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Dubé MO, Ingwersen KG, Roy JS, Desmeules F, Lewis J, Juul-Kristensen B, Vobbe J, Jensen SL, McCreesh K. Do therapeutic exercises impact supraspinatus tendon thickness? Secondary analyses of the combined dataset from two randomized controlled trials in patients with rotator cuff-related shoulder pain. J Shoulder Elbow Surg 2024; 33:1918-1927. [PMID: 38762149 DOI: 10.1016/j.jse.2024.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The mechanistic response of rotator cuff tendons to exercises within the context of rotator cuff-related shoulder pain (RCRSP) remains a significant gap in current research. A greater understanding of this response can shed light on why individuals exhibit varying responses to exercise interventions. It can also provide information on the influence of certain types of exercise on tendons. The primary aim of this article is to explore if changes in supraspinatus tendon thickness (SSTT) ratio differ between exercise interventions (high load vs. low load). The secondary aims are to explore if changes in SSTT ratio differ between ultrasonographic tendinopathy subgroups (reactive vs. degenerative) and if there are associations between tendinopathy subgroups, changes in tendon thickness ratio, and clinical outcomes (disability). METHODS This study comprises secondary analyses of the combined dataset from two randomized controlled trials that compared high and low-load exercises in patients with RCRSP. In those trials, different exercise interventions were compared: 1) progressive high-load strengthening exercises and 2) low-load strengthening with or without motor control exercises. In 1 trial, there was also a third group that was not allocated to exercises (education only). Ultrasound-assessed SSTT ratio, derived from comparing symptomatic and asymptomatic sides, served as the primary measure in categorizing participants into tendinopathy subgroups (reactive, normal and degenerative) at baseline. RESULTS Data from 159 participants were analyzed. Two-way repeated measures ANOVAs revealed significant Group (P < .001) and Group × Time interaction (P < .001) effects for the SSTT ratio in different tendinopathy subgroups, but no Time effect (P = .63). Following the interventions, SSTT ratio increased in the "Degenerative" subgroup (0.14 [95% confidence interval {CI}: 0.09-0.19]), decreased in the "Reactive" subgroup (-0.11 [95% CI: -0.16 to -0.06]), and remained unchanged in the "Normal" subgroup (-0.01 [95% CI: -0.04 to 0.02]). There was no Time (P = .21), Group (P = .61), or Group × Time interaction (P = .66) effect for the SSTT ratio based on intervention allocation. Results of the linear regression did not highlight any significant association between the tendinopathy subgroup (P = .25) or change in SSTT ratio (P = .40) and change in disability score. CONCLUSION Findings from this study suggest that, over time, SSTT in individuals with RCRSP tends to normalize, compared to the contralateral side, regardless of the exercise intervention. Different subgroups of symptomatic tendons behave differently, emphasizing the need to potentially consider tendinopathy subtypes in RCRSP research. Future adequately powered studies should investigate how those different tendinopathy subgroups may predict long-term clinical outcomes.
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Affiliation(s)
- Marc-Olivier Dubé
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada; School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Kim Gordon Ingwersen
- Research Unit in Physio - and Occupational Therapy, Department of Physio- and Occupational Therapy, Lillebaelt Hospital - Vejle, Vejle, Denmark
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada; School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - François Desmeules
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, Finchley Memorial Hospital, London, UK; School of Health Sciences, University of Nottingham, Nottingham, UK; School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus; Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Birgit Juul-Kristensen
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jette Vobbe
- Orthopaedic Department, Shoulder Unit, Lillebaelt Hospital, Vejle Hospital, Vejle, Denmark
| | - Steen Lund Jensen
- Orthopaedic Department, Shoulder Unit, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Karen McCreesh
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Chan DD, Guilak F, Sah RL, Calve S. Mechanobiology of Hyaluronan: Connecting Biomechanics and Bioactivity in Musculoskeletal Tissues. Annu Rev Biomed Eng 2024; 26:25-47. [PMID: 38166186 DOI: 10.1146/annurev-bioeng-073123-120541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Hyaluronan (HA) plays well-recognized mechanical and biological roles in articular cartilage and synovial fluid, where it contributes to tissue structure and lubrication. An understanding of how HA contributes to the structure of other musculoskeletal tissues, including muscle, bone, tendon, and intervertebral discs, is growing. In addition, the use of HA-based therapies to restore damaged tissue is becoming more prevalent. Nevertheless, the relationship between biomechanical stimuli and HA synthesis, degradation, and signaling in musculoskeletal tissues remains understudied, limiting the utility of HA in regenerative medicine. In this review, we discuss the various roles and significance of endogenous HA in musculoskeletal tissues. We use what is known and unknown to motivate new lines of inquiry into HA biology within musculoskeletal tissues and in the mechanobiology governing HA metabolism by suggesting questions that remain regarding the relationship and interaction between biological and mechanical roles of HA in musculoskeletal health and disease.
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Affiliation(s)
- Deva D Chan
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA;
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Farshid Guilak
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
- Shriners Hospitals for Children-St. Louis, St. Louis, Missouri, USA
| | - Robert L Sah
- Shu Chien-Gene Lay Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - Sarah Calve
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado, USA
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Wang N, Wang H, Shen L, Liu X, Ma Y, Wang C. Aging-Related Rotator Cuff Tears: Molecular Mechanisms and Implications for Clinical Management. Adv Biol (Weinh) 2024; 8:e2300331. [PMID: 38295015 DOI: 10.1002/adbi.202300331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/15/2023] [Indexed: 02/02/2024]
Abstract
Shoulder pain and disabilities are prevalent issues among the elderly population, with rotator cuff tear (RCT) being one of the leading causes. Although surgical treatment has shown some success, high postoperative retear rates remain a great challenge, particularly in elderly patients. Aging-related degeneration of muscle, tendon, tendon-to-bone enthesis, and bone plays a critical role in the development and prognosis of RCT. Studies have demonstrated that aging worsens muscle atrophy and fatty infiltration, alters tendon structure and biomechanical properties, exacerbates enthesis degeneration, and reduces bone density. Although recent researches have contributed to understanding the pathophysiological mechanisms of aging-related RCT, a comprehensive systematic review of this topic is still lacking. Therefore, this article aims to present a review of the pathophysiological changes and their clinical significance, as well as the molecular mechanisms underlying aging-related RCT, with the goal of shedding light on new therapeutic approaches to reduce the occurrence of aging-related RCT and improve postoperative prognosis in elderly patients.
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Affiliation(s)
- Ni Wang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Haoyuan Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Longxiang Shen
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Xudong Liu
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yanhong Ma
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Chongyang Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
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Özçadırcı A, Doğan Y, Öztürk F, Cinemre ŞA, Coşkun G, Özçakar L. Shoulder structures and strength in competitive preadolescent swimmers: A longitudinal ultrasonographic study. PM R 2024; 16:47-53. [PMID: 37294616 DOI: 10.1002/pmrj.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Repetitive shoulder movements during competitive training may cause changes in the strength of periarticular shoulder structures in preadolescent swimmers. OBJECTIVE To prospectively determine the effects of training on shoulder periarticular structures and muscle strength in preadolescent swimmers. DESIGN Prospective cohort study. SETTING Community-based natatorium. PARTICIPANTS Twenty-four preadolescent swimmers aged 10-12 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Measurements were repeated in three periods as preseason, midseason, and postseason. Ultrasonographic measurements (supraspinatus tendon thickness, humeral head cartilage thickness, deltoid muscle thickness, and acromiohumeral distance) were performed using a portable device and a linear probe. Shoulder (flexion, extension, abduction, internal and external rotation) and back (serratus anterior, lower, and middle trapezius) isometric muscle strength were measured with a handheld dynamometer. RESULTS Supraspinatus tendon thickness and acromiohumeral distance were similar in all periods (all p > .05); however, deltoid muscle and humeral head cartilage thicknesses increased throughout the season (p = .002, p = .008, respectively). Likewise, whereas shoulder muscle strength increased (all p < .05), back muscle strength was similar in all periods (all p > .05). CONCLUSIONS In preadolescent swimmers, acromiohumeral distance and supraspinatus tendon thickness seem to not change; but humeral head cartilage and deltoid muscle thicknesses as well as shoulder muscle strength increase throughout the season.
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Affiliation(s)
- Aykut Özçadırcı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yahya Doğan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ferhat Öztürk
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | | | - Gürsoy Coşkun
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Kwan KYC, Ng KWK, Rao Y, Zhu C, Qi S, Tuan RS, Ker DFE, Wang DM. Effect of Aging on Tendon Biology, Biomechanics and Implications for Treatment Approaches. Int J Mol Sci 2023; 24:15183. [PMID: 37894875 PMCID: PMC10607611 DOI: 10.3390/ijms242015183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Tendon aging is associated with an increasing prevalence of tendon injuries and/or chronic tendon diseases, such as tendinopathy, which affects approximately 25% of the adult population. Aged tendons are often characterized by a reduction in the number and functionality of tendon stem/progenitor cells (TSPCs), fragmented or disorganized collagen bundles, and an increased deposition of glycosaminoglycans (GAGs), leading to pain, inflammation, and impaired mobility. Although the exact pathology is unknown, overuse and microtrauma from aging are thought to be major causative factors. Due to the hypovascular and hypocellular nature of the tendon microenvironment, healing of aged tendons and related injuries is difficult using current pain/inflammation and surgical management techniques. Therefore, there is a need for novel therapies, specifically cellular therapy such as cell rejuvenation, due to the decreased regenerative capacity during aging. To augment the therapeutic strategies for treating tendon-aging-associated diseases and injuries, a comprehensive understanding of tendon aging pathology is needed. This review summarizes age-related tendon changes, including cell behaviors, extracellular matrix (ECM) composition, biomechanical properties and healing capacity. Additionally, the impact of conventional treatments (diet, exercise, and surgery) is discussed, and recent advanced strategies (cell rejuvenation) are highlighted to address aged tendon healing. This review underscores the molecular and cellular linkages between aged tendon biomechanical properties and the healing response, and provides an overview of current and novel strategies for treating aged tendons. Understanding the underlying rationale for future basic and translational studies of tendon aging is crucial to the development of advanced therapeutics for tendon regeneration.
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Affiliation(s)
- Ka Yu Carissa Kwan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kerry Ng
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ying Rao
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chenxian Zhu
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shengcai Qi
- Department of Prosthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai 200040, China;
| | - Rocky S. Tuan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dai Fei Elmer Ker
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dan Michelle Wang
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
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Lu J, Li H, Zhang Z, Xu R, Wang J, Jin H. Platelet-rich plasma in the pathologic processes of tendinopathy: a review of basic science studies. Front Bioeng Biotechnol 2023; 11:1187974. [PMID: 37545895 PMCID: PMC10401606 DOI: 10.3389/fbioe.2023.1187974] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Tendinopathy is a medical condition that includes a spectrum of inflammatory and degenerative tendon changes caused by traumatic or overuse injuries. The pathological mechanism of tendinopathy has not been well defined, and no ideal treatment is currently available. Platelet-rich plasma (PRP) is an autologous whole blood derivative containing a variety of cytokines and other protein components. Various basic studies have found that PRP has the therapeutic potential to promote cell proliferation and differentiation, regulate angiogenesis, increase extracellular matrix synthesis, and modulate inflammation in degenerative tendons. Therefore, PRP has been widely used as a promising therapeutic agent for tendinopathy. However, controversies exist over the optimal treatment regimen and efficacy of PRP for tendinopathy. This review focuses on the specific molecular and cellular mechanisms by which PRP manipulates tendon healing to better understand how PRP affects tendinopathy and explore the reason for the differences in clinical trial outcomes. This article has also pointed out the future direction of basic research and clinical application of PRP in the treatment of tendinopathy, which will play a guiding role in the design of PRP treatment protocols for tendinopathy.
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Affiliation(s)
- Jialin Lu
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Han Li
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Ziyu Zhang
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Rui Xu
- Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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Menezes R, Vincent R, Osorno L, Hu P, Arinzeh TL. Biomaterials and tissue engineering approaches using glycosaminoglycans for tissue repair: Lessons learned from the native extracellular matrix. Acta Biomater 2023; 163:210-227. [PMID: 36182056 PMCID: PMC10043054 DOI: 10.1016/j.actbio.2022.09.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 01/30/2023]
Abstract
Glycosaminoglycans (GAGs) are an important component of the extracellular matrix as they influence cell behavior and have been sought for tissue regeneration, biomaterials, and drug delivery applications. GAGs are known to interact with growth factors and other bioactive molecules and impact tissue mechanics. This review provides an overview of native GAGs, their structure, and properties, specifically their interaction with proteins, their effect on cell behavior, and their mechanical role in the ECM. GAGs' function in the extracellular environment is still being understood however, promising studies have led to the development of medical devices and therapies. Native GAGs, including hyaluronic acid, chondroitin sulfate, and heparin, have been widely explored in tissue engineering and biomaterial approaches for tissue repair or replacement. This review focuses on orthopaedic and wound healing applications. The use of GAGs in these applications have had significant advances leading to clinical use. Promising studies using GAG mimetics and future directions are also discussed. STATEMENT OF SIGNIFICANCE: Glycosaminoglycans (GAGs) are an important component of the native extracellular matrix and have shown promise in medical devices and therapies. This review emphasizes the structure and properties of native GAGs, their role in the ECM providing biochemical and mechanical cues that influence cell behavior, and their use in tissue regeneration and biomaterial approaches for orthopaedic and wound healing applications.
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Affiliation(s)
- Roseline Menezes
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, United States
| | - Richard Vincent
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, United States
| | - Laura Osorno
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, United States
| | - Phillip Hu
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, United States
| | - Treena Livingston Arinzeh
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, United States; Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States.
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Ostadi Moghaddam A, Arshee MR, Lin Z, Sivaguru M, Phillips H, McFarlin BL, Toussaint KC, Wagoner Johnson AJ. An indentation-based framework for probing the glycosaminoglycan-mediated interactions of collagen fibrils. J Mech Behav Biomed Mater 2023; 140:105726. [PMID: 36827935 PMCID: PMC10061372 DOI: 10.1016/j.jmbbm.2023.105726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023]
Abstract
Microscale deformation processes, such as reorientation, buckling, and sliding of collagen fibrils, determine the mechanical behavior and function of collagenous tissue. While changes in the structure and composition of tendon have been extensively studied, the deformation mechanisms that modulate the interaction of extracellular matrix (ECM) constituents are not well understood, partly due to the lack of appropriate techniques to probe the behavior. In particular, the role of glycosaminoglycans (GAGs) in modulating collagen fibril interactions has remained controversial. Some studies suggest that GAGs act as crosslinkers between the collagen fibrils, while others have not found such evidence and postulate that GAGs have other functions. Here, we introduce a new framework, relying on orientation-dependent indentation behavior of tissue and computational modeling, to evaluate the shear-mediated function of GAGs in modulating the collagen fibril interactions at a length scale more relevant to fibrils compared to bulk tests. Specifically, we use chondroitinase ABC to enzymatically deplete the GAGs in tendon; measure the orientation-dependent indentation response in transverse and longitudinal orientations; and infer the microscale deformation mechanisms and function of GAGs from a microstructural computational model and a modified shear-lag model. We validate the modeling approach experimentally and show that GAGs facilitate collagen fibril sliding with minimal crosslinking function. We suggest that the molecular reconfiguration of GAGs is a potential mechanism for their microscale, strain-dependent viscoelastic behavior. This study reveals the mechanisms that control the orientation-dependent indentation response by affecting the shear deformation and provides new insights into the mechanical function of GAGs and collagen crosslinkers in collagenous tissue.
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Affiliation(s)
- A Ostadi Moghaddam
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - M R Arshee
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Z Lin
- School of Engineering, Brown University, Providence, RI, 02912, USA
| | - M Sivaguru
- Flow Cytometry and Microscopy to Omics, Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA
| | - H Phillips
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - B L McFarlin
- Department of Women, Children and Family Health Science, University of Illinois College of Nursing, Chicago, IL, 60612, USA
| | - K C Toussaint
- School of Engineering, Brown University, Providence, RI, 02912, USA
| | - A J Wagoner Johnson
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA; Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA; Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
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9
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Korcari A, Przybelski SJ, Gingery A, Loiselle AE. Impact of aging on tendon homeostasis, tendinopathy development, and impaired healing. Connect Tissue Res 2023; 64:1-13. [PMID: 35903886 PMCID: PMC9851966 DOI: 10.1080/03008207.2022.2102004] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/11/2022] [Indexed: 02/03/2023]
Abstract
Aging is a complex and progressive process where the tissues of the body demonstrate a decreased ability to maintain homeostasis. During aging, there are substantial cellular and molecular changes, with a subsequent increase in susceptibility to pathological degeneration of normal tissue function. In tendon, aging results in well characterized alterations in extracellular matrix (ECM) structure and composition. In addition, the cellular environment of aged tendons is altered, including a marked decrease in cell density and metabolic activity, as well as an increase in cellular senescence. Collectively, these degenerative changes make aging a key risk factor for the development of tendinopathies and can increase the frequency of tendon injuries. However, inconsistencies in the extent of age-related degenerative impairments in tendons have been reported, likely due to differences in how "old" and "young" age-groups have been defined, differences between anatomically distinct tendons, and differences between animal models that have been utilized to study the impact of aging on tendon homeostasis. In this review, we address these issues by summarizing data by well-defined age categories (young adults, middle-aged, and aged) and from anatomically distinct tendon types. We then summarize in detail how aging affects tendon mechanics, structure, composition, and the cellular environment based on current data and underscore what is currently not known. Finally, we discuss gaps in the current understanding of tendon aging and propose key avenues for future research that can shed light on the specific mechanisms of tendon pathogenesis due to aging.
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Affiliation(s)
- Antonion Korcari
- Department of Orthopaedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | | | - Anne Gingery
- Division of Orthopedic Surgery Research, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Alayna E Loiselle
- Department of Orthopaedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
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10
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Choi YH, Cho SH, Seo J, Ahn JH, Kim YC. Apoptosis Occurs in the Anterior Talofibular Ligament of Patients With Chronic Lateral Ankle Instability: An In Vitro Study. Clin Orthop Relat Res 2022; 480:2420-2429. [PMID: 35973121 PMCID: PMC9653187 DOI: 10.1097/corr.0000000000002337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/06/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic lateral ankle instability is treated operatively, whereas most acute ankle sprains associated with acute anterior talofibular ligament injury are usually treated nonoperatively. This treatment strategy is widely accepted and has been validated using a variety of clinical or radiological methods. We suspected that there may be biological differences between chronic and acutely injured ligaments, particularly with respect to apoptosis. Apoptosis is known to cause ligament degeneration. If it could be demonstrated that apoptosis occurs more in the anterior talofibular ligament tissues of patients with chronic lateral ankle instability compared with patients with acute anterior talofibular ligament injury, biological evidence could be supported. QUESTIONS/PURPOSES We sought to (1) elucidate the difference in the extent of apoptosis between patients with chronic lateral ankle instability and those with acute anterior talofibular ligament injury. In addition, we asked: (2) What is the expression level of apoptotic enzymes such as caspases 3, 7, 8, and 9 and cytochrome c in each patient group? (3) Is there a correlation between apoptotic activities and the symptom duration period of chronic lateral ankle instability? METHODS Between March 2019 and February 2021, 50 patients were prospectively enrolled in this study. Anterior talofibular ligament tissues were harvested from patients who were divided into two groups: the chronic lateral ankle instability group and the acute anterior talofibular ligament injury group. Patients with insufficient remaining ligaments were excluded from the chronic lateral ankle instability group, and cases in which the tissue was severely damaged or the quality of collected tissue was insufficient because of severe impingement into the fracture site were excluded from the acute anterior talofibular ligament injury group. Tissues were collected from 21 patients (11 males and 10 females) in the chronic lateral ankle instability group with a mean age of 37 ± 14 years and from 17 patients (6 males and 11 females) in the acute anterior talofibular ligament injury group with a mean age of 49 ± 17 years. To investigate our first purpose, apoptotic cells were counted using a TUNEL assay. To answer our second question, Western blotting for apoptotic enzymes such as caspases 3, 7, 8, and 9 and cytochrome c was performed to investigate apoptotic activity. Immunohistochemistry was also used to detect apoptotic enzymes. To answer our third question, the time elapsed after the first symptom related to chronic lateral ankle instability occurred and the expression level of each enzyme was investigated. RESULTS More apoptotic cells were observed in the chronic lateral ankle instability group than in the acute anterior talofibular ligament injury group in the TUNEL assay. Western blotting revealed that the apoptotic activities of the chronic lateral ankle instability group were higher than those of the acute anterior talofibular ligament injury group: caspase 3 was 117 in the chronic lateral ankle instability group and 59 in the acute anterior talofibular ligament injury group (mean difference 58 [95% confidence interval (CI) 31 to 86]; p < 0.001), caspase 7 was 138 in the chronic lateral ankle instability group and 45 in the acute anterior talofibular ligament injury group (mean difference 93 [95% CI 58 to 128]; p < 0.001), caspase 8 was 126 in the chronic lateral ankle instability group and 68 in the acute anterior talofibular ligament injury group (mean difference 58 [95% CI 29 to 89]; p < 0.001), caspase 9 was 128 in the chronic lateral ankle instability group and 54 in the acute anterior talofibular ligament injury group (mean difference 74 [95% CI 44 to 104]; p < 0.001), and cytochrome c was 139 in the chronic lateral ankle instability group and 51 in the acute anterior talofibular ligament injury group (mean difference 88 [95% CI 46 to 129]; p < 0.001). Immunohistochemistry revealed higher expression of caspases 3, 7, 8, and 9 and cytochrome c in the chronic lateral ankle instability group compared with those in the acute anterior talofibular ligament injury group. Caspases 3, 7, and 9 showed no correlation with duration of chronic lateral ankle instability symptoms: the Pearson correlation coefficient was 0.22 [95% CI -0.25 to 0.69] for caspase 3 (p = 0.36), 0.29 [95% CI -0.16 to 0.74] for caspase 7 (p = 0.23), and 0.29 [95% CI -0.16 to 0.74] for caspase 9 (p = 0.23). CONCLUSION In chronic lateral ankle instability, apoptotic activity in the anterior talofibular ligament was higher than in acute anterior talofibular ligament injury. CLINICAL RELEVANCE Apoptosis occurs more in chronic injured ligaments than in acutely injured ligaments. Although urgent surgical repair is not required for acute anterior talofibular ligament injury, chronic lateral ankle instability may progress if the nonoperative treatment is not successful. Further research should focus not only on timing of apoptotic progression, but also on biological augmentation to reverse or prevent apoptosis within the anterior talofibular ligament.
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Affiliation(s)
- Youn-Ho Choi
- Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hyun Cho
- Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - JeongYong Seo
- Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hoon Ahn
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon-Chung Kim
- Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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11
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Izumi S, Oichi T, Shetye SS, Zhang K, Wilson K, Iwamoto M, Kuo CK, Akabudike N, Adachi N, Soslowsky LJ, Enomoto-Iwamoto M. Inhibition of glucose use improves structural recovery of injured Achilles tendon in mice. J Orthop Res 2022; 40:1409-1419. [PMID: 34460123 PMCID: PMC8882710 DOI: 10.1002/jor.25176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/21/2021] [Accepted: 08/16/2021] [Indexed: 02/04/2023]
Abstract
Injured tendons do not regain their native structure except at fetal or very young ages. Healing tendons often show mucoid degeneration involving accumulation of sulfated glycosaminoglycans (GAGs), but its etiology and molecular base have not been studied substantially. We hypothesized that quality and quantity of gene expression involving the synthesis of proteoglycans having sulfated GAGs are altered in injured tendons and that a reduction in synthesis of sulfated GAGs improves structural and functional recovery of injured tendons. C57BL6/j mice were subjected to Achilles tendon tenotomy surgery. The injured tendons accumulated sulfate proteoglycans as early as 1-week postsurgery and continued so by 4-week postsurgery. Transcriptome analysis revealed upregulation of a wide range of proteoglycan genes that have sulfated GAGs in the injured tendons 1 and 3 weeks postsurgery. Genes critical for enzymatic reaction of initiation and elongation of chondroitin sulfate GAG chains were also upregulated. After the surgery, mice were treated with the 2-deoxy-d-glucose (2DG) that inhibits conversion of glucose to glucose-6-phosphate, an initial step of glucose metabolism as an energy source and precursors of monosaccharides of GAGs. The 2DG treatment reduced accumulation of sulfated proteoglycans, improved collagen fiber alignment, and reduced the cross-sectional area of the injured tendons. The modulus of the 2DG-treated groups was higher than that in the vehicle group, but not of statistical significance. Our findings suggest that mucoid degeneration in injured tendons may result from the upregulated expression of genes involved the synthesis of sulfate proteoglycans and can be inhibited by reduction of glucose utilization.
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Affiliation(s)
- Soutarou Izumi
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health sciences, Hiroshima University, Japan
| | - Takeshi Oichi
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore
| | - Snehal S. Shetye
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia PA
| | - Kairui Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University
| | - Kimberly Wilson
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore
| | - Masahiro Iwamoto
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore
| | - Catherine K. Kuo
- Fischell Department of Bioengineering, University of Maryland College Park
| | - Ngozi Akabudike
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health sciences, Hiroshima University, Japan
| | - Louis J. Soslowsky
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia PA
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12
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Brazier J, Antrobus MR, Herbert AJ, Callus PC, Stebbings GK, Day SH, Heffernan SM, Kilduff LP, Bennett MA, Erskine RM, Raleigh SM, Collins M, Pitsiladis YP, Williams AG. Gene Variants Previously Associated with Reduced Soft Tissue Injury Risk: Part 1 - Independent Associations with Elite Status in Rugby. Eur J Sport Sci 2022; 23:726-735. [PMID: 35293840 DOI: 10.1080/17461391.2022.2053752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractThere is growing evidence of genetic contributions to tendon and ligament pathologies. Given the high incidence and severity of tendon and ligament injuries in elite rugby, we studied whether 13 gene polymorphisms previously associated with tendon/ligament injury were associated with elite athlete status. Participants from the RugbyGene project were 663 elite Caucasian male rugby athletes (RA) (mean (standard deviation) height 1.85 (0.07) m, mass 101 (12) kg, age 29 (7) yr), including 558 rugby union athletes (RU) and 105 rugby league athletes. Non-athletes (NA) were 909 Caucasian men and women (56% female; height 1.70 (0.10) m, mass 72 (13) kg, age 41 (23) yr). Genotypes were determined using TaqMan probes and groups compared using Χ2 and odds ratio (OR). COLGALT1 rs8090 AA genotype was more frequent in RA (27%) than NA (23%; P = 0.006). COL3A1 rs1800255 A allele was more frequent in RA (26%) than NA (23%) due to a greater frequency of GA genotype (39% vs 33%). For MIR608 rs4919510, RA had 1.7 times the odds of carrying the CC genotype compared to NA. MMP3 rs591058 TT genotype was less common in RA (25.1%) than NA (31.2%; P < 0.04). For NID1 rs4660148, RA had 1.6 times the odds of carrying the TT genotype compared to NA. It appears that elite rugby athletes have an inherited advantage that contributes to their elite status, possibly via resistance to soft tissue injury. These data may, in future, assist personalized management of injury risk amongst athletes.
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Affiliation(s)
- Jon Brazier
- Manchester Metropolitan University Institute of Sport, Manchester, UK.,Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK.,Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Mark R Antrobus
- Manchester Metropolitan University Institute of Sport, Manchester, UK.,Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK.,Sport and Exercise Science, University of Northampton, Northampton NN1 5PH, UK
| | - Adam J Herbert
- Department of Sport and Exercise, School of Health Sciences, Birmingham City University, Birmingham, B15 3TN, UK
| | - Peter C Callus
- Manchester Metropolitan University Institute of Sport, Manchester, UK.,Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Georgina K Stebbings
- Manchester Metropolitan University Institute of Sport, Manchester, UK.,Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Stephen H Day
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK
| | - Shane M Heffernan
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Liam P Kilduff
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Mark A Bennett
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Robert M Erskine
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK.,Institute of Sport, Exercise and Health, University College London, London, WC1E 6BT, UK
| | - Stuart M Raleigh
- School of Health Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - Malcolm Collins
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, 7700, South Africa
| | - Yannis P Pitsiladis
- FIMS Reference Collaborating Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Brighton, BN2 0YJ, UK
| | - Alun G Williams
- Manchester Metropolitan University Institute of Sport, Manchester, UK.,Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK.,Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK.,Institute of Sport, Exercise and Health, University College London, London, WC1E 6BT, UK
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13
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Allaith S, Tew SR, Hughes CE, Clegg PD, Canty-Laird EG, Comerford EJ. Characterisation of key proteoglycans in the cranial cruciate ligaments (CCLs) from two dog breeds with different predispositions to CCL disease and rupture. Vet J 2021; 272:105657. [PMID: 33941333 DOI: 10.1016/j.tvjl.2021.105657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/23/2022]
Abstract
Cranial cruciate ligament disease and rupture (CCLD/R) is one of the most common orthopaedic conditions in dogs, eventually leading to osteoarthritis of the stifle joint. Certain dog breeds such as the Staffordshire bull terrier have an increased risk of developing CCLD/R. Previous studies into CCLD/R have found that glycosaminoglycan levels were elevated in cranial cruciate ligament (CCL) tissue from high-risk breeds when compared to the CCL from a low-risk breed to CCLD/R. Our objective was to determine specific proteoglycans/glycosaminoglycans in the CCL and to see whether their content was altered in dog breeds with differing predispositions to CCLD/R. Disease-free CCLs from Staffordshire bull terriers (moderate/high-risk to CCLD/R) and Greyhounds (low-risk to CCLD/R) were collected and key proteoglycan/glycosaminoglycans were determined by semi-quantitative Western blotting, quantitative biochemistry, quantitative reverse transcription polymerase chain reaction, and immunohistochemistry. Gene expression of fibromodulin (P = 0.03), aggrecan (P = 0.0003), and chondroitin-6-sulphate stubs (P = 0.01) were significantly increased, and for fibromodulin this correlated with an increase in protein content in Staffordshire bull terriers compared to Greyhound CCLs (P = 0.02). Decorin (P = 0.03) and ADAMTS-4 (P = 0.04) gene expression were significantly increased in Greyhounds compared to Staffordshire bull terrier CCLs. The increase of specific proteoglycans and glycosaminoglycans within the Staffordshire bull terrier CCLs may indicate a response to higher compressive loads, potentially altering their risk to traumatic injury. The higher decorin content in the Greyhound CCLs is essential for maintaining collagen fibril strength, while the increase of ADAMTS-4 indicates a higher rate of turnover helping to regulate normal CCL homeostasis in Greyhounds.
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Affiliation(s)
- S Allaith
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK; The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), UK
| | - S R Tew
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK; The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), UK
| | - C E Hughes
- School of Biosciences, University of Cardiff, Sir Martin Evans Building, Museum Avenue, Cardiff, CF 10 3AX, UK
| | - P D Clegg
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK; The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), UK
| | - E G Canty-Laird
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK; The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), UK
| | - E J Comerford
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK; Small Animal Teaching Hospital, Leahurst Campus, School of Veterinary Science, University of Liverpool, Chester High Rd, Neston CH64 7TE, UK; The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), UK.
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14
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Siadat SM, Zamboulis DE, Thorpe CT, Ruberti JW, Connizzo BK. Tendon Extracellular Matrix Assembly, Maintenance and Dysregulation Throughout Life. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1348:45-103. [PMID: 34807415 DOI: 10.1007/978-3-030-80614-9_3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In his Lissner Award medal lecture in 2000, Stephen Cowin asked the question: "How is a tissue built?" It is not a new question, but it remains as relevant today as it did when it was asked 20 years ago. In fact, research on the organization and development of tissue structure has been a primary focus of tendon and ligament research for over two centuries. The tendon extracellular matrix (ECM) is critical to overall tissue function; it gives the tissue its unique mechanical properties, exhibiting complex non-linear responses, viscoelasticity and flow mechanisms, excellent energy storage and fatigue resistance. This matrix also creates a unique microenvironment for resident cells, allowing cells to maintain their phenotype and translate mechanical and chemical signals into biological responses. Importantly, this architecture is constantly remodeled by local cell populations in response to changing biochemical (systemic and local disease or injury) and mechanical (exercise, disuse, and overuse) stimuli. Here, we review the current understanding of matrix remodeling throughout life, focusing on formation and assembly during the postnatal period, maintenance and homeostasis during adulthood, and changes to homeostasis in natural aging. We also discuss advances in model systems and novel tools for studying collagen and non-collagenous matrix remodeling throughout life, and finally conclude by identifying key questions that have yet to be answered.
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Affiliation(s)
| | - Danae E Zamboulis
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Chavaunne T Thorpe
- Comparative Biomedical Sciences, The Royal Veterinary College, University of London, London, UK
| | - Jeffrey W Ruberti
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Brianne K Connizzo
- Department of Biomedical Engineering, Boston University, Boston, MA, USA.
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15
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Randelli F, Sartori P, Carlomagno C, Bedoni M, Menon A, Vezzoli E, Sommariva M, Gagliano N. The Collagen-Based Medical Device MD-Tissue Acts as a Mechanical Scaffold Influencing Morpho-Functional Properties of Cultured Human Tenocytes. Cells 2020; 9:cells9122641. [PMID: 33302563 PMCID: PMC7763591 DOI: 10.3390/cells9122641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/27/2022] Open
Abstract
Mechanotransduction is the ability of cells to translate mechanical stimuli into biochemical signals that can ultimately influence gene expression, cell morphology and cell fate. Tenocytes are responsible for tendon mechanical adaptation converting mechanical stimuli imposed during mechanical loading, thus affecting extracellular matrix homeostasis. Since we previously demonstrated that MD-Tissue, an injectable collagen-based medical compound containing swine-derived collagen as the main component, is able to affect tenocyte properties, the aim of this study was to analyze whether the effects triggered by MD-Tissue were based on mechanotransduction-related mechanisms. For this purpose, MD-Tissue was used to coat Petri dishes and cytochalasin B was used to deprive tenocytes of mechanical stimulation mediated by the actin cytoskeleton. Cell morphology, migration, collagen turnover pathways and the expression of key mechanosensors were analyzed by morphological and molecular methods. Our findings confirm that MD-Tissue affects collagen turnover pathways and favors cell migration and show that the MD-Tissue-induced effect represents a mechanical input involving the mechanotransduction machinery. Overall, MD-Tissue, acting as a mechanical scaffold, could represent an effective medical device for a novel therapeutic, regenerative and rehabilitative approach to favor tendon healing in tendinopathies.
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Affiliation(s)
- Filippo Randelli
- Hip Department (CAD) Gaetano Pini—CTO Orthopedic Institute, Università degli Studi di Milano, Piazza Cardinal Ferrari 1, 20122 Milan, Italy;
| | - Patrizia Sartori
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
| | - Cristiano Carlomagno
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy; (C.C.); (M.B.)
| | - Marzia Bedoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy; (C.C.); (M.B.)
| | - Alessandra Menon
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Elena Vezzoli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
| | - Michele Sommariva
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
| | - Nicoletta Gagliano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
- Correspondence: ; Tel.: +39-02-50315374
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Vedadghavami A, Zhang C, Bajpayee AG. Overcoming negatively charged tissue barriers: Drug delivery using cationic peptides and proteins. NANO TODAY 2020; 34:100898. [PMID: 32802145 PMCID: PMC7425807 DOI: 10.1016/j.nantod.2020.100898] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Negatively charged tissues are ubiquitous in the human body and are associated with a number of common diseases yet remain an outstanding challenge for targeted drug delivery. While the anionic proteoglycans are critical for tissue structure and function, they make tissue matrix dense, conferring a high negative fixed charge density (FCD) that makes drug penetration through the tissue deep zones and drug delivery to resident cells extremely challenging. The high negative FCD of these tissues is now being utilized by taking advantage of electrostatic interactions to create positively charged multi-stage delivery methods that can sequentially penetrate through the full thickness of tissues, create a drug depot and target cells. After decades of work on attempting delivery using strong binding interactions, significant advances have recently been made using weak and reversible electrostatic interactions, a characteristic now considered essential to drug penetration and retention in negatively charged tissues. Here we discuss these advances using examples of negatively charged tissues (cartilage, meniscus, tendons and ligaments, nucleus pulposus, vitreous of eye, mucin, skin), and delve into how each of their structures, tissue matrix compositions and high negative FCDs create barriers to drug entry and explore how charge interactions are being used to overcome these barriers. We review work on tissue targeting cationic peptide and protein-based drug delivery, compare and contrast drug delivery designs, and also present examples of technologies that are entering clinical trials. We also present strategies on further enhancing drug retention within diseased tissues of lower FCD by using synergistic effects of short-range binding interactions like hydrophobic and H-bonds that stabilize long-range charge interactions. As electrostatic interactions are incorporated into design of drug delivery materials and used as a strategy to create properties that are reversible, tunable and dynamic, bio-electroceuticals are becoming an exciting new direction of research and clinical work.
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Affiliation(s)
- Armin Vedadghavami
- Department of Bioengineering, Northeastern University, Boston, MA, 02115, USA
| | - Chenzhen Zhang
- Department of Bioengineering, Northeastern University, Boston, MA, 02115, USA
| | - Ambika G. Bajpayee
- Department of Bioengineering, Northeastern University, Boston, MA, 02115, USA
- Department of Mechanical Engineering, Northeastern University, Boston, MA, 02115, USA
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17
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Prabutzki P, Leopold J, Schubert S, Schiller J, Nimptsch A. De novo synthesis of phospholipids and sphingomyelin in multipotent stromal cells - Monitoring studies by mass spectrometry. Chem Phys Lipids 2020; 232:104965. [PMID: 32888915 DOI: 10.1016/j.chemphyslip.2020.104965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/16/2020] [Accepted: 08/23/2020] [Indexed: 02/07/2023]
Abstract
Musculoskeletal diseases are extremely widespread and a significant burden on the health systems of the industrialized countries. The use of mesenchymal stromal cells is a promising approach to cure cartilage and tendon injuries, which often also occur in younger people as consequences of sport accidents. Although particular interest is on the collagen and the glycosaminoglycan composition of the tendon and potential alterations compared to healthy tissue, there is nowadays also increasing evidence that some selected phospholipids (PL) are potential mediators of tissue regeneration. Therefore, PL (and potential changes thereof) attract increasing interest in this field. We have used positive and negative ion matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) to elucidate the lipid compositions of human mesenchymal stromal cells in dependence on the composition of the cell culture medium and the cultivation time. The de novo biosynthesis of PL was monitored by adding 13C labeled glucose or deuterated palmitic acid (d31-PA) to the cells and the incorporation of 13C or 2H into the different PL classes was investigated by electrospray ionization (ESI) mass spectrometry (MS). It is remarkable that all PL classes (for instance, phosphatidylcholine and -inositol) exhibited 13C incorporation - but not the sphingomyelin (SM) which is the most abundant sphingolipid in the majority of human tissues and body fluids. Using suitable internal standards it could be shown, that only 12C-containing SM is de novo generated while no 13C-labeled SM could be monitored - independent of the cultivation time, which was varied between 7 and 28 days. SM impurities stemming from the cell culture medium and the used MALDI matrix compounds (2,5-dihydroxybenzoic acid (DHB) or 9-aminoacridine (9-AA)) could be ruled out. However, incorporation of deuterated palmitic acid (d31-PA) could be observed for multiple PL, including SM. Therefore, it is suggested that there must exist another, so far unknown SM biosynthesis pathway. This pathway does not make use of glucose but relies on the use of other molecules as energy sources. Potential pathways to explain the experimental observations are discussed.
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Affiliation(s)
- Patricia Prabutzki
- Leipzig University, Faculty of Medicine, Institute for Medical Physics and Biophysics, Härtelstraße 16-18, D-04107, Leipzig, Germany
| | - Jenny Leopold
- Leipzig University, Faculty of Medicine, Institute for Medical Physics and Biophysics, Härtelstraße 16-18, D-04107, Leipzig, Germany
| | - Susanna Schubert
- Leipzig University, Saxonian Incubator for Clinical Translation, Philipp-Rosenthal-Straße 55, D-04103, Leipzig, Germany
| | - Jürgen Schiller
- Leipzig University, Faculty of Medicine, Institute for Medical Physics and Biophysics, Härtelstraße 16-18, D-04107, Leipzig, Germany
| | - Ariane Nimptsch
- Leipzig University, Faculty of Medicine, Institute for Medical Physics and Biophysics, Härtelstraße 16-18, D-04107, Leipzig, Germany.
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Xie Y, Liu S, Qu J, Wu P, Tao H, Chen S. Quantitative Magnetic Resonance Imaging UTE-T2* Mapping of Tendon Healing After Arthroscopic Rotator Cuff Repair: A Longitudinal Study. Am J Sports Med 2020; 48:2677-2685. [PMID: 32813550 DOI: 10.1177/0363546520946772] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quantitative ultrashort echo time-T2* (UTE-T2*) mapping shows promise for the detection of potential tendon biochemical conditions, while validation against established clinical studies in the shoulder is needed. PURPOSE To evaluate and characterize the healing process of the repaired rotator cuff based on longitudinal changes in UTE-T2* values, clinical outcomes, and repair status in patients after arthroscopic rotator cuff repair (ARCR). STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients with ARCR (n = 25) underwent quantitative MRI and clinical examinations at serial follow-up time points: 3, 6, 12, and 24 months postoperatively. Age-matched healthy controls (n = 15) were evaluated at 3 and 12 months after enrollment. Clinical scores included the Constant, American Shoulder and Elbow Surgeons, and Fudan University Shoulder score, and visual analog scale for pain. The MRI examination included UTE-T2*mapping. UTE-T2* maps were generated for T2* values at the healing site. Sugaya classification was adopted to evaluate the repair status. Longitudinal analyses of clinical outcomes, UTE-T2* changes, and Sugaya classification were conducted. RESULTS The overall retear rate was 8% (2/25, all Sugaya type IV). All patients (including the ones with retear) achieved satisfactory outcomes at 12 months that lasted to 24 months on the basis of clinical scores. The mean UTE-T2* values at the healing site showed an increase from 3 to 6 months (P = .03) and then decreased to a level similar to that observed in age-matched healthy tendons at 12 months (P = .1). No significant differences were found between UTE-T2* values at 12 and 24 months (P = .6). UTE-T2* values at the healing site significantly varied with the repair status according to Sugaya classification (P < .05). Moreover, significant correlations were noted between clinical scores and UTE-T2* values at 6 months (r = -0.6 to -0.3; all P < .05) and 12 months (r = -0.6 to -0.2; all P < .05). CONCLUSION This study indicated a healing-related relationship between clinical outcomes and quantitative UTE-T2* values, which highlights the potential of using UTE-T2* mapping to track the tendon-healing process noninvasively. Moreover, the repaired tendon was comparable to age-matched healthy controls at 12-month follow-up based on UTE-T2* values.
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Affiliation(s)
- Yuxue Xie
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Puye Wu
- GE Healthcare, MR Research, Beijing, China
| | - Hongyue Tao
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
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19
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Marcucci L, Reggiani C. Increase of resting muscle stiffness, a less considered component of age-related skeletal muscle impairment. Eur J Transl Myol 2020. [DOI: 10.4081/ejtm.2020.8982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Elderly people perform more slowly movements of everyday life as rising from a chair, walking, and climbing stairs. This is in the first place due to the loss of muscle contractile force which is even more pronounced than the loss of muscle mass. In addition, a secondary, but not negligible, component is the rigidity or increased stiffness which requires greater effort to produce the same movement and limits the range of motion of the joints. In this short review, we discuss the possible determinants of the limitations of joint mobility in healthy elderly, starting with the age-dependent alterations of the articular structure and focusing on the increased stiffness of the skeletal muscles. Thereafter, the possible mechanisms of the increased stiffness of the muscle-tendon complex are considered, among them changes in the muscle fibers, alterations of the connective components (extracellular matrix or ECM, aponeurosis, fascia and tendon) and remodeling of the neural pattern of muscle activation with increased of antagonist co-activation.
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20
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Marcucci L, Reggiani C. Increase of resting muscle stiffness, a less considered component of age-related skeletal muscle impairment. Eur J Transl Myol 2020; 30:8982. [PMID: 32782762 PMCID: PMC7385684 DOI: 10.4081/ejtm.2019.8982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
Elderly people perform more slowly movements of everyday life as rising from a chair, walking, and climbing stairs. This is in the first place due to the loss of muscle contractile force which is even more pronounced than the loss of muscle mass. In addition, a secondary, but not negligible, component is the rigidity or increased stiffness which requires greater effort to produce the same movement and limits the range of motion of the joints. In this short review, we discuss the possible determinants of the limitations of joint mobility in healthy elderly, starting with the age-dependent alterations of the articular structure and focusing on the increased stiffness of the skeletal muscles. Thereafter, the possible mechanisms of the increased stiffness of the muscle-tendon complex are considered, among them changes in the muscle fibers, alterations of the connective tissue components, i.e., extracellular matrix (ECM), aponeurosis, tendon and fascia, and remodeling of the neural pattern of muscle activation that increases antagonist co-activation.
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Affiliation(s)
- Lorenzo Marcucci
- Department of Biomedical Sciences, Padova University, Padova, Italy.,Center for Mechanics of Biological Materials, Padova University, Padova, Italy.,Center for Biosystems Dynamics Research, RIKEN, Suita, Osaka, 565-0874, Japan
| | - Carlo Reggiani
- Department of Biomedical Sciences, Padova University, Padova, Italy.,Center for Mechanics of Biological Materials, Padova University, Padova, Italy.,Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
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21
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Martin CL, Bergman MR, Deravi LF, Paten JA. A Role for Monosaccharides in Nucleation Inhibition and Transport of Collagen. Bioelectricity 2020; 2:186-197. [PMID: 34471846 DOI: 10.1089/bioe.2020.0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Collagenous tissues are composed of precisely oriented, tightly packed collagen fibril bundles to confer the maximal strength within the smallest volume. While this compact form benefits mobility, it consequentially restricts vascularity and cell density to a minimally viable level in some regions. These tissues reside in a homeostatic state with an unstable equilibrium, where perturbations to structure or molecular milieu cause descension into a long-term compromised state. Several studies have shown that glycosaminoglycans are key molecules required for healthy tissue maintenance. Our long-term goal is to determine if glycosaminoglycans serve a critical function of stabilizing soluble monomeric collagen in the interstitial fluid that bathes tissue for immediate availability in tissue development and repair in vivo. Materials and Methods: To test glycosaminoglycan and collagen interactions at the most fundamental level, we have explored the effect of the monosaccharides that populate the glycosaminoglycans of the extracellular matrix on collagen assembly kinetics, pre-established matrix stability, and collagen incorporation into a preassembled matrix. Results: Results showed that monosaccharides increased the threshold concentration required for spontaneous polymerization by at least three orders of magnitude. When the monosaccharides were introduced to a pre-existing collagen network, fibrillar dissociation was undetectable. Fluorescent-labeling studies illustrated that in the presence of the saccharide solution, soluble collagen maintains the functional capacity to integrate into a pre-existing network. Conclusion: This work demonstrates a feasible role for glycosaminoglycans in supporting tissue remodeling and highlights the potential importance of age-related deterioration of glycosaminoglycan biosynthesis in reference to the homeostasis of collagen-based tissues.
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Affiliation(s)
- Cassandra L Martin
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, Massachusetts, USA
| | - Michael R Bergman
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, Massachusetts, USA
| | - Leila F Deravi
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, Massachusetts, USA
| | - Jeffrey A Paten
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, Massachusetts, USA.,John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
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22
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Porter KN, Blanch PD, Walker HM, Shield AJ. The effect of previous shoulder pain on supraspinatus tendon thickness changes following swimming practice. Scand J Med Sci Sports 2020; 30:1442-1448. [DOI: 10.1111/sms.13678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/27/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kirsten N. Porter
- School of Exercise and Nutrition Science Queensland University of Technology Brisbane Australia
- Sport and Performance Innovation Excellence Queensland Academy of Sport Brisbane QLD Australia
- School of Physiotherapy Australian Catholic University Ballarat VIC Australia
| | - Peter D. Blanch
- School of Allied Health Sciences Brisbane Lions Football Club Woolloongabba QLD Australia
- School of Allied Health Sciences Griffith University Gold Coast QLD Australia
| | - Helen M. Walker
- School of Physiotherapy Physio4athletes Melbourne VIC Australia
| | - Anthony J. Shield
- School of Exercise and Nutrition Science Queensland University of Technology Brisbane Australia
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23
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Anz AW, Edison J, Denney TS, Branch EA, Walz CR, Brock KV, Goodlett MD. 3-T MRI mapping is a valid in vivo method of quantitatively evaluating the anterior cruciate ligament: rater reliability and comparison across age. Skeletal Radiol 2020; 49:443-452. [PMID: 31482257 DOI: 10.1007/s00256-019-03301-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE As biologic augmentation methods emerge, objective measures of soft tissues are necessary for developmental study. The purpose of this study was to develop a quantitative MRI mapping protocol for the ACL. The objectives were (1) to provide age-based T2 relaxation, T2* relaxation, and volume values in healthy individuals, (2) to establish the intra-rater and inter-rater reliability of ACL mapping, and (3) to determine whether 3-T or 7-T MRI is more appropriate for future clinical trials. MATERIALS AND METHODS Thirty healthy participants, aged 18-62, asymptomatic for knee pathology and without history of knee injury underwent both a 3-T and 7-T MRI. Manual image mapping of the anterior cruciate ligament was performed by two observers and processed to obtain T2, T2*, and volume values. Analysis of variance and two-way random effects model were used to calculate statistical significance and intraclass correlation coefficients. RESULTS Across all participants, 3-T and 7-T mean T2, T2* and volume values were 37.1 ± 7.9 and 39.7 ± 6.2 ms (p = 0.124), 10.9 ± 1.3 and 10.9 ± 0.9 ms (p = 0.981), and 2380 ± 602 and 2484 ± 736 mm3 (p = 0.551), respectively. The T2, T2*, and volume did not vary between age cohorts (p > 0.05). Excellent inter-rater and intra-rater reliability regarding T2 and T2* values was found. While ACL volume exhibited good inter-rater reliability and excellent intra-rater reliability. CONCLUSIONS T2 relaxation values and ACL volume do not vary with age and therefore can be used as a quantifiable, non-invasive method to assess ACL graft maturation. 7-T MRI analysis was not superior to 3-T MRI analysis, suggesting that 3-T MRI is practical and capable for future comparative studies.
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Affiliation(s)
- Adam W Anz
- Andrews Institute for Orthopaedics & Sports Medicine, 1040 Gulf Breeze Parkway, Gulf Breeze, FL, 32561, USA.
| | - Jos Edison
- Edward Via College of Osteopathic Medicine, 910 South Donahue Drive, Auburn, AL, 36832, USA
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, 200 Broun Hall, Auburn, AL, 36849, USA
| | - Eric A Branch
- Andrews Institute for Orthopaedics & Sports Medicine, 1040 Gulf Breeze Parkway, Gulf Breeze, FL, 32561, USA
| | - Christopher R Walz
- Department of Electrical and Computer Engineering, Auburn University, 200 Broun Hall, Auburn, AL, 36849, USA
| | - Kenny V Brock
- Edward Via College of Osteopathic Medicine, 910 South Donahue Drive, Auburn, AL, 36832, USA
| | - Michael D Goodlett
- Auburn University Athletics, Auburn Athletics Complex, 392 S Donahue Drive, Auburn, AL, 36849, USA
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24
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Lui PPY, Wong CM. Biology of Tendon Stem Cells and Tendon in Aging. Front Genet 2020; 10:1338. [PMID: 32010194 PMCID: PMC6976534 DOI: 10.3389/fgene.2019.01338] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022] Open
Abstract
Both tendon injuries and tendinopathies, particularly rotator cuff tears, increase with tendon aging. Tendon stem cells play important roles in promoting tendon growth, maintenance, and repair. Aged tendons show a decline in regenerative potential coupled with a loss of stem cell function. Recent studies draw attention to aging primarily a disorder of stem cells. The micro-environment (“niche”) where stem cells resided in vivo provides signals that direct them to metabolize, self-renew, differentiate, or remain quiescent. These signals include receptors and secreted soluble factors for cell-cell communication, extracellular matrix, oxidative stress, and vascularity. Both intrinsic cellular deficits and aged niche, coupled with age-associated systemic changes of hormonal and metabolic signals can inhibit or alter the functions of tendon stem cells, resulting in reduced fitness of these primitive cells and hence more frequent injuries and poor outcomes of tendon repair. This review aims to summarize the biological changes of aged tendons. The biological changes of tendon stem cells in aging are reviewed after a systematic search of the PubMed. Relevant factors of stem cell aging including cell-intrinsic factors, changes of microenvironment, and age-associated systemic changes of hormonal and metabolic signals are examined, with findings related to tendon stem cells highlighted when literature is available. Future research directions on the aging mechanisms of tendon stem cells are discussed. Better understanding of the molecular mechanisms underlying the functional decline of aged tendon stem cells would provide insight for the rational design of rejuvenating therapies.
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Affiliation(s)
| | - Chi Ming Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
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25
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Cipollaro L, Sahemey R, Oliva F, Maffulli N. Immunohistochemical features of rotator cuff tendinopathy. Br Med Bull 2019; 130:105-123. [PMID: 31093655 DOI: 10.1093/bmb/ldz016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Rotator cuff tendinopathy is a common musculoskeletal ailment in sedentary and athletic individuals. Various mediators of inflammation have been detected in human tendons: they are thought to initiate or progress the course of tendinopathy. SOURCES OF DATA An online search was conducted using AMED, CINAHL, Embase, The Cochrane Library, PEDro and Pubmed, using the terms tendinopathy, tendon, tendinitis, tendinosis, histology, histopathology, immunohistochemistry, immunohistochemical, rotator cuff and pain. AREAS OF AGREEMENT Histological examination of tendinopathic tendons shows degeneration of the collagen structure and infiltration of fat and vessels, together with increased expression of inflammatory cytokines, MMP-1, 2, 3, 9, 13, vascular endothelial growth factor and Hypoxia inducible factor (HIF). AREAS OF CONTROVERSY Most of the studies about this topic exhibited limited validity because of lack of appropriately matched controls and no inclusion or exclusion criteria. The evidence associated with the histopathological analysis of the rotator cuff is limited. GROWING POINTS The histochemical and immunohistochemical features of rotator cuff tendinopathy are still unclear. A thorough understanding of the vascularity, innervation and biochemical mediators of pain could be used to target rotator cuff pathology, and possibly guide the therapy of painful rotator cuff disorders. AREAS TIMELY FOR DEVELOPING RESEARCH There is a need for a validated reproducible method of rotator cuff tendon biopsy evaluation. We require further studies with improved designs to effectively evaluate the histological and immunohistochemical features of rotator cuff tendinopathy.
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Affiliation(s)
- Lucio Cipollaro
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Rajpreet Sahemey
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, Queen Mary University of London, London, England
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, Queen Mary University of London, London, England.,Keele University, School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, England
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26
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Li Y, Dai G, Shi L, Lin Y, Chen M, Li G, Rui Y. The Potential Roles of Tendon Stem/Progenitor Cells in Tendon Aging. Curr Stem Cell Res Ther 2019; 14:34-42. [PMID: 30332976 DOI: 10.2174/1574888x13666181017112233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/15/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022]
Abstract
Aging is a key dangerous factor for the occurrence and severity of tendon injury, but the exact cognition of the relationship is elusive at present. More previous studies suggest age-related changes occur at tendon mechanical properties, structure and composition, but the pathological alternations may be overlooked, which might be a cause for the structure and function variations, and even speed up the progress of age-related disorders. Recently, the presence of tendon stem/progenitor cells (TSPCs) would provide new insights for the pathogenesis of tendon aging. In this review, the tendon mechanical properties, structure and composition are presented in brief, then, the pathological changes of the aging tendon are described firstly, and the latest researches on alterations of TSPCs in the pathogenesis of tendon aging have also been analyzed. At a cellular level, the hypothetical model of altered TSPCs fate for tendon aging is also proposed. Moreover, the regulation of TSPCs as a potential way of the therapies for age-related tendon diseases is discussed. Therefore, reversing the impaired function of TSPCs and promoting the tenogenic differentiation of TSPCs could become hot spots for further study and give the opportunity to establish new treatment strategies for age-related tendon injuries.
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Affiliation(s)
- Yingjuan Li
- Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, 87 Ding Jia Qiao, Nanjing 210009, China.,School of Medicine, Southeast University, N0.87 Ding Jia Qiao, Nanjing 210009, China.,China Orthopedic Regenerative Medicine Group, Hangzhou, Zhejiang 310000, China
| | - Guangchun Dai
- School of Medicine, Southeast University, N0.87 Ding Jia Qiao, Nanjing 210009, China.,Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, Jiangsu 210009, China.,Orthopaedic Trauma Institute, Southeast University, Nanjing, Jiangsu 210009, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, Jiangsu 210009, China.,Orthopaedic Trauma Institute, Southeast University, Nanjing, Jiangsu 210009, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China.,Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Program of Stem Cell and Regeneration, School of Biomedical Science, and Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yucheng Lin
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, Jiangsu 210009, China.,Orthopaedic Trauma Institute, Southeast University, Nanjing, Jiangsu 210009, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China
| | - Minhao Chen
- School of Medicine, Southeast University, N0.87 Ding Jia Qiao, Nanjing 210009, China.,Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, Jiangsu 210009, China.,Orthopaedic Trauma Institute, Southeast University, Nanjing, Jiangsu 210009, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China
| | - Gang Li
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Program of Stem Cell and Regeneration, School of Biomedical Science, and Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yunfeng Rui
- School of Medicine, Southeast University, N0.87 Ding Jia Qiao, Nanjing 210009, China.,China Orthopedic Regenerative Medicine Group, Hangzhou, Zhejiang 310000, China.,Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, Jiangsu 210009, China.,Orthopaedic Trauma Institute, Southeast University, Nanjing, Jiangsu 210009, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, China
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27
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Gumina S, Villani C, Arceri V, Fagnani C, Nisticò L, Venditto T, Castagna A, Candela V. Rotator Cuff Degeneration: The Role of Genetics. J Bone Joint Surg Am 2019; 101:600-605. [PMID: 30946193 DOI: 10.2106/jbjs.18.00761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature is certain regarding the multifactorial etiology of rotator cuff degeneration. However, it remains unclear if rotator cuff degeneration exclusively depends on intrinsic and extrinsic factors or if it is also genetically determined. We compared the health status of cuff tendons, evaluated with a magnetic resonance imaging (MRI) study, between elderly monozygotic and dizygotic twins with the aim of separating the contributions of genetics from shared and unique environments. METHODS The rotator cuff tendon status was assessed using the Sugaya classification by MRI. Heritability, defined as the proportion of total variance of a specific characteristic in a particular population due to a genetic cause, was calculated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment, which contributes to twin and sibling similarity, was calculated as the difference between the monozygotic correlation coefficient and the heritability index. RESULTS We identified 33 pairs of elderly twins: 17 monozygotic pairs and 16 dizygotic pairs, with a mean age (and standard deviation) of 64.62 ± 3.32 years. The polychoric correlation was 0.62 in monozygotic twins and 0.53 in dizygotic twins. The calculated heritability index was 0.18 (18%), and the contribution was 0.44 (44%) for the shared environment and 0.38 (38%) for the unique environment. CONCLUSIONS The role of genetics in rotator cuff degeneration is quantified by our study on elderly monozygotic and dizygotic twins; however, it is only partial with respect to the contribution of shared and unique environments.
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Affiliation(s)
- Stefano Gumina
- Department of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza, University of Rome, Rome, Italy
| | - Ciro Villani
- Department of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza, University of Rome, Rome, Italy
| | - Valerio Arceri
- Shoulder and Elbow Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Corrado Fagnani
- Centre for Behavioural Sciences and Mental Health, Italian Institute of Health, Rome, Italy
| | - Lorenza Nisticò
- Centre for Behavioural Sciences and Mental Health, Italian Institute of Health, Rome, Italy
| | - Teresa Venditto
- Department of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza, University of Rome, Rome, Italy
| | | | - Vittorio Candela
- Department of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza, University of Rome, Rome, Italy
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Abstract
We begin this chapter by describing normal characteristics of several pertinent connective tissue components, and some of the basic changes they undergo with ageing. These alterations are not necessarily tied to any specific disease or disorders, but rather an essential part of the normal ageing process. The general features of age-induced changes, such as skin wrinkles, in selected organs with high content of connective or soft tissues are discussed in the next part of the chapter. This is followed by a section dealing with age-related changes in specific diseases that fall into at least two categories. The first category encompasses common diseases with high prevalence among mostly ageing populations where both genetic and environmental factors play roles. They include but may not be limited to atherosclerosis and coronary heart disease, type II diabetes, osteopenia and osteoporosis, osteoarthritis, tendon dysfunction and injury, age-related disorders of spine and joints. Disorders where genetics plays the primary role in pathogenesis and progression include certain types of progeria, such as Werner syndrome and Hutchinson-Gilford progeria belong to the second category discussed in this chapter. These disorders are characterized by accelerated signs and symptoms of ageing. Other hereditary diseases or syndromes that arise from mutations of genes encoding for components of connective tissue and are less common than diseases included in the first group will be discussed briefly as well, though they may not be directly associated with ageing, but their connective tissue undergoes some changes compatible with ageing. Marfan and Ehlers-Danlos syndromes are primary examples of such disorders. We will probe the role of specific components of connective tissue and extracellular matrix if not in each of the diseases, then at least in the main representatives of these disorders.
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Affiliation(s)
- Carolyn Ann Sarbacher
- Department of Pathology, College of Veterinary Medicine, The University of Georgia and AU/UGA Medical Partnership, Athens, GA, USA
| | - Jaroslava T Halper
- Department of Pathology, College of Veterinary Medicine, The University of Georgia and AU/UGA Medical Partnership, Athens, GA, USA.
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Effect of a Collagen-Based Compound on Morpho-Functional Properties of Cultured Human Tenocytes. Cells 2018; 7:cells7120246. [PMID: 30563214 PMCID: PMC6316559 DOI: 10.3390/cells7120246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Greater Trochanter Pain Syndrome (GTPS) is the main reason for recalcitrant lateral hip pain. Gluteus medius and minimus tendinopathy plays a key role in this setting. An injectable medical compound containing collagen type I (MD-Tissue, Guna) has been produced with the aim to counteract the physiological and pathological degeneration of tendons. In this study we aimed at characterizing the effect of this medical compound on cultured human gluteal tenocytes, focusing on the collagen turnover pathways, in order to understand how this medical compound could influence tendon biology and healing. Methods: Tenocytes were obtained from gluteal tendon fragments collected in eight patients without any gluteal tendon pathology undergoing total hip replacement through an anterior approach. Cell proliferation and migration were investigated by growth curves and wound healing assay, respectively. The expression of genes and proteins involved in collagen turnover were analysed by real-time PCR, Slot blot and SDS-zymography. Results: Our data show that tenocytes cultured on MD-Tissue, compared to controls, have increased proliferation rate and migration potential. MD-Tissue induced collagen type I (COL-I) secretion and mRNA levels of tissue inhibitor of matrix metalloproteinases (MMP)-1 (TIMP-1). Meanwhile, lysyl hydroxylase 2b and matrix metalloproteinases (MMP)-1 and -2, involved, respectively, in collagen maturation and degradation, were not affected. Conclusions: Considered as a whole, our results suggest that MD-Tissue could induce in tenocytes an anabolic phenotype by stimulating tenocyte proliferation and migration and COL-I synthesis, maturation, and secretion, thus favouring tendon repair. In particular, based on its effect on gluteal tenocytes, MD-Tissue could be effective in the discouraging treatment of GTPS. From now a rigorous clinical investigation is desirable to understand the real clinical potentials of this compound.
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Spargoli G. SUPRASPINATUS TENDON PATHOMECHANICS: A CURRENT CONCEPTS REVIEW. Int J Sports Phys Ther 2018; 13:1083-1094. [PMID: 30534473 PMCID: PMC6253746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Tendinopathy of the supraspinatus muscle is a frequent cause of shoulder pain. Although it is a common condition, the pathophysiology is not fully understood. The purpose of this clinical commentary is to provide an overview of the pathophysiology of supraspinatus tendinopathy and discuss the conservative treatment solutions. DESCRIPTION Supraspinatus tendinopathy is thought to be caused by both intrinsic, and extrinsic factors. Structural and biological changes happen when tendinopathy develops. Cellular and extracellular modifications characterize tendon healing stages that continue over time. Assessment is paramount in order to differentiate the structure involved, and to offer a proper treatment solution. RELATION TO CLINICAL PRACTICE Knowledge of the general concepts regarding the development of supraspinatus tendinopathy, and of the healing process should guide physiotherapists when proposing treatment options. Physical modalities commonly utilized for supraspinatus tendinopathy such as: laser, ultrasound, and shock-wave therapy have little and contradictory evidence. Exercise in form of eccentric training may be considered as it seems to have beneficial effects, however, more research is needed.
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Eskildsen SM, Berkoff DJ, Kallianos SA, Weinhold PS. The use of an IL1-receptor antagonist to reverse the changes associated with established tendinopathy in a rat model. Scand J Med Sci Sports 2018; 29:82-88. [PMID: 30256459 DOI: 10.1111/sms.13310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 02/04/2023]
Abstract
Interleukin-1 (IL1) is a cytokine that plays a role in inflammation and is a potential contributor to the inflammation present in tendinopathy. Its inhibition may be of use in the treatment of tendinopathy and has been a target for treatment. To evaluate how an IL1-receptor antagonist (IL1-RA) reverses pathologic changes associated with established patellar tendinopathy, we randomized 48 Sprague-Dawley retired breeder rats into three groups having weekly bilateral patellar tendon injections for 6 weeks. The control group received 0.1 mL saline for 6 weeks. The intervention groups were treated with 0.1 mL 2% carrageenan for 4 weeks. Beginning at week three, the IL1-RA group received 0.94 mg of the IL1-RA (2.5 mg/kg) added to the 0.1 mL 2% carrageenan and 0.94 mg of the IL1-RA alone for the final 2 weeks, while the CAR received 0.1 mL saline for the final 2 weeks. Animals were euthanized 6 weeks after initial injection. The CAR group demonstrated significantly (P < 0.05) shorter tendon lengths (7.81 ± 0.44 mm) than the control (8.25 ± 0.58 mm) and IL1-RA (8.34 ± 0.52 mm) group (P < 0.05). Macroscopically, plaque-like formations were reduced and margins of the tendon were more evident in the IL1-RA group compared to the CAR group. CAR group demonstrated significantly greater histopathologic changes (inflammatory cell density, disorganization of collagen, nuclear rounding, and angiogenesis) than the control and IL1-RA group. No significant difference in mechanical properties of the tendon was noted. These findings demonstrate IL1-RA can reduce pathologic changes in the patellar tendon in an established tendonitis model although did not demonstrate a difference in mechanical properties.
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Affiliation(s)
- Scott M Eskildsen
- Department of Orthopaedics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - David J Berkoff
- Department of Orthopaedics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Stephen A Kallianos
- Department of Orthopaedics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Paul S Weinhold
- Department of Orthopaedics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Cao W, Sun Y, Liu L, Wang Z, Wu JY, Qiu L, Wang YX, Yuan Y, Shen SF, Chen Q, Chen T, Zhang W, Wu CJ, Liu FX, Zhong SG, Chen L, Tong MH, Cui LG, Guo RJ. A Multicenter Large-Sample Shear Wave Ultrasound Elastographic Study of the Achilles Tendon in Chinese Adults. JOURNAL OF ULTRASOUND IN MEDICINE 2018; 38:1191-1200. [PMID: 30208234 DOI: 10.1002/jum.14797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The changes in the viscoelasticity of the Achilles tendon are related to tendinopathy. Therefore, constructing a data model in the healthy population is essential to understanding the key factors affecting the viscoelasticity of the Achilles tendon. The purpose of our research was to obtain large sample data, construct a data model, and determine parameters that affect the elastic modulus of the Achilles tendon in healthy Chinese adults. METHODS We designed a prospective multicenter clinical trial to evaluate the viscoelasticity of the Achilles tendon by using shear wave elastography. A total of 1165 healthy adult participants from 17 Chinese hospitals were recruited for the assessment. The necessary parameters (age, height, weight, and body mass index) were recorded. The elastic modulus (Young modulus) was obtained from the middle of the Achilles tendon and calculated with feet in naturally relaxed, dorsal, and plantar positions. The thickness and perimeter of the Achilles tendon were measured via cross section on the same site. A multiple linear regression was performed to find the key factors affecting the Young modulus of the Achilles tendon. RESULTS The Young modulus of the left Achilles tendon in the natural relaxed position followed a normal distribution (P > .05) with a mean ± SD of 374.24 ± 106.12 kPa. The regression equations showed a positive correlation between the Young modulus and weight and a negative correlation between the Young modulus and the circumference or thickness of the left Achilles tendon (P < .05). CONCLUSIONS The Young modulus of the Achilles tendon as measured by shear wave elastography is related to body weight as well as the perimeter or thickness of the tendon.
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Affiliation(s)
- Wen Cao
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang Sun
- Department of Ultrasound, Peking University Third Hospital, Peking University, Beijing, China
| | - Li Liu
- Department of Ultrasound, Peking University Shenzhen Hospital, Peking University, Shenzhen, China
| | - Zhu Wang
- Department of Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin Yu Wu
- Department of Ultrasound, Harbin First Hospital, Harbin, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Xiang Wang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yu Yuan
- Department of Ultrasound, Tianjin Hospital, Tianjin, China
| | - Su Fang Shen
- Department of Ultrasound, Baoding First Center Hospital, Baoding, China
| | - Qin Chen
- Department of Ultrasound, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Tao Chen
- Department of Ultrasound, Beijing Ji Shui Tan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Wen Zhang
- Department of Ultrasound, Guangdong Sports Hospital, Guangzhou, China
| | - Chang Jun Wu
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Feng Xia Liu
- Department of Ultrasound, Xiamen Fifth Hospital, Xiamen University, Xiamen, China
| | - Shi Gen Zhong
- Department of Ultrasound, Chongqing General Hospital, Chongqing, China
| | - Li Chen
- Department of Ultrasound, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ming Hui Tong
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Li Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Peking University, Beijing, China
| | - Rui Jun Guo
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Jancuska J, Matthews J, Miller T, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff. Orthop J Sports Med 2018; 6:2325967118797891. [PMID: 30320144 PMCID: PMC6154263 DOI: 10.1177/2325967118797891] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The number of systematic reviews and meta-analyses published on the rotator cuff (RC) has increased markedly. PURPOSE To quantify the number of systematic reviews and meta-analyses published on the RC and to provide a qualitative summary of the literature. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic search for all systematic reviews and meta-analyses pertaining to the RC published between January 2007 and September 2017 was performed with PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews. Narrative reviews and non-English language articles were excluded. RESULTS A total of 1078 articles were found, of which 196 met the inclusion criteria. Included articles were summarized and divided into 15 topics: anatomy and function, histology and genetics, diagnosis, epidemiology, athletes, nonoperative versus operative treatment, surgical repair methods, concomitant conditions and surgical procedures, RC tears after total shoulder arthroplasty, biological augmentation, postoperative rehabilitation, outcomes and complications, patient-reported outcome measures, cost-effectiveness of RC repair, and quality of randomized controlled trials. CONCLUSION A qualitative summary of the systematic reviews and meta-analyses published on the RC can provide surgeons with a single source of the most current literature.
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Affiliation(s)
- Jeffrey Jancuska
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - John Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Tyler Miller
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A. Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J. Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
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Connizzo BK, Grodzinsky AJ. Multiscale Poroviscoelastic Compressive Properties of Mouse Supraspinatus Tendons Are Altered in Young and Aged Mice. J Biomech Eng 2018; 140:2666618. [PMID: 29238818 PMCID: PMC5816244 DOI: 10.1115/1.4038745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/04/2017] [Indexed: 02/02/2023]
Abstract
Rotator cuff disorders are one of the most common causes of shoulder pain and disability in the aging population but, unfortunately, the etiology is still unknown. One factor thought to contribute to the progression of disease is the external compression of the rotator cuff tendons, which can be significantly increased by age-related changes such as muscle weakness and poor posture. The objective of this study was to investigate the baseline compressive response of tendon and determine how this response is altered during maturation and aging. We did this by characterizing the compressive mechanical, viscoelastic, and poroelastic properties of young, mature, and aged mouse supraspinatus tendons using macroscale indentation testing and nanoscale high-frequency AFM-based rheology testing. Using these multiscale techniques, we found that aged tendons were stiffer than their mature counterparts and that both young and aged tendons exhibited increased hydraulic permeability and energy dissipation. We hypothesize that regional and age-related variations in collagen morphology and organization are likely responsible for changes in the multiscale compressive response as these structural parameters may affect fluid flow. Importantly, these results suggest a role for age-related changes in the progression of tendon degeneration, and we hypothesize that decreased ability to resist compressive loading via fluid pressurization may result in damage to the extracellular matrix (ECM) and ultimately tendon degeneration. These studies provide insight into the regional multiscale compressive response of tendons and indicate that altered compressive properties in aging tendons may be a major contributor to overall tendon degeneration.
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Affiliation(s)
- Brianne K. Connizzo
- Department of Biological Engineering,
Massachusetts Institute of Technology,
Cambridge, MA 02139
| | - Alan J. Grodzinsky
- Department of Biological Engineering,Massachusetts Institute of Technology,
Cambridge, MA 02139;
Center for Biomedical Engineering,Massachusetts Institute of Technology,
Cambridge, MA 02139;
Department of Electrical Engineeringand Computer Science,
Massachusetts Institute of Technology,
Cambridge, MA 02139;
Department of Mechanical Engineering,Massachusetts Institute of Technology,
Cambridge, MA 02139
e-mail:
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35
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Yang B, O'Connell GD. Swelling of fiber-reinforced soft tissues is affected by fiber orientation, fiber stiffness, and lamella structure. J Mech Behav Biomed Mater 2018; 82:320-328. [PMID: 29653381 DOI: 10.1016/j.jmbbm.2018.03.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/13/2018] [Accepted: 03/29/2018] [Indexed: 01/13/2023]
Abstract
Native and engineered fiber-reinforced tissues are composites comprised of stiff collagen fibers embedded within an extrafibrillar matrix that is capable of swelling by absorbing water molecules. Tissue swelling is important for understanding stress distributions between collagen fibers and extrafibrillar matrix, as well as for understanding mechanisms of tissue failure. The swelling behavior of fiber-reinforced tissues in the musculoskeletal system has been largely attributed to the glycosaminoglycan content. Recent work demonstrated anisotropy in the swelling response of the annulus fibrosus in the intervertebral disc. It is well known that collagen fiber orientation affects elastic behavior, but the effect of collagen fiber network on tissue swelling behavior is not well understood. In this study, we developed three series of models to evaluate the effect of collagen fiber orientation, fiber network architecture (i.e., single or multi-fiber families within a layer), and fiber stiffness on bulk tissue swelling, which was simulated by describing the extrafibrillar matrix as a triphasic material, as proposed by Lai et al. Model results were within one standard deviation of reported mean values for changes in tissue volume, width, and thickness under free swelling conditions. The predicted swelling response of single-fiber family structures was highly dependent on fiber orientation and the number of lamellae in the bulk tissue. Moreover, matrix swelling resulted in tissue to twist, which reduced fiber deformations, demonstrating a balance between fiber deformation and matrix swelling. Large changes in fiber stiffness (20 × increase) had a relatively small effect on tissue swelling (~ 2% decrease in swelling). In conclusion, fiber angle, fiber architecture (defined as single- versus multiple fiber families in a layer), and the number of layers in a single fiber family structure directly affected tissue swelling behavior, including fiber stretch, fiber reorientation, and tissue deformation. These findings support the need to develop computational models that closely mimic the native architecture in order to understand mechanisms of stress distributions and tissue failure.
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Affiliation(s)
- Bo Yang
- Department of Mechanical Engineering, University of California, Berkeley, United States
| | - Grace D O'Connell
- Department of Mechanical Engineering, University of California, Berkeley, United States; Department of Orthopaedic Surgery, University of California, San Francisco, United States.
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36
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Heinemeier KM, Schjerling P, Øhlenschlæger TF, Eismark C, Olsen J, Kjær M. Carbon-14 bomb pulse dating shows that tendinopathy is preceded by years of abnormally high collagen turnover. FASEB J 2018; 32:4763-4775. [PMID: 29570396 DOI: 10.1096/fj.201701569r] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tendons are essential weight-bearing structures that are often affected by tendinopathy, which leads to pain and impaired mobility. In healthy Achilles tendons, no significant renewal of the weight-bearing collagen matrix seems to occur during adult life, but tendinopathy may lead to increased turnover. The carbon-14 ([14C]) bomb pulse method was used to measure lifelong replacement rates of collagen in tendinopathic and healthy Achilles tendons (tendinopathic: n = 25, born 1937-1972. Healthy: n = 10, born 1929-1966). As expected, the healthy tendon collagen had not been replaced during adulthood, but in tendinopathic tendon, a substantial renewal had occurred. Modeling of the [14C] data suggested that one half of the collagen in tendinopathic matrix had undergone continuous slow turnover for years before the presentation of symptoms. This finding allows for a new concept in tendon pathogenesis because it suggests that either the symptoms of tendinopathy represent a late phase of a very prolonged disease process, or an abnormally high collagen exchange could be a risk factor for tendon disorders rather than being a result of disease.-Heinemeier, K. M., Schjerling, P., Øhlenschlæger, T. F., Eismark, C., Olsen, J., Kjær, M. Carbon-14 bomb pulse dating shows that tendinopathy is preceded by years of abnormally high collagen turnover.
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Affiliation(s)
- Katja Maria Heinemeier
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schjerling
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tommy F Øhlenschlæger
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Eismark
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Olsen
- Department of Physics and Astronomy, Aarhus Accelerator Mass Spectrometry (AMS) Centre, Aarhus University, Aarhus, Denmark
| | - Michael Kjær
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Roth SP, Burk J, Schiller J, Nimptsch A. De novo synthesis of glycosaminoglycans by equine multipotent mesenchymal stromal cells in vitro – Studied by stable isotopic labeling and matrix-assisted laser desorption ionization mass spectrometry. J Carbohydr Chem 2018. [DOI: 10.1080/07328303.2018.1428988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Susanne Pauline Roth
- Faculty of Veterinary Medicine, Equine Clinic & Hospital Leipzig, Leipzig University, Leipzig, Germany
- Saxonian Incubator for Clinical Translation, Leipzig University, Leipzig, Germany
| | - Janina Burk
- Faculty of Veterinary Medicine, Equine Clinic & Hospital Leipzig, Leipzig University, Leipzig, Germany
- Faculty of Veterinary Medicine, Institute of Veterinary Physiology, Leipzig University, Leipzig, Germany
| | - Jürgen Schiller
- Leipzig University, Institute for Medical Physics and Biophysics, Leipzig, Germany
| | - Ariane Nimptsch
- Leipzig University, Institute for Medical Physics and Biophysics, Leipzig, Germany
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Gumina S, Candela V, Mariani L, Venditto T, Catalano C, Castellano S, Santilli V, Giannicola G, Castagna A. Rotator cuff degeneration of the healthy shoulder in patients with unilateral arm amputation is not worsened by overuse. Knee Surg Sports Traumatol Arthrosc 2018; 26:182-187. [PMID: 28707116 DOI: 10.1007/s00167-017-4619-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 06/19/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE In order to evaluate whether overuse has a significant role in rotator cuff tear (RCT) aetiology, we evaluated both shoulders of patients with old unilateral arm amputation expecting a higher rate of RC degeneration in the healthy side. METHODS Nineteen males and six females (mean age: 57.3 ± 10.1) with an old (>20 years) unilateral arm amputation were submitted to an MRI of both shoulders. Tendon status and muscle tropism were evaluated according to Sugaya and Fuchs classifications, respectively; the acromion humeral distance was measured. Statistical analysis was performed to verify the prevalence of Sugaya and Fuchs categories in each sides. RESULTS A significant prevalence of Sugaya type II in the amputated side (p = 0.02) and of type I in the healthy side (p < 0.001) was found. Rotator cuff was healthy in 28 and 52% of amputated and non-amputated side, respectively. The mean acromio-humeral distances of the amputated and healthy side were 0.8 cm (SD: 0.1) and 0.9 cm (SD: 0.1), respectively, (p = 0.02). A significant prevalence of Fuchs type II category in the healthy side (p < 0.001) was found. Fuchs III/IV were observed in 40 and 12% of amputated and healthy side, respectively. CONCLUSIONS The present study resizes the role of overuse on the aetiology of RCT. Cuff tear prevalence in not amputated shoulders, inevitably submitted to functional overload, was not higher than that of coetaneous subjects with two functional upper limbs. Shoulder non-use is a risk factor for rotator cuff tear. As the prevalence of rotator cuff degeneration/tear is higher in the amputee side, non-use is a more relevant risk factor than overuse. In the daily clinical practice, patients with rotator cuff tear should be encouraged to shoulder movement because rotator cuff tendon status could be worsened by disuse. LEVEL OF EVIDENCE III.
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Affiliation(s)
- S Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza, University of Rome, Rome, Italy.
| | - V Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza, University of Rome, Rome, Italy
| | - L Mariani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza, University of Rome, Rome, Italy
| | - T Venditto
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza, University of Rome, Rome, Italy
| | - C Catalano
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - V Santilli
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza, University of Rome, Rome, Italy
| | - G Giannicola
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza, University of Rome, Rome, Italy
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Gagliano N, Menon A, Cabitza F, Compagnoni R, Randelli P. Morphological and molecular characterization of human hamstrings shows that tendon features are not influenced by donor age. Knee Surg Sports Traumatol Arthrosc 2018; 26:343-352. [PMID: 28770299 DOI: 10.1007/s00167-017-4661-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/26/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE Age-related modifications of tendons, such as reduced tenocyte proliferation and modified extracellular matrix (ECM) turnover, have been previously described, but results are often incomplete and discordant. The aim of this study was to investigate, using morphological and molecular methods, the effect of ageing on human tendons and tenocytes, especially focusing on the collagen turnover pathways, in order to understand how the ageing process could influence tendon biology and structure. METHODS Morphological analysis was performed on fragments from human semitendinosus and gracilis tendons harvested from 10 adult (mean age 41.8 ± 13.3 years) and 6 aged healthy patients (mean age 72.7 ± 7.0 years) by haematoxylin and eosin, Sirius red and Alcian blue staining. The expression of genes and proteins involved in collagen turnover and focal adhesions was assessed by real-time PCR, slot blot and zymography in cultured tenocytes. Cytoskeleton arrangement was studied by immunofluorescence and cell migration by wound healing assay. RESULTS The structure and composition of ECM in ageing tendons are preserved as well as the expression of genes and proteins involved in collagen turnover pathways. Although morphological analysis revealed that ageing tenocytes tended to an impaired migration potential and that actin filaments are occasionally shorter and randomly distributed, the expression of proteins involved in focal adhesion formation is preserved. CONCLUSION Results of this study suggest that the structure of ageing tendons is preserved and that ageing tenocytes maintain their ability for ECM remodelling, supporting the hypothesis that ageing tendons maintain their biomechanical properties. The biological reliability of aged tendons has a clinical relevance, supporting the use of tendon autografts also in the elderly patients. Since the common and successful orthopaedic procedure of anterior cruciate ligament reconstruction using either autografts or allografts is becoming more common in older age groups, these findings suggest that the donor age would not significantly influence the clinical outcome.
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Affiliation(s)
- Nicoletta Gagliano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - Alessandra Menon
- 1st Department, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Federico Cabitza
- Istituto Ortopedico Galeazzi, Milan, Italy
- Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Riccardo Compagnoni
- 1st Department, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Pietro Randelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- 1st Department, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
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40
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McCreesh KM, Purtill H, Donnelly AE, Lewis JS. Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy: potential implications for exercise therapy. BMJ Open Sport Exerc Med 2017; 3:e000279. [PMID: 29333279 PMCID: PMC5759726 DOI: 10.1136/bmjsem-2017-000279] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 12/29/2022] Open
Abstract
Background/aim Exercise imparts a load on tendon tissue that leads to changes in tendon properties. Studies suggest that loading immediately reduces tendon thickness, with a loss of this response in symptomatic tendinopathy. No studies investigating the response of tendon dimensions to load for the rotator cuff tendons exist. This study aimed to examine the short-term effect of loading on the thickness of the supraspinatus tendon and acromiohumeral distance those with and without rotator cuff tendinopathy. Methods Participants were 20 painfree controls, and 23 people with painful rotator cuff tendinopathy. Supraspinatus tendon thickness and acromiohumeral distance were measured using ultrasound scans before, and at three time points after loading (1, 6 and 24 hours). Loading involved isokinetic eccentric and concentric external rotation and abduction. Results There was a significant increase in supraspinatus tendon thickness in the pain group at 1 (7%, ∆=0.38, 95% CI 0.19 to 0.57) and 6 hours (11%, ∆=0.53, 95% CI 0.34 to 0.71), although only the 6 hours difference exceeded minimal detectable difference. In contrast, there was a small non-significant reduction in thickness in controls. The acromiohumeral distance reduced significantly in both groups at 1 hour (controls: ∆=0.64, 95% CI 0.38 to 0.90; pain: ∆=1.1, 95% CI 0.85 to 1.33), with a larger change from baseline in the pain group. Conclusion Those diagnosed with painful supraspinatus tendinopathy demonstrated increased thickening with delayed return to baseline following loading. Rehabilitation professionals may need to take into account the impact of loading to fatigue when planning rehabilitation programmes.
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Affiliation(s)
- Karen M McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Helen Purtill
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Alan E Donnelly
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland
| | - Jeremy S Lewis
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.,Department of Musculoskeletal Services, Central London Community Healthcare NHS Trust, London, UK.,Department of Allied Health Professions, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
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41
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Musculoskeletal Injuries and Regenerative Medicine in the Elderly Patient. Phys Med Rehabil Clin N Am 2017; 28:777-794. [DOI: 10.1016/j.pmr.2017.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Oliveira LP, Vieira CP, Marques PP, Pimentel ER. Do different tendons exhibit the same response following chronic exposure to statins? Can J Physiol Pharmacol 2017; 95:333-339. [PMID: 28112540 DOI: 10.1139/cjpp-2016-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over the past few years, a number of cases of tendon injuries associated with statin therapy have been reported. In this study, we assessed whether statins can affect the extracellular matrix (ECM) of the deep digital flexor tendon (DDFT) and patellar tendon (PT). Wistar rats were assigned to groups treated with atorvastatin (A20, A80), treated with simvastatin (S20, S80), and control. Zymography, Western blotting for collagen I, non-collagenous proteins (NCP), glycosaminoglycans (GAGs), and hydroxyproline quantifications were performed. DDFT findings: NCP were increased in A20 and A80; higher concentration of hydroxyproline was found in S80; levels of GAGs was increased in all statin-treated groups; collagen I was increased in S80 and pro-MMP-2 activity was reduced in A80, S20, and S80. PT findings: NCP were reduced in A20, A80, and S80; GAGs was reduced in A80 and S20; collagen I was increased in A20 and pro-MMP-2 activity was reduced in the S20. Both the statins provoked marked changes in both tendons. All these changes may make the tendons more prone to microdamage and ruptures. Therefore, a better understanding of the behavior of the tendon ECM components under statin therapy may provide important insights into the mechanisms behind statin-induced tendon injuries.
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Affiliation(s)
- L P Oliveira
- a Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - C P Vieira
- b Department of Pharmacology, Medical Sciences College, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - P P Marques
- c Department of Biochemistry, Federal University of Alfenas - Unifal, Alfenas, MG, Brazil
| | - E R Pimentel
- a Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Campinas, SP, Brazil
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Choi RK, Smith MM, Martin JH, Clarke JL, Dart AJ, Little CB, Clarke EC. Chondroitin sulphate glycosaminoglycans contribute to widespread inferior biomechanics in tendon after focal injury. J Biomech 2016; 49:2694-2701. [PMID: 27316761 DOI: 10.1016/j.jbiomech.2016.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/28/2016] [Accepted: 06/01/2016] [Indexed: 11/24/2022]
Abstract
Both mechanical and structural properties of tendon change after injury however the causal relationship between these properties is presently unclear. This study aimed to determine the extent of biomechanical change in post-injury tendon pathology and whether the sulphated glycosaminoglycans (glycosaminoglycans) present are a causal factor in these changes. Equine superficial digital flexor tendons (SDF tendons) were surgically-injured in vivo (n=6 injured, n=6 control). Six weeks later they were harvested and regionally dissected into twelve regions around the lesion (equal medial/lateral, proximal/distal). Glycosaminoglycans were removed by enzymatic (chondroitinase) treatment. Elastic modulus (modulus) and ultimate tensile strength (UTS) were measured under uniaxial tension to failure, and tendon glycosaminoglycan content was measured by spectrophotometry. Compared to healthy tendons, pathology induced by the injury decreased modulus (-38%; 95%CI -49% to -28%; P<0.001) and UTS (-38%; 95%CI -48% to -28%; P<0.001) and increased glycosaminoglycan content (+52%; 95%CI 39% - 64%; P<0.001) throughout the tendon. Chondroitinase-mediated glycosaminoglycan removal (50%; 95%CI 21-79%; P<0.001) in surgically-injured pathological tendons caused a significant increase in modulus (5.6MPa/µg removed; 95%CI 0.31-11; P=0.038) and UTS (1.0MPa per µg removed; 95%CI 0.043-2; P=0.041). These results demonstrate that the chondroitin/dermatan sulphate glycosaminoglycans that accumulate in pathological tendon post-injury are partly responsible for the altered biomechanical properties.
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Affiliation(s)
- Rachel K Choi
- Murray Maxwell Biomechanics Laboratory (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia; Raymond Purves Bone and Joint Research Laboratories (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia
| | - Margaret M Smith
- Raymond Purves Bone and Joint Research Laboratories (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia
| | - Joshua H Martin
- Murray Maxwell Biomechanics Laboratory (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia
| | - Jillian L Clarke
- Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - Andrew J Dart
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney, Camden, New South Wales, Australia
| | - Christopher B Little
- Raymond Purves Bone and Joint Research Laboratories (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia.
| | - Elizabeth C Clarke
- Murray Maxwell Biomechanics Laboratory (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia
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A Structural and Mechanism-Based Perspective Toward Understanding Pediatric and Adult Sports Injuries. AJR Am J Roentgenol 2016; 206:980-6. [DOI: 10.2214/ajr.15.15937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tosun HB, Gümüştaş SA, Kom M, Uludağ A, Serbest S, Eröksüz Y. The Effect of Sodium Hyaluronate plus Sodium Chondroitin Sulfate Solution on Peritendinous Adhesion and Tendon Healing: An Experimental Study. Balkan Med J 2016; 33:258-66. [PMID: 27308069 DOI: 10.5152/balkanmedj.2016.140172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 09/16/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adhesion formation following tendon injury is a serious clinical problem. AIMS In this experimental study, the effects of the combination of sodium hyaluronate (HA) and chondroitin sulfate (CS) on peritendinous adhesion and tendon healing were evaluated. STUDY DESIGN Animal experimentation. METHODS Twenty-one mature Sprague Dawley male rats were randomly divided into three equal groups. The rats' Achilles tendons were cut and repaired with a modified Kessler technique. About 0.25 and 0.50 mL of the HA and CS (HA+CS) combination were injected subcutaneously into the repair site of the rats in groups 1 and 2, respectively, on days 0, 3, 7, and 10. The subjects in group 3 were used as the control group. At 6 weeks, all rats were euthanized. The tenotomy site was examined macroscopically in all animal subjects. Four samples were assigned to the histopathological examination group, and the others were assigned to the biomechanical assessment group. RESULTS Inflammation and adhesion in both treatment groups were observed at a lower rate than in the control group. The collagen filaments in both treatment groups were regular and the number was low when compared to the control group. However, there was no statistically significant difference between group 1 and the control group. The quantity, quality, and grade of the adhesions were statistically significantly lower in group 2 when compared with the other groups. The mean maximum stress strength in group 2 was statistically significantly higher than that in group 1 and the control group. CONCLUSION Local administration of the HA+CS combination solution is a valid tool for preventing peritendinous adhesion after extrasynovial tendon repair such as Achilles tendon, and is a treatment option in such cases.
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Affiliation(s)
- Hacı Bayram Tosun
- Department of Orthopaedics and Traumatology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Seyit Ali Gümüştaş
- Department of Orthopaedics and Traumatology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Mustafa Kom
- Department of Surgery, Fırat University School of Veterinary Medicine, Elazığ, Turkey
| | - Abuzer Uludağ
- Department of Orthopaedics and Traumatology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Sancar Serbest
- Department of Orthopaedic Surgery, İnegöl State Hospital, Bursa, Turkey
| | - Yesari Eröksüz
- Department of Pathology, Fırat University School of Veterinary Medicine, Elazığ, Turkey
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Berkoff DJ, Kallianos SA, Eskildsen SM, Weinhold PS. Use of an IL1-receptor antagonist to prevent the progression of tendinopathy in a rat model. J Orthop Res 2016; 34:616-22. [PMID: 26418607 DOI: 10.1002/jor.23057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/09/2015] [Indexed: 02/04/2023]
Abstract
This study evaluated if inhibiting IL1-β activity with an IL1-receptor antagonist (IL1-RA) will prevent pathologic changes commonly seen in tendinopathy. Thirty-six Sprague-Dawley retired-breeder rats were divided into three groups having weekly bilateral patellar tendon injections: CON (0.1 ml Saline), CAR (0.1 ml 2% carrageenan), IL1-RA (0.1 ml 2% CAR plus 0.94 mg of the IL1-RA, 2.5 mg/kg). Carrageenan was used to establish tendinopathy in two groups due to its ability to develop tendinopathy in prior studies. Animals were euthanized 3 weeks after initial injection. The CAR group demonstrated significantly (p < 0.05) shorter tendon lengths (8.61 ± 0.38 mm) relative to CON (8.94 ± 0.38 mm) that was prevented in the IL1-RA (9.02 ± 0.30 mm) as well as significantly increased collagenase activity in the CAR (0.061 ± 0.043) compared to CON (0.027 ± 0.015) (p< 0.05). By histological evaluation, the CAR group demonstrated significantly greater inflammation than IL1-RA, and CON (p < 0.05). CAR showed a trend for increased cross-sectional area relative to CON that was absent in the IL1-RA. IL1-RA can effectively inhibit the development of mechanical, chemical, and histologic changes seen with carrageenan-induced tendonitis.
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Affiliation(s)
- David J Berkoff
- Department of Orthopaedics, University of North Carolina-Chapel Hill, North Carolina UNC
| | - Steven A Kallianos
- Department of Orthopaedics, University of North Carolina-Chapel Hill, North Carolina UNC
| | - Scott M Eskildsen
- Department of Orthopaedics, University of North Carolina-Chapel Hill, North Carolina UNC
| | - Paul S Weinhold
- Department of Orthopaedics, University of North Carolina-Chapel Hill, North Carolina UNC
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Influence of Ageing on Tendon Homeostasis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 920:247-60. [DOI: 10.1007/978-3-319-33943-6_24] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Tendon Stem Cells: Mechanobiology and Development of Tendinopathy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 920:53-62. [DOI: 10.1007/978-3-319-33943-6_5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Salini V, Vanni D, Pantalone A, Abate M. Platelet Rich Plasma Therapy in Non-insertional Achilles Tendinopathy: The Efficacy is Reduced in 60-years Old People Compared to Young and Middle-Age Individuals. Front Aging Neurosci 2015; 7:228. [PMID: 26696880 PMCID: PMC4674567 DOI: 10.3389/fnagi.2015.00228] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/23/2015] [Indexed: 12/15/2022] Open
Abstract
Background: Platelet Rich Plasma (PRP) has shown positive and long-lasting effects in patients with tendinopathies. However, information about age-related differences in the clinical outcome is limited. Aim of this retrospective study was to compare the efficacy of PRP therapy in young and elderly subjects suffering for Achilles tendinopathy. Materials and method: Patients with recalcitrant non-insertional Achilles tendinopathy were enrolled. Clinical (VISA-A) and instrumental (ultrasonography) data were collected at baseline and after 1, 3, 6, and 12 months. PRP injections (once a week for 3 weeks) were performed in sterile conditions and under ultrasound (US) control. Results: Forty-four subjects (29 young: mean age 39.5 ± 6.9; 15 elderly: mean age 61.5 ± 5.3) were retrospectively evaluated. At baseline, no significant differences were observed in the clinical and US parameters. Throughout the whole length of the study, a significant increase of VISA-A score was seen in both groups (from 50.3 ± 8.8 to 76.1 ± 6.6 in the young group, and from 48.7 ± 7.6 to 61.1 ± 9.4 in the elderly group); however, the infra-groups comparison showed better results in young patients, compared to the aged counterpart. Conclusion: Our results show that PRP is less effective in aged people. This finding can be ascribed to several biochemical and biomechanical differences documented in tendons of young and elderly subjects (reduced number and functionality of tenocytes and tenoblasts), which becomes more evident in the long-term tissue healing. However, prospective trials, using different PRP preparations and enrolling a larger number of subjects, are needed to draw more sound and definitive conclusions.
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Affiliation(s)
- Vincenzo Salini
- Orthopaedic and Traumatalogical Clinic, Department of Medicine and Science of Aging, Università degli Studi "G. d'Annunzio" Chieti-Pescara Chieti, Italy
| | - Daniele Vanni
- Orthopaedic and Traumatalogical Clinic, Department of Medicine and Science of Aging, Università degli Studi "G. d'Annunzio" Chieti-Pescara Chieti, Italy
| | - Andrea Pantalone
- Orthopaedic and Traumatalogical Clinic, Department of Medicine and Science of Aging, Università degli Studi "G. d'Annunzio" Chieti-Pescara Chieti, Italy
| | - Michele Abate
- Orthopaedic and Traumatalogical Clinic, Department of Medicine and Science of Aging, Università degli Studi "G. d'Annunzio" Chieti-Pescara Chieti, Italy
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50
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Gumina S, Arceri V, Fagnani C, Venditto T, Catalano C, Candela V, Nisticò L. Subacromial Space Width: Does Overuse or Genetics Play a Greater Role in Determining It? An MRI Study on Elderly Twins. J Bone Joint Surg Am 2015; 97:1647-52. [PMID: 26491128 DOI: 10.2106/jbjs.o.00379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Age and peripheral microcirculation disorders are the main causes of rotator cuff degeneration. Acromion variants may affect subacromial space width, causing a pathological narrowing of the space that may compromise the cuff integrity. However, it is not clear if the subacromial space width is genetically determined or if it changes according to loading conditions. To clarify this unresolved question, we performed an MRI (magnetic resonance imaging) study with the aim of evaluating the acromiohumeral distance in a group of elderly monozygotic and dizygotic twins, and we analyzed the obtained data using the twin design to separate the contributions of shared and unique environments. METHODS We identified twenty-nine pairs of elderly twins. On MRI scans, we evaluated the acromiohumeral distance and health status of the rotator cuff tendons. Heritability, defined as the proportion of total variance of a specific characteristic in a particular population due to a genetic cause, was estimated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment, due to environmental factors that contribute to twin and sibling similarity, was calculated as the difference between the monozygotic correlation coefficient and the heritability index. One-way ANOVA (analysis of variance) was used to estimate the differences among job categories, both in the total cohort and within zygosity groups. RESULTS The intraclass correlation coefficient was substantially higher for monozygotic than for dizygotic twins, indicating a high degree of concordance of the acromiohumeral distance in pairs of individuals who shared 100% of their genes. The heritability index was 0.82, and shared and unique environmental contributions were both 0.09. There were no significant differences among subjects in different job categories, either in the total cohort (p = 0.685) or within the monozygotic (p = 0.719) and dizygotic groups (p = 0.957). CONCLUSIONS The acromiohumeral distance is mainly genetically determined and only marginally influenced by external factors.
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Affiliation(s)
- S Gumina
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - V Arceri
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - C Fagnani
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. E-mail address:
| | - T Venditto
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - C Catalano
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - V Candela
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - L Nisticò
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. E-mail address:
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