinical treatment of 56 cases of ankylosing spondylitis using a combination of traditional Chinese and Western medicine","volume":"18","author":"Wang","year":"2012","journal-title":"Dang Dai Yi Xue"},{"key":"ref24","first-page":"1870","article-title":"Efficacy of total glucosides of Peony combined with sulfasalazine in the treatment of ankylosing spondylitis","volume":"23","author":"Zou","year":"2012","journal-title":"Mod Diagn Treat"},{"key":"ref25","first-page":"35","article-title":"Observation on the therapeutic effect of Pavlin combined with sulfasalazine in the treatment of ankylosing spondylitis","volume":"22","author":"Chang","year":"2013","journal-title":"China Pharm"},{"key":"ref26","first-page":"995","article-title":"Clinical observation on the treatment of ankylosing spondylitis with total ginsenosides of white Peony root combined with thalidomide","volume":"25","author":"Ruan","year":"2013","journal-title":"Mod Pract Med"},{"key":"ref27","first-page":"201","article-title":"Clinical analysis of the treatment of ankylosing spondylitis with total saponins of Paeonia lactiflora combined with sulfapyridine","volume":"18","author":"Wang","year":"2013","journal-title":"Yiyao Qianyan"},{"key":"ref28","first-page":"601","article-title":"Study of mechanism of glucosides of paeony in treating inactive ankylosing spondylitis patients","volume":"45","author":"Li","year":"2014","journal-title":"J New Med"},{"key":"ref29","first-page":"1848","article-title":"Observation on the efficacy and safety of total saponins of white Peony combined with thalidomide in the treatment of ankylosing spondylitis","volume":"17","author":"Wu","year":"2014","journal-title":"Chin J Coal Ind Med"},{"key":"ref30","first-page":"53","article-title":"The therapeutic effect and mechanism analysis of total glycosides of Paeonia lactiflora in the treatment of ankylosing spondylitis","volume":"2","author":"Liu","year":"2015","journal-title":"Psychol Doctor"},{"key":"ref31","first-page":"43","article-title":"Analysis of curative effect of TGP in the treatment of ankylosing spondylitis","volume":"21","author":"Zhang","year":"2015","journal-title":"J Med Inform"},{"key":"ref32","first-page":"9","article-title":"Clinical observation of total glucosides of paeony combined with methotrexate and sulfasalazine in treatment of ankylosing spondylitis","volume":"10","author":"Mou","year":"2017","journal-title":"Chin J Clin Ration Drug Use"},{"key":"ref33","first-page":"147","article-title":"Application value of paeony glmcosides and thalidomide in the treatment of ankylosing spondylitis and the effects on CRP, ESR and TNF-\u03b1","volume":"15","author":"Zhang","year":"2017","journal-title":"J Bethune Med Sci"},{"key":"ref34","first-page":"651","article-title":"Induction, remission, and maintenance of ankylosing spondylitis by Tripterygium glycosides, total glucosides of paeony capsule combined sulfasalazine","volume":"38","author":"Zheng","year":"2018","journal-title":"Chin J Integr Tradit West Med"},{"key":"ref35","first-page":"1171","article-title":"Effect of osteotomy combined with TGP on sagittal balance and ESR in patients with ankylosing spondylitis","volume":"36","author":"Cao","year":"2019","journal-title":"Tianjin J Tradit Chin Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"107","DOI":"10.14163\/j.cnki.11-5547\/r.2020.05.047","article-title":"Effects of thalidomide, total glucosides of paeony, sulfasalazine combined therapy on the disease activity of patients with ankylosing spondylitis","volume":"15","author":"Liu","year":"2020","journal-title":"China Pract Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"46","DOI":"10.16588\/j.cnki.issn2096-8426.2022.01.011","article-title":"Clinical therapeutic effect and drug safety study of total glycosides of Paeonia lactiflora in patients with ankylosing spondylitis","volume":"44","author":"Pei","year":"2022","journal-title":"J Guizhou Univ Tradit Chin Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1093\/rheumatology\/ket387","article-title":"Global prevalence of ankylosing spondylitis","volume":"53","author":"Dean","year":"2014","journal-title":"Rheumatology (Oxford)"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.13748\/j.cnki.issn1007-7693.2021.13.015","article-title":"Research progress on mechanism and pharmacological activitiesresearch progress on mechanism and pharmacological activities","volume":"38","author":"Yang","year":"2021","journal-title":"Chin J Mod Appl Pharm"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"4000","DOI":"10.1093\/rheumatology\/kead268","article-title":"CCL20 inhibition for treating inflammation in ankylosing spondylitis","volume":"62","author":"Won","year":"2023","journal-title":"Rheumatology (Oxford)"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e23964","DOI":"10.1002\/jcla.23964","article-title":"Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis","volume":"35","author":"Wu","year":"2021","journal-title":"J Clin Lab Anal"},{"key":"ref42","first-page":"443","article-title":"Qianghuo shengshi decoction inhibits the activation of the TLR4\/NF-\u03baB signaling pathway, the release of pro-inflammatory factors, and the progression of ankylosing spondylitis","volume":"33","author":"Zhang","year":"2024","journal-title":"Chin J Histochem Cytochem"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1080\/08820139.2022.2154162","article-title":"Resveratrol attenuates ankylosing spondylitis in mice by inhibiting the TLR4\/NF-\u03baB\/NLRP3 pathway and regulating gut microbiota","volume":"52","author":"Ding","year":"2023","journal-title":"Immunol Investig"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"195","DOI":"10.13457\/j.cnki.jncm.2025.09.036","article-title":"Exploration of mechanism of Tripterygium wilfordii Radix in preventing and treating ankylosing spondylitis based on network pharmacology and molecular docking","volume":"57","author":"Liu","year":"2025","journal-title":"New Chin Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"453","DOI":"10.19945\/j.cnki.issn.1006-3250.2024.03.028","article-title":"Exploration of the molecular mechanism of icariin interventionin ankylosing spondylitis based on network pharmacology and experimental verification","volume":"30","author":"Xu","year":"2024","journal-title":"J Basic Chin Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.gene.2015.06.018","article-title":"Regulation and function of the human HSP90AA1 gene","volume":"570","author":"Zuehlke","year":"2015","journal-title":"Gene"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"980867","DOI":"10.3389\/fendo.2022.980867","article-title":"Identification and validation of ferroptosis key genes in bone mesenchymal stromal cells of primary osteoporosis based on bioinformatics analysis","volume":"13","author":"Xia","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref48","first-page":"272","article-title":"Hyperactivation of PI3K\/Akt\/m TOR signal pathway impairs TNF-\u03b1-induced autophagy in mesenchymal stem cells from patients with ankylosing spondylitis","volume":"42","author":"Liu","year":"2022","journal-title":"J South Med Univ"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"3843","DOI":"10.1111\/jcmm.14228","article-title":"EPC-derived exosomes promote osteoclastogenesis through LncRNA-MALAT1","volume":"23","author":"Cui","year":"2019","journal-title":"J Cell Mol Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/nyas.12059","article-title":"Role of PI3K\/Akt and mTOR complexes in Th17 cell differentiation","volume":"1280","author":"Nagai","year":"2013","journal-title":"Ann N Y Acad Sci"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"e870","DOI":"10.1002\/iid3.870","article-title":"PCSK9 promotes T helper 1 and T helper 17 cell differentiation by activating the nuclear factor-\u03baB pathway in ankylosing spondylitis","volume":"11","author":"Cai","year":"2023","journal-title":"Immun Inflamm Dis"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1001025","DOI":"10.3389\/fimmu.2022.1001025","article-title":"From bench to bedside: calprotectin (S100A8\/S100A9) as a biomarker in rheumatoid arthritis","volume":"13","author":"Inciarte-Mundo","year":"2022","journal-title":"Front Immunol"},{"key":"ref53","first-page":"1065","article-title":"The relationship between TLR4, JAK3 gene expression and Th17\/Treg imbalance in peripheral blood of patients with ankylosing spondylitis","volume":"52","author":"Zhang","year":"2024","journal-title":"Tianjin Med J"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"96993","DOI":"10.18632\/oncotarget.20823","article-title":"Interleukin-17A-promoted MSC2 polarization related with new bone formation of ankylosing spondylitis","volume":"8","author":"He","year":"2017","journal-title":"Oncotarget"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1615\/CritRevImmunol.2020033210","article-title":"Inflammation, NF-\u03baB, and chronic diseases: how are they linked?","volume":"40","author":"Kunnumakkara","year":"2020","journal-title":"Crit Rev Immunol"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1186\/s12967-023-04449-0","article-title":"CX3CL1 promotes M1 macrophage polarization and osteoclast differentiation through NF-\u03baB signaling pathway in ankylosing spondylitis in vitro","volume":"21","author":"Feng","year":"2023","journal-title":"J Transl Med"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"D1670","DOI":"10.1093\/nar\/gkae973","article-title":"Generic diagramming platform (GDP): a comprehensive database of high-quality biomedical graphics","volume":"53","author":"Jiang","year":"2025","journal-title":"Nucleic Acids Res"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1738150\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:37:51Z","timestamp":1774593471000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1738150\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":57,"alternative-id":["10.3389\/fnut.2026.1738150"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1738150","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"article-number":"1738150"}}