The first multicenter and randomized clinical trial of herbal Fufang for treatment of postmenopausal osteoporosis

This multicenter and randomized clinical trial showed that daily oral herbal formula Xian Ling Gu Bao (XLGB) was safe in postmenopausal women over a 1-year treatment. Those patients (n ∼ 50) treated with XLGB at the conventional dose demonstrated a statistically significant increase in dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) at lumbar spine at 6 months and a numerically increased BMD at 12 months.

INTRODUCTION

The aim of this study was to examine the safety and efficacy of a herbal formula XLGB in postmenopausal women (ChiCTR-TRC-00000347).

METHODS

One hundred eighty healthy postmenopausal women (≥60 years old) with BMD T-score ≤ -2.0 (lumbar spine or femoral neck) were recruited from four clinical centers to receive low-dose (conventional dose) XLGB (L-XLGB group, 3 g/day, n = 61) or high-dose XLGB (H-XLGB group, 6 g/day, n = 58) or placebo (CON group, n = 61). Women received daily calcium (500 mg) and vitamin D (200 IU) supplementation. Primary endpoints were lumbar spine BMD and safety; secondary endpoints were femoral neck BMD and bone turnover markers measured at baseline and at 6 and 12 months.

RESULTS

Of 180 women recruited, 148 completed the study. The compliance in each group was comparable. Prominent adverse events were not observed in either group. In the L-XLGB group at 6 months, lumbar spine BMD by DXA increased significantly from baseline (+2.11% versus CON +0.58%, p < 0.05), but femoral neck BMD did not; at 12 months, BMD in the L-XLGB group decreased from 6-month levels yet remained higher than baseline, but without difference from the CON group. There was no dose-dependent response. Bone turnover marker levels declined during the first 6 months after XLGB treatment. There was no significant difference in the overall incidence of side effects among treatment and control groups.

CONCLUSION

XLGB over 1-year treatment at the conventional dose demonstrated safe and only a statistically significant increase in BMD at lumbar spine at 6 months in postmenopausal women.

Association of single-nucleotide polymorphisms in HLA class II/III region with knee osteoarthritis

OBJECTIVE

A genome-wide association study and a replication using Japanese, Spanish and Greek Caucasian populations have recently indicated two single-nucleotide polymorphisms (SNPs) (rs7775228 and rs10947262) associated with knee Osteoarthritis (OA) susceptibility. We have further evaluated the association in knee OA subjects from Han Chinese and Australian Caucasian origin.

METHODS

Two independent case-control association studies were performed using Han Chinese and Australian Caucasian populations. The two SNPs were genotyped in patients who had primary symptomatic knee OA with radiographic confirmation and/or received total knee replacement surgery as well as in matched controls. They were subjected to statistic analyses.

RESULTS

A total of 991 OA patients and 1536 controls were genotyped. No significant difference was detected in genotype or allele frequencies of the two SNPs between knee OA and control groups in the two populations (all P>0.05). The association was also negative even after stratification by sex, body mass index (BMI) and Kellgren/Lawrence scores. The significant heterogeneity was detected between Chinese and Japanese (both P<0.05). In the Caucasian samples, no significant heterogeneity was detected (both P>0.05). The result of meta-analysis showed significant association between knee OA and rs10947262 in total subjects [summary OR=1.26, 95%confidence intervals (CI)=1.07-1.27, P=3 × 10(-8)] and in Caucasian samples (summary OR=1.28, 95%CI=1.04-1.57, P=0.02).

CONCLUSION

We demonstrated no association between the two SNPs in human leukocyte antigen (HLA) class II/III region and knee OA in Han Chinese population. A significant association was detected between SNP rs10947262 and knee OA in Caucasian subjects. Further replication studies are required to identify the impact of controversial association.

The glycoprotein Ibalpha-von Willebrand factor interaction induces platelet apoptosis

BACKGROUND

The interaction of glycoprotein (GP) Ibalpha with von Willebrand factor (VWF) initiates platelet adhesion, and simultaneously triggers intracellular signaling cascades leading to platelet aggregation and thrombus formation. Some of the signaling events are similar to those occurring during apoptosis, however, it is still unclear whether platelet apoptosis is induced by the GPIbalpha-VWF interaction.

OBJECTIVES

To investigate whether the GPIbalpha-VWF interaction induces platelet apoptosis and the role of 14-3-3zeta in apoptotic signaling.

METHODS

Apoptotic events were assessed in platelets or Chinese hamster ovary (CHO) cells expressing wild-type (1b9) or mutant GPIb-IX interacting with VWF by flow cytometry or western blotting.

RESULTS

Ristocetin-induced GPIbalpha-VWF interaction elicited apoptotic events in platelets, including phosphatidylserine exposure, elevations of Bax and Bak, gelsolin cleavage, and depolarization of mitochondrial inner transmembrane potential. Apoptotic events were also elicited in platelets exposed to pathologic shear stresses in the presence of VWF; however, the shear-induced apoptosis was eliminated by the anti-GPIbalpha antibody AK2. Furthermore, apoptotic events occurred in 1b9 cells stimulated with VWF and ristocetin, but were significantly diminished in two CHO cell lines expressing mutant GPIb-IX with GPIbalpha truncated at residue 551 or a serine-to-alanine mutation at the 14-3-3zeta-binding site in GPIbalpha.

CONCLUSIONS

This study demonstrates that the GPIbalpha-VWF interaction induces apoptotic events in platelets, and that the association of 14-3-3zeta with the cytoplasmic domain of GPIbalpha is essential for apoptotic signaling. This finding may suggest a novel mechanism for platelet clearance or some thrombocytopenic diseases.

Expansion of CD14+CD16+ peripheral monocytes among patients with aseptic loosening

OBJECTIVE AND DESIGN

In this study, we have investigated the relevance of peripheral blood inflammatory CD14(+)CD16(+) monocytes phenotype to patients with aseptic loosening (AL).

MATERIAL AND TREATMENT

Immunophenotypes of monocytes were examined among patients with AL (n = 43), patients with mechanical loosening (ML, n = 30), patients with stable implant (SI, n = 16), and patients with osteoarthritis (OA, n = 17) using flow cytometry.

METHODS

Immunological assay was used to measure TNF-alpha and IL-1 beta levels in both sera and culture media of implant wear stimulated CD14(+)CD16(+) and CD14(++)CD16(-) monocytes. Periprosthetic tissues were collected during surgery for histological assessment.

RESULTS

The frequency of CD14(+)CD16(+) monocytes showed significant increase in AL patients than in ML, SI, and OA patients. A positive association was found between the subpopulation of CD14(+)CD16(+) monocytes and plasma TNF-alpha and IL-1 beta level in AL patients. Furthermore, a positive correlation existed between the subpopulation of CD14(+)CD16(+) monocytes and the total histopathology score.

CONCLUSION

The results indicate that CD14(+)CD16(+) monocytes represent a sensitive marker for the disease activity of AL, and may serve as an effective prognostic index to identify total joint replacement recipients who are at increased risk for osteolysis and progression of AL.

Inhibition of the development of collagen-induced arthritis in Wistar rats through vagus nerve suspension: a 3-month observation

OBJECTIVE AND DESIGN

In this study, we have investigated the effects of vagus nerve suspension in a rat model of collagen-induced arthritis (CIA) .

MATERIALS AND TREATMENT

CIA was induced in male Wistar rats and vagus nerve suspension or sham operation was performed on day 10 after the second immunization. All rats were monitored for macroscopic signs of clinical arthritis and cytokine titres within 2 months after the second immunization. Radiological and histological examination were performed 3 months after the second immunization.

RESULTS

Rats subjected to vagus nerve suspension (the test group) showed nerve activities that resemble electrical stimulation of the vagus nerve in the control group. Compared to control, the test group had reduced soft-tissue swelling, arthritic scores, TNF-alpha level and Collagen-II antibody titre, throughout the course of the experiment. Sham operation produced similar suppression on the CIA symptoms as the test group but most of the effects produced by sham operation subsided after 27 or 35 days.

CONCLUSION

Vagus nerve suspension is a novel approach to achieve sustained long-term stimulation of the vague nerve. This procedure can suppress the development of CIA in rats.

Synaptonemal complex analysis of hybrid and purebred water buffaloes (Bubalus bubalis)

The morphology of the synaptonemal complex (SC) in river (2n = 50) and swamp (2n = 48) water buffaloes and their hybrids, was studied by electron microscopic analysis. In 2n = 49 hybrids, F2 and backcrosses the formation and pairing behaviour of a trivalent at zygotene-pachytene confirmed that river and swamp buffaloes differ by a centromere-to-telomere (C-T) tandem fusion. While 29% of spermatocytes from a purebred river buffalo and 16% from a purebred swamp buffalo had pairing abnormalities, a significantly higher frequency of abnormalities (48-72%) was recorded in F1, F2, and backcrosses with 2n = 48, 49 or 50. Highest abnormality frequencies occurred in 2n = 49 bulls. Abnormal pairing configurations often resulted from interactions between unpaired chromosome axes or segments. Zygotene-pachytene meiotic progress appeared delayed in hybrid bulls, and the frequency of SC abnormalities decreased from XY type I substage to type V substage. The variation in SC abnormality data from hybrids was consistent with the levels of sperm abnormality previously reported.

The Sma I polymorphism in the von Willebrand factor gene associated with acute ischemic stroke

The von Willebrand factor (vWF) is a highly multimerized glycoprotein that promotes platelet adhesion and aggregation at a high shear rate, and also acts as a carrier of coagulation factor VIII. vWF has been identified as a risk factor for recurrent myocardial infarction in the general population. It has been reported that two polymorphisms of vWF gene promoter and the Thr789Ala polymorphism in vWF gene are associated with arterial thrombosis. The Sma I polymorphism is located in intron 2 of vWF gene. The relevance of this polymorphism to thrombotic disease was investigated by genotypic identification in two case-control studies: 107 patients with acute ischemic stroke, 49 patients with acute myocardial infarction (AMI), and 113 health controls age- and race-matched for each patient. Twenty-eight (26.2%) of the 107 patients with acute ischemic stroke, 8 (16.3%) of 49 patients with AMI, and 11 (9.7%) of 113 controls were found to be homozygous for CC genotype, respectively. The prevalence of the CC genotype in acute ischemic stroke was significantly higher than that of the normal controls (odds ratio [OR]=3.29, 95% confidence interval [CI]=1.54-7.01,.01>P>.001). However, the prevalence of the CC genotype in AMI was not significantly different from that of the normal controls (OR=1.81, 95% CI=0.68-4.82,.30>P>.20). Plasma vWF:Ag was also determined by enzyme-linked immunosorbent assay (ELISA) on the frozen plasma of 122 subjects. The mean plasma vWF:Ag levels of the controls, patients with acute ischemic stroke, and AMI were 0.468, 0.584, and 0.783 U/ml, respectively. The mean level of plasma vWF:Ag did not differ significantly between controls and patients with acute ischemic stroke (P=.195), but had significantly difference between controls and patients with AMI (P=.001). No association was found between the Sma I polymorphism and vWF plasma levels in controls, patients with acute ischemic stroke, or the AMI group (one-way ANOVA, P=.323, P=.315, P=.96). Results show that the Sma I polymorphism is strongly associated with increased risk of acute ischemic stroke, however, no association was observed between this polymorphism and AMI. This polymorphism of vWF may represent a newly identified risk factor for acute ischemic stroke in Chinese. Whether it is the real functional variant associated with acute ischemic stroke remains to be elucidated.

[The development and application of computer-aided bone histomorphometry system]

The aim of this study is to develop a Computer-aided Bone Histomorphometry System. The method is based on the Micro-graphical Digital System composed of microscope, digital camera, computer and related programs. The methodology was developed to measure the basic data on each image of visual field of hard bone tissue with computer-assistance. Following this, the parameters of bone volume, bone structure and bone metabolism were calculated based on the standardization of bone histomorphometry. Such method has been used in the experimental and clinical studies of osteoporosis to predict the fracture risk and evaluate the drug effect.

A histomorphometric and molecular study on stress adaptability of freeze-dried bone allograft

OBJECTIVE

To Investigate stress adaptability of freeze-dried bone allograft.

METHODS

Cortical and cancellous allograft were transplanted to each side of the midshaft diaphyseal ulna in two groups of 28 animals. The left transplanted allograft was free from fixation and bore a normal physiological load, while the right transplanted allograft was protected from loading by a simple external fixator and bore less load. Animals were sacrificed at the 2nd, 4th, 8th, 16th week after transplantation and specimens were taken out for bone histomorphometry studies and analysis of collagen gene expression by in situ cDNA-mRNA hybridization.

RESULTS

Labeled surface(LS) and bone mineral apposition rate(MAR) of the normally loaded graft-host bone interface were significantly higher than that of the less loaded side at the 4th, 8th, 16th week after transplantation. Parameters reflecting the internal repair process of the allograft, such as LS in cortical and cancellous bone or MAR in cortical bone of the normally loaded side were significantly higher than those of the less loaded side at the 16th week after transplantation. The result of in situ hybridization indicated that more osteoblast-like cells expressing the type I collagen gene were found in the interface or interior of normally loaded grafts.

CONCLUSION

The stimulus of physiologic load can accelerate the early union of allograft-host bone interface and later new bone creep substitution to the necrotic allograft.

[The Rsa I and Sma I polymorphisms in the von Willebrand factor gene discrimination by hybridization with oligonucleotide arrays]

OBJECTIVE

To develop a new assay for the Rsa I and Sma I polymorphisms (single nucleotide polymorphism, SNP) in the von Willebrand factor gene detection that utilizes oligonucleotide arrays (DNA chips) on glass supports. Expoloring the association of the RsaI and SmaI polymorphisms in the von Willebrand factor gene with thrombosis in Chinese.

METHODS

Allele-specific oligonucleotides are covalently immobilized on glutaradehyde derivatized glass slides in arrays. Single strand PCR product of PCR-amplified genomic DNA is fluorescently labeled by assymetric PCR with fluorescently tagged dUTP and hybridized to the support-bound oligonucleotide array. The hybridization pattern is detected by fluorescence scenning. The effect of hybridization conditions were evaluated and optimized. The method was validated by the discrimination of blinded DNA samples identified by restriction enzymes. 50 patients with thrombosis were examined by this method.

RESULTS

The genotypes scored by oligonucleotide arrays assay were in 100% agreement with restriction enzymes results. The genotype distributions GG, GA, AA and CC, CT, TT of RsaI and SmaI polymorphisms of patients or controls were 4.0%, 12.0%, 84.0% and 24.0%, 44.0%, 32.0% or 1.4%, 11.8%, 86.8% and 8.8%, 57.4%, 33.8%. The allele frequencies G, A and C, T were 10.0%, 90.0% and 46.0%, 54.0% or 7.4%, 92.6% and 37.5%, 62.5%. No statistical difference in genotype distribution and allele frequencies was observed between patients with thrombosis and the control groups (all P > 0.05).

CONCLUSION

A rapid and accurate method for the RsaI and SmaI polymorphisms in the von Willebrand factor gene detection, or for the analysis of single nucleotide polymorphism (SNP) has been developed using oligonucleotide arrays on glass supports. No association was observed between the Rsa I and Sma I polymorphisms in the vWF gene and thrombotic disease.

Identification and characterization of a melanin-concentrating hormone receptor

Melanin-concentrating hormone (MCH), a neuropeptide expressed in central and peripheral nervous systems, plays an important role in the control of feeding behaviors and energy metabolism. An orphan G protein-coupled receptor (SLC-1/GPR24) has recently been identified as a receptor for MCH (MCHR1). We report here the identification and characterization of a G protein-coupled receptor as the MCH receptor subtype 2 (MCHR2). MCHR2 has higher protein sequence homology to MCHR1 than any other G protein-coupled receptor. The expression of MCHR2 has been detected in many regions of the brain. In contrast to MCHR1, which is intronless in the coding region and is located at the chromosomal locus 22q13.3, the MCHR2 gene has multiple exons and is mapped to locus 6q21. MCHR2 is specifically activated by nanomolar concentrations of MCH, binds to MCH with high affinity, and signals through Gq protein. This discovery is important for a full understanding of MCH biology and the development of potential therapeutics for diseases involving MCH, including obesity.

[Application of computer image process to the research on the contact characteristics of subtalar joint]

With the use of computer image processing technology, a new method was proposed for studying the contact characteristics of the subtalar joint. The results showed the total subtalar articulation area was 9.52 +/- 0.40 cm2. On neutral position and under 600 N load, the contact area of the subtalar joint was 2.00 +/- 0.11 cm2. The contact area of the posterior articulation was significantly larger than that of the anterior and medial articulation (p < 0.01). The average contact pressure was 19.3 +/- 1.38 N, the force transmitted by the subtalar was 389.16 +/- 28.75 N, which accounted for about 64.86% of the applied shank load (600 N), and 69.39% of the force was transmitted by the posterior articulation. The posterior articulation plays an important role in the load. The fracture line of the calcaneus often appears in this area.

[The computer-aided measurement of medullary canal in proximal femur]

This study was conducted to search the law of the parameters of medullary canal section shape in proximal femur. The methods of image-processing and taper-curve-fit mathematics were adopted in the acquisition of data and parameters. Computer-aided method and manual method were employed to measure 10 samples of section shape in proximal femur. The results showed that no significant difference was seen between the computer-aided method and manual method(P> 0.05). This approach could reduce man-made errors and process mass samples automatically by computer.

Effects of recombinant human growth hormone (r-hGH) on experimental osteoporotic fracture healing

OBJECTIVE

To observe the effect of recombinant human growth hormone (r-hGH) on osteoporotic fracture healing in rats, and to provide an effective therapy for osteoporotic fracture.

METHODS

Thirty-six female 8-month-old SD rats were randomized into two groups: therapy group and control group. After the experimental model of osteoporotic fracture was established, the therapy group was treated with r-hGH of 2.7 mg/kg body weigh/day (1 mg=3 IU) for 10 days continuously by daily subcutaneous injection; whereas the control group was treated with equivalent saline. Plasma insulin-like growth factor I concentration was detected and bone mineral density (BMD) as well as biomechanical strength of callus were measured at 2, 4, 8 weeks.

RESULTS

Plasma insulin-like growth factor I concentration in the therapy group was higher than that in the control group (P<0.005) at 2nd week and began to decline at 4th week. At 8th week, there was no significant difference between the two groups. At 4th week, callus area and BMD in therapy group were higher than those in the control group, but at 8th week, they were lower and BMD had a significant difference between the two groups (P<0.001). Biomechanical testing of callus showed that torsional strength of the therapy group was higher than that of the control group at 4th or 8th week, meanwhile maximum torsional angle had a significant difference between the two groups (P<0.005).

CONCLUSIONS

The results show that exogenous r-hGH can stimulate osteoporotic fracture healing in rats.

Stress-relaxation plates and the remodeling of callus and cortex under the plate in rabbits

OBJECTIVE

To study the influence of a stress-relaxation plate on the remodeling of callus and cortex under the plate.

METHODS

The bilateral tibia diaphysis of New Zealand rabbit were osteotomized and fixed with stress-relaxation plate (SRP) and rigid plate (RP), respectively. Polarized light microscopy and transmission electron microscopy (TEM) were used to study the remodeling of callus and the cortex under the plate from 4 to 24 weeks postoperatively.

RESULTS

Polarized light microscopy: the structural changes of callus and cortex beneath the plate are similar in the SRP and RP groups at the early postoperative stage, manifesting an alignment disorder of collagen fibers with a weak birefringence in the callus and absorption cavities in the cortex under the plate. After the twelfth postoperative week, the SRP group showed callus starting to transform to lamellar bone and absorption cavities in the cortex under the plate becoming smaller. By contrast in the RP group the absorption cavities in the callus and cortex under the plate became larger and the whole layer of cortex was cancellated. TEM: the active osteoclasts appeared in both SRP and RP groups in the period from 4 to 8 weeks postoperatively. In the SRP group, many functionally active osteoblasts could be seen on the surface of the bone, while in the RP group, the osteoblasts were not very active. By 24 weeks postoperatively, the shape of osteocytes were normal but the number of the osteoclasts were small in the SRP group. In the RP group, the osteoclasts became more active and osteocytic osteolysis was manifested.

CONCLUSIONS

Fixation with SRP not only enhanced callus remodeling, but also abated the degree of osteoporosis in the cortex under the plate. This approach may lead to an improved osteosynthetic apparatus.

Three mRNA transcripts of the proopiomelanocortin gene in human placenta at term

The proopiomelanocortin (POMC) gene whose normal pituitary specific mRNA product is 1200 bases (b) is also expressed in placenta and its peptide derivatives such as ACTH and beta-endorphin may play an important role in the initiation of labor. So far, two mRNA transcripts, one small (800b) and one large (1380b) have been reported in placenta by Northern blot analysis, similar to other endocrine tissues and various extrapituitary tumors; however, it is questionable whether both of these transcripts are effectively translated to a functional protein. We examined by Northern blot analysis the size and the differential expression of placental POMC gene transcripts in pregnant women with different modes of delivery. Placental tissues were collected from two groups of pregnant women, six with vaginal delivery (VD) and five with cesarean section (CS). In both groups of placentae three POMC gene transcripts were detected of 800, 1200 and 1380 bases; the 1200b pituitary specific species often predominated and was always present. The 800b transcript was also always present, while the large transcript (1380b) was expressed in 3/6 VD and 2/5 CS placental tissues. No differences in the relative levels of any of these mRNA species showing effect of the mode of delivery were observed. We conclude that POMC gene transcription in placental tissue at term gives rise to three mRNA transcripts, thus resembling extrapituitary tumors. The reported changes in the levels of the derivative peptides according to the mode of delivery do not reflect changes in POMC mRNA levels and could be attributed to a post-translational effect.

[Effects of recombinant human growth hormone on cortical bone of ovariectomized rats]

OBJECTIVE

To study the effects of recombinant human growth hormone on cortical bone of middle femur and vertebra of variectomized rats.

METHODS

Forty 6 month-old SD rats received low or high dose of growth hormone subcutaneously 3 months after ovariectomy for 8 weeks. Bone density and biomechanical strength of the femur were measured, and the thickness of cortical bone of the middle femur and L(2) vertebra was observed. The results were compared with those in estrogen group.

RESULTS

Growth hormone increased the thickness of cortical bone and biomechanical strength and bone density. Estrogen therapy showed no effects on bone density and biomechanical strength of cortical bone.

CONCLUSION

Recombinant human growth hormone can prevent bone loss from cortical bone of ovariectomized rat.

p53-independent role of MDM2 in TGF-beta1 resistance

Transforming growth factor-beta (TGF-beta) inhibits cell proliferation, and acquisition of TGF-beta resistance has been linked to tumorigenesis. A genetic screen was performed to identify complementary DNAs that abrogated TGF-beta sensitivity in mink lung epithelial cells. Ectopic expression of murine double minute 2 rescued TGF-beta-induced growth arrest in a p53-independent manner by interference with retinoblastoma susceptibility gene product (Rb)/E2F function. In human breast tumor cells, increased MDM2 expression levels correlated with TGF-beta resistance. Thus, MDM2 may confer TGF-beta resistance in a subset of tumors and may promote tumorigenesis by interference with two independent tumor suppressors, p53 and Rb.