Identification and validation of biomarkers of Shenggu Zaizao Wan in the treatment of steroid-induced osteonecrosis of the femoral head by integrating network pharmacology and bulk transcriptomic

Background Steroid-induced osteonecrosis of the femoral head (SONFH) is a debilitating condition. Research has shown that Shenggu Zaizao Wan (SZW) may have therapeutic effects on SONFH. This study aimed to elucidate the mechanisms by which SZW treats SONFH. Methods SONFH and control samples were retrieved from a database to identify differentially expressed genes (DEGs). Biomarkers were obtained through the intersection of DEGs and potential targets, machine learning, and expression validation. A nomogram was constructed, followed by gene set enrichment analysis (GSEA) of biomarkers and immune infiltration analysis. Molecular docking was conducted, and the expression of biomarkers was evaluated using real-time quantitative reverse transcription PCR (RT-qPCR). Results A total of 69 potential SZW targets and 1,671 DEGs were identified. IKBKB and PRKCA were established as biomarkers for SONFH, and a nomogram was developed. GSEA indicated that IKBKB and PRKCA may influence pathways related to the ribosome. Immune infiltration analysis revealed that CD4 + T cells play a role in SONFH. Molecular docking showed a strong affinity between SZW compounds and biomarkers. The expression of biomarkers in clinical samples aligned with the results from bioinformatics analysis. Conclusion This study identified IKBKB and PRKCA as potential biomarkers and targets for SZW treatment in SONFH.