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Xiang Y, Hu X, Yang X, Wang G, Li Y, Sun F, Song E. Andrographolide suppresses fibrogenic phenotype of chondrocytes and ameliorates osteoarthritis by regulating miR-137/BMP7 axis. J Orthop 2025; 64:108-116. [PMID: 39691644 PMCID: PMC11648649 DOI: 10.1016/j.jor.2024.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 11/19/2024] [Accepted: 11/23/2024] [Indexed: 12/19/2024] Open
Abstract
Background Pathogenic degeneration of cartilage and the generation of fibrotic cartilage are crucial characteristics linked to the progression of osteoarthritis (OA). The current research aims to explore the potential function of the miR-137/BMP7 pathway in regulating the fibrogenic transition of chondrocytes associated with OA, as well as assess the therapeutic potential of andrographolide. Methods Samples of cartilage from the knees of patients with OA and individuals without OA were gathered to investigate the expression patterns of miR-137, BMP7, and markers associated with fibrosis. A cell model using primary chondrocytes stimulated with interleukin (IL)-1β was developed to study the involvement of the miR-137/BMP7 axis during the fibrogenic transition of these cells. Additionally, we utilized an animal model of OA in order to assess the beneficial effects of the anti-inflammatory natural compound andrographolide on the fibrogenesis induced by OA in vivo. Results Elevated levels of fibrogenic and inflammatory factors were linked to decreased miR-137 expression in OA samples. In IL-1β-treated chondrocytes, there was an upregulation of fibrogenic markers alongside a reduction in miR-137 levels. The overexpression of miR-137 inhibited fibrogenesis through the negative regulation of BMP7. Additionally, treatment with andrographolide was effective in attenuating the fibrogenic phenotype in chondrocytes and mitigating OA pathogenesis via modulating the miR-137/BMP7 pathway. Conclusion miR-137 downregulation and BMP7 overexpression might contribute to the fibrogenic features in OA-related chondrocytes. Andrographolide attenuates fibrogenic phenotype in chondrocytes and alleviates the severity of OA by modulating the miR-137/BMP7 axis.
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Affiliation(s)
- Yaoyu Xiang
- Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Xidan Hu
- Clinical Pharmacy Center, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Xianguang Yang
- Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Guoliang Wang
- Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Yanlin Li
- Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Fei Sun
- Department of Orthopedics, Traditional Chinese Medicine Hospital of Luliang County, Qujing, 655602, Yunnan, China
| | - En Song
- Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
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Kanayama T, Takata Y, Ishida Y, Takemoto N, Nishimura M, Demura S, Nakase J. Changes in the position of the medial meniscus owing to degenerative meniscus tears. Asia Pac J Sports Med Arthrosc Rehabil Technol 2025; 40:7-11. [PMID: 39911311 PMCID: PMC11791009 DOI: 10.1016/j.asmart.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 12/20/2024] [Accepted: 01/12/2025] [Indexed: 02/07/2025] Open
Abstract
Background While meniscal extrusion has been recognized as a key factor in meniscal dysfunction and osteoarthritis (OA) development, the specific movement of the posterior horn of the medial meniscus (MM) during extrusion, particularly in early-stage OA, remains unexplored. Therefore, in this study, we investigated the position of the MM in patients with medial knee pain and a Kellgren-Lawrence grade ≤1, investigating the relationship between meniscal extrusion and degenerative tears. We hypothesized that the MM extrusion (MME) would be larger when degenerative tears are present; the anterior horn would move posteriorly, and the posterior horn would move anteriorly, accordingly. Methods A total of 181 knees (mean age 61.7 ± 12.1 years; 97 men and 84 women) were included. Simple radiographs were used to measure the weight-bearing line ratio and medial proximal tibia angle. Magnetic resonance imaging was used to measure the medial proximal tibia slope, medial meniscus extrusion, anterior and posterior horn position, and degenerative tears on the posterior segment of the medial meniscus. Those with degenerative tears were designated as group T and those without were designated as group C. Student's t-test and Pearson's χ2 test were performed to compare groups T and C. Statistical significance was set at p < 0.05. Results Group T had a significantly larger medial posterior tibial slope (group T: 7.4 ± 2.3°; group C: 6.6 ± 2.2°, p = 0.010) and medial meniscus extrusion (group T: 2.7 ± 1.4 mm; group C: 1.9 ± 1.2 mm, p < 0.001) scores compared with group C. Furthermore, the posterior point of the anterior horn (group T: 16.3 ± 5.0 %; group C: 14.3 ± 3.8 %, p = 0.004) and anterior point of the posterior horn (group T: 36.4 ± 7.1 %; group C:26.9 ± 5.9 %, p < 0.001) were significantly larger in group T than in group C. Conclusion Degenerative MM tears cause not only MME but also an anteroposterior shift.
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Affiliation(s)
- Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Yasushi Takata
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Yoshihiro Ishida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Naoki Takemoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Manase Nishimura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Satoru Demura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
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Asadikorayem M, Weber P, Zhang S, Surman F, Fercher D, Fonti M, Bevc K, Kauppinen S, Frondelius T, Finnilä MAJ, Zenobi-Wong M. In-situ-forming zwitterionic hydrogel does not ameliorate osteoarthritis in vivo, despite protective effects ex vivo. BIOMATERIALS ADVANCES 2025; 169:214151. [PMID: 39700642 DOI: 10.1016/j.bioadv.2024.214151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 12/11/2024] [Accepted: 12/12/2024] [Indexed: 12/21/2024]
Abstract
Osteoarthritis (OA) is one of the most common degenerative joint diseases, with no effective therapeutic options available. In this study, we aimed to develop an interpenetrating, in-situ-forming hydrogel based on biocompatible and anti-fouling zwitterionic (ZI) polymers for early-stage OA treatment. We hypothesized that the anti-fouling properties of zwitterions could provide tissue protection, and the high charge density of these polymers would enhance tissue penetration and lubrication. The hydrogel comprises carboxybetaine acrylamide as the ZI backbone and tyramine acrylamide as a functional comonomer to enable enzymatic and tissue-adhesive crosslinking. The hydrogel demonstrated exceptional tissue penetration and long-term retention in bovine cartilage explants. Moreover, hydrogel application protected cartilage in inflammatory media, enhanced lubrication, and decreased permeability. However, ZI hydrogel injection in collagenase-induced osteoarthritis model in rats did not prevent cartilage degeneration, and similar levels of tissue degradation and surface roughness were observed in rats injected with the ZI hydrogel and in OA controls. Additionally, ZI polymer without in-situ crosslinking resulted in increased cartilage degradation compared to both hydrogel and OA control. Furthermore, synovial tissue inflammation and significantly increased immune cell infiltration were observed in response to ZI materials. This study highlights the potential immunogenicity effect of ZI polymers in our disease model, contributing to impaired protective effects as well as exacerbated degeneration.
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Affiliation(s)
- Maryam Asadikorayem
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, Otto-Stern-Weg 7, 8093 Zürich, Switzerland
| | - Patrick Weber
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, Otto-Stern-Weg 7, 8093 Zürich, Switzerland
| | - Shipin Zhang
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, Otto-Stern-Weg 7, 8093 Zürich, Switzerland
| | - František Surman
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, Otto-Stern-Weg 7, 8093 Zürich, Switzerland
| | - David Fercher
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, Otto-Stern-Weg 7, 8093 Zürich, Switzerland
| | - Marina Fonti
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, Otto-Stern-Weg 7, 8093 Zürich, Switzerland
| | - Kajetana Bevc
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, Otto-Stern-Weg 7, 8093 Zürich, Switzerland
| | - Sami Kauppinen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, 90220 Oulu, Finland
| | - Tuomas Frondelius
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, 90220 Oulu, Finland
| | - Mikko A J Finnilä
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, 90220 Oulu, Finland; Biocenter Oulu, University of Oulu, Aapistie 5A, 90220 Oulu, Finland
| | - Marcy Zenobi-Wong
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, Otto-Stern-Weg 7, 8093 Zürich, Switzerland.
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Qiu H, Pan G, Mao X, Cai X, Song L, Shao L, Mao H, Wang R, Xiong D. A shear-responsive and lubricating hyaluronic acid-chondroitin sulfate-decellularized matrix hydrogel for articular cartilage regeneration. Carbohydr Polym 2025; 352:123171. [PMID: 39843076 DOI: 10.1016/j.carbpol.2024.123171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 11/26/2024] [Accepted: 12/17/2024] [Indexed: 01/06/2025]
Abstract
The high-dynamic, high-loading environment in the joint cavity puts urgent demands on the cartilage regenerative materials with shear responsiveness and lubrication. Here, a new type of injectable hydrogel composed of oxidized hyaluronic acid (OHA), adipic dihydrazide-grafted hyaluronic acid (HA-ADH), oxidized chondroitin sulfate (OChs), and decellularized extracellular matrix methacrylate (dECMMA) was fabricated. The aldehyde groups in OHA and OChs reacted with the amino groups in HA-ADH to form a dynamic hydrogel, which was then covalently crosslinked with dECMMA to create a dual-crosslinked hydrogel with sufficient mechanical strength. This hydrogel possesses injectability and self-healing capabilities, making it suitable for use in the dynamic and high-frequency loading environment of joint cartilage. dECMMA fibers in this hydrogel could be oriented and aligned under certain shear forces, together with the biopolymers, giving the hydrogel lubricity and low strain-liquid transition properties that do not interfere with the daily mobility of the joint. In vitro and in vivo experiments showed that the hydrogel has sufficient tissue adhesion and excellent biocompatibility, promotes chondrocyte migration, and induces stem cell differentiation. The animal experiments demonstrated that the hydrogel promoted cartilage repair, and the lubricating effect of the newborn cartilage was close to that of normal cartilage.
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Affiliation(s)
- Haofeng Qiu
- School of Materials Science and Engineering, Nanjing University of Science & Technology, Nanjing 210094, PR China; Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, PR China; Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, PR China
| | - Gaoke Pan
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, PR China; Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, PR China; School of Medicine, Ningbo University, Ningbo 315211, PR China
| | - Xufeng Mao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315010, PR China
| | - Ximing Cai
- School of Materials Science and Engineering, Nanjing University of Science & Technology, Nanjing 210094, PR China
| | - Lei Song
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, PR China; Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, PR China
| | - Lei Shao
- School of Medicine, Ningbo University, Ningbo 315211, PR China
| | - Haijiao Mao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315010, PR China.
| | - Rong Wang
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, PR China; Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, PR China.
| | - Dangsheng Xiong
- School of Materials Science and Engineering, Nanjing University of Science & Technology, Nanjing 210094, PR China.
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Tanaka S, Shinonaga A, Tsuru T, Sato Y, Taguchi M, Igarashi M, Takane R, Robbins SM. Pain Catastrophizing Is Associated With Health-Related Quality of Life in Patients With Hip Osteoarthritis: A Multicenter Cross-Sectional Study. Musculoskeletal Care 2025; 23:e70034. [PMID: 39739373 DOI: 10.1002/msc.70034] [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: 12/06/2024] [Revised: 12/06/2024] [Accepted: 12/16/2024] [Indexed: 01/02/2025]
Abstract
OBJECTIVE This study aimed to examine the relationship between pain catastrophizing (PC) and health-related quality of life (HRQoL), while accounting for pain intensity and other factors in patients with hip osteoarthritis (OA). METHODS This multicenter, cross-sectional study included a total of 160 participants and was conducted at five hospitals in Japan. The primary outcome was the HRQoL status, which was assessed using the Japanese version of the 12-item Short Form. Physical (PCS-12) and mental (MCS-12) component summary scores were used as dependent variables. Age, sex, body mass index (BMI), affected side, hip OA severity, bilateral range of motion (ROM), muscle strength, pain intensity, and PC scale scores were measured as independent variables. After screening, multiple regression analysis was performed for each outcome. RESULTS Higher BMI (β = -0.17, p < 0.05), higher hip flexion ROM on the unaffected side (β = -0.26, p < 0.05), lower hip flexion ROM on the affected side (β = 0.22, p < 0.05) and higher PC scale score (β = -0.28, p < 0.05) were associated with worse PCS-12. In addition, higher BMI (β = -0.18, p < 0.05) and higher PC scale scores (β = -0.29, p < 0.05) were associated with worse MCS-12 after accounting for confounding factors. CONCLUSION This study suggested that PC is an issue in patients with hip OA and is a potential target for interventions aimed at improving HRQoL.
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Affiliation(s)
- Shigeharu Tanaka
- Physical Therapy Major, Department of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Sayama, Japan
| | - Atsushi Shinonaga
- Rehabilitation Center, Kawasaki Geriatric Medical Center, Okayama, Japan
| | - Takashi Tsuru
- Department of Rehabilitation, Suita Municipal Hospital, Suita, Japan
| | - Yuya Sato
- Department of Rehabilitation, Konan Kakogawa Hospital, Kakogawa, Japan
| | - Masahiro Taguchi
- Rehabilitation, Ishii-kai medical corp., Ishii hospital, Isesaki, Japan
| | - Masashi Igarashi
- Rehabilitation, Ishii-kai medical corp., Ishii hospital, Isesaki, Japan
| | - Ryosuke Takane
- Department Physical Therapy, Japanese Red Cross Society Wakayama Medical Center of Rehabilitation, Wakayama, Japan
| | - Shawn M Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Bradley PX, Kim-Wang SY, Blaisdell BS, Riofrio AD, Collins AT, Heckelman LN, Obunadike EC, Widmyer MR, Paranjape CS, Crook BS, Lad NK, Sutter EG, Mann BP, Spritzer CE, DeFrate LE. Tibiofemoral cartilage strain and recovery following a 3-mile run measured using deep learning segmentation of bone and cartilage. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100556. [PMID: 39802079 PMCID: PMC11720442 DOI: 10.1016/j.ocarto.2024.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 12/02/2024] [Indexed: 01/16/2025] Open
Abstract
Objective We sought to measure the deformation of tibiofemoral cartilage immediately following a 3-mile treadmill run, as well as the recovery of cartilage thickness the following day. To enable these measurements, we developed and validated deep learning models to automate tibiofemoral cartilage and bone segmentation from double-echo steady-state magnetic resonance imaging (MRI) scans. Design Eight asymptomatic male participants arrived at 7 a.m., rested supine for 45 min, underwent pre-exercise MRI, ran 3 miles on a treadmill, and finally underwent post-exercise MRI. To assess whether cartilage recovered to its baseline thickness, participants returned the following morning at 7 a.m., rested supine for 45 min, and underwent a final MRI session. These images were used to generate 3D models of the tibia, femur, and cartilage surfaces at each time point. Site-specific tibial and femoral cartilage thicknesses were measured from each 3D model. To aid in these measurements, deep learning segmentation models were developed. Results All trained deep learning models demonstrated repeatability within 0.03 mm or approximately 1 % of cartilage thickness. The 3-mile run induced mean compressive strains of 5.4 % (95 % CI = 4.1 to 6.7) and 2.3 % (95 % CI = 0.6 to 4.0) for the tibial and femoral cartilage, respectively. Furthermore, both tibial and femoral cartilage thicknesses returned to within 1 % of baseline thickness the following day. Conclusions The 3-mile treadmill run induced a significant decrease in both tibial and femoral cartilage thickness; however, this was largely ameliorated the following morning.
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Affiliation(s)
- Patrick X. Bradley
- Department of Mechanical Engineering and Materials Science, Duke University, United States
| | - Sophia Y. Kim-Wang
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | | | - Alexie D. Riofrio
- Department of Radiology, Duke University School of Medicine, United States
| | - Amber T. Collins
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Lauren N. Heckelman
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Eziamaka C. Obunadike
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Margaret R. Widmyer
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Chinmay S. Paranjape
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Bryan S. Crook
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Nimit K. Lad
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Edward G. Sutter
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Brian P. Mann
- Department of Mechanical Engineering and Materials Science, Duke University, United States
| | - Charles E. Spritzer
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
- Department of Radiology, Duke University School of Medicine, United States
| | - Louis E. DeFrate
- Department of Mechanical Engineering and Materials Science, Duke University, United States
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
- Department of Biomedical Engineering, Duke University, United States
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Imamura R, Teramoto A, Murahashi Y, Okada Y, Okimura S, Akatsuka Y, Watanabe K, Yamashita T. Ultra-Short Echo Time-MRI T2* Mapping of Articular Cartilage Layers Is Associated with Histological Early Degeneration. Cartilage 2025; 16:118-124. [PMID: 37846091 PMCID: PMC11744601 DOI: 10.1177/19476035231205685] [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: 09/13/2022] [Revised: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Ultra-short TE (UTE) sequences on MRI are a technique that improves the visualization of tissues with short T2 relaxation time, such as deep cartilage layers. In addition, T2* relaxation time calculated from the UTE has the potential to evaluate water molecules bound to the cartilage matrix. This study was performed to determine if there is an association between UTE-T2* relaxation time by cartilage layer and histological degeneration in knee osteoarthritis (OA). DESIGN Seven knees that had undergone total knee arthroplasty (TKA) were included in the study, and the lateral tibial cartilage, which had the least degeneration of the resected bones, was used as the sample. The T2* relaxation time of 4 patients with no abnormal findings on MRI was the reference relaxation time. Histological degeneration of TKA samples was assessed by the Mankin score and graded as the early OA group (≤3 points) and the advanced OA group (≥4 points). The association between T2* relaxation time and Mankin grade in each cartilage layer was compared. The effect of angiogenesis to the tidemark on T2* relaxation time was also compared. RESULTS T2* relaxation time of the cartilage layer was significantly longer in early OA than that in the control group. In the deep cartilage layer, the mean T2* relaxation time for angiogenesis (-) was 15.7 ms, whereas it was significantly shorter for angiogenesis (+) at 8.2 ms. CONCLUSIONS The UTE-T2* relaxation time was associated with histological cartilage degeneration, suggesting a potential application in monitoring early cartilage degeneration.
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Affiliation(s)
- Rui Imamura
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yasutaka Murahashi
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Shinichiro Okimura
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yoshihiro Akatsuka
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
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8
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Jacobs CA, Jones MH, Collins JE, Waddell LM, Li X, Winalski CS, Pietrosimone B, Kraus VB, Otero M, Wellsandt E, Schmitt LC, Spindler KP, Anderson DD, Rodeo SA, Magnussen RA, Wolf BR, Hart JM, Stone AV, Conley CE, Golightly YM, Myer GD, Snyder-Mackler L, Lotz MK, Kim JS, McLeod MM, Huebner JL, Lisee C, Selzer F, Katz JN, Long K, Frier KC, Betensky DJ, Felson DT, Losina E. The PIKASO trial (Preventing Injured Knees from Osteoarthritis: Severity Outcomes): Rationale and design features for a randomized controlled trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100563. [PMID: 39867299 PMCID: PMC11758201 DOI: 10.1016/j.ocarto.2024.100563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 12/16/2024] [Indexed: 01/28/2025] Open
Abstract
Objective Given the high burden and increasing prevalence of post-traumatic osteoarthritis (PTOA), identifying clinically beneficial strategies to prevent or delay its onset could improve the quality of life of those at high risk of developing the disease. Methods Preventing Injured Knees from OsteoArthritis: Severity Outcomes (PIKASO) is a multicenter blinded, parallel, two-arm randomized controlled trial of 512 individuals aged 18-45 years undergoing anterior cruciate ligament reconstruction (ACLR). This study is designed to evaluate the efficacy of a 12-month intervention of oral metformin vs. placebo in decreasing the rate of structural knee changes and pain. Participants will be asked to take up to 1500 mg/day of either metformin or placebo as tolerated. The primary outcomes are Knee injury and Osteoarthritis Outcome Score (KOOS) Pain subscale scores averaged between 12 and 24 months after randomization, and MRI derived cartilage structural change at 24 months. The trial will be deemed successful if at least one of the two primary outcomes reaches the preplanned effect size with sufficient statistical certainty. In this paper, we describe PIKASO elements according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Results Our multidisciplinary team developed the methods and statistical analysis plan for a placebo controlled, randomized clinical trial to determine whether metformin alters pain and early osteoarthritic changes after ACLR. Discussion This manuscript outlines the rationale, study design, and implementation of the PIKASO trial aiming to prevent the onset of PTOA after ACLR. Trial registration clinicaltrials.gov NCT06096259.
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Affiliation(s)
- Cale A. Jacobs
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Morgan H. Jones
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jamie E. Collins
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Xiaojuan Li
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | - Miguel Otero
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | - Scott A. Rodeo
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Joe M. Hart
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | | | | | | | | | | | | | - Faith Selzer
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey N. Katz
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kyna Long
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Elena Losina
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - for PIKASO Team
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Cleveland Clinic Foundation, Cleveland, OH, USA
- University of North Carolina, Chapel Hill, NC, USA
- Duke University School of Medicine, Durham, NC, USA
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
- University of Nebraska Medical Center, Omaha, NE, USA
- Ohio State University, Columbus, OH, USA
- University of Iowa, Iowa City, IA, USA
- University of Kentucky, Lexington, KY, USA
- Emory University, Atlanta, GA, USA
- University of Delaware, Newark, DE, USA
- Scripps Research, La Jolla, CA, USA
- Arthritis Foundation, Atlanta, GA, USA
- University of Georgia, Athens, GA, USA
- Boston University School of Medicine, Boston, MA, USA
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9
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Fauchon C, Binvignat M, Berenbaum F, Conaghan PG, Peyron R, Sellam J. Brain functional imaging contributions in osteoarthritis-related pain: A viewpoint. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100554. [PMID: 39720583 PMCID: PMC11667684 DOI: 10.1016/j.ocarto.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 11/23/2024] [Indexed: 12/26/2024] Open
Abstract
Objective Neuroimaging investigations are critical to provide a more direct assessment of brain disturbances associated with osteoarthritis (OA)-related pain, and to better understand its pathophysiology to develop new treatment strategies. This viewpoint aims to summarize the importance of the brain in OA pain. Method A European working group on pain in osteoarthritis GO-PAIN (Going Inside Osteoarthritis-related Pain Phenotyping) has been created to work on a global assessment of the OA-related pain. Relevant scientific literature was evaluated, summarized and discussed to expose advances in functional brain alterations related-to OA pain. Results Findings of neuroimaging studies are highly heterogenous and based on small sample size, but some key brain alterations associated with OA pain can be identified across experiments. A systematic literature review conducted by Hall and colleagues (2023) found lower activity, connectivity, and grey matter volume in the right anterior insula in patients with OA than in healthy controls. Other works also pointed out that activity of specific brain regions could serve as a potential surrogate biomarker, but several limitations and confounding factors needs to be addressed. Conclusions Brain functional imaging provides opportunities to accurately address an OA-related pain endophenotype. To encompass limitations and fill the gaps from the previous studies, we propose a blueprint for the next 5 years and stimulate ideas for others working in the field.
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Affiliation(s)
- Camille Fauchon
- University of Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Marie Binvignat
- Department of Rheumatology, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
- Centre de Recherche Saint-Antoine (CRSA) Inserm UMRS-938, Sorbonne Université, Paris, France
| | - Francis Berenbaum
- Department of Rheumatology, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
- Centre de Recherche Saint-Antoine (CRSA) Inserm UMRS-938, Sorbonne Université, Paris, France
| | - Philip G. Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Roland Peyron
- Université Jean Monnet, CHU Saint-Etienne, Inserm UMR-1028, CRNL, NeuroPain, Saint-Etienne, France
| | - Jérémie Sellam
- Department of Rheumatology, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
- Centre de Recherche Saint-Antoine (CRSA) Inserm UMRS-938, Sorbonne Université, Paris, France
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10
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Katz DH, Lindholm ME, Ashley EA. Charting the Molecular Terrain of Exercise: Energetics, Exerkines, and the Future of Multiomic Mapping. Physiology (Bethesda) 2025; 40:0. [PMID: 39136551 DOI: 10.1152/physiol.00024.2024] [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: 05/07/2024] [Revised: 08/09/2024] [Accepted: 08/09/2024] [Indexed: 11/21/2024] Open
Abstract
Physical activity plays a fundamental role in human health and disease. Exercise has been shown to improve a wide variety of disease states, and the scientific community is committed to understanding the precise molecular mechanisms that underlie the exquisite benefits. This review provides an overview of molecular responses to acute exercise and chronic training, particularly energy mobilization and generation, structural adaptation, inflammation, and immune regulation. Furthermore, it offers a detailed discussion of known molecular signals and systemic regulators activated during various forms of exercise and their role in orchestrating health benefits. Critically, the increasing use of multiomic technologies is explored with an emphasis on how multiomic and multitissue studies contribute to a more profound understanding of exercise biology. These data inform anticipated future advancement in the field and highlight the prospect of integrating exercise with pharmacology for personalized disease prevention and treatment.
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Affiliation(s)
- Daniel H Katz
- Division of Cardiovascular MedicineStanford University School of Medicine, Stanford, California, United States
| | - Maléne E Lindholm
- Division of Cardiovascular MedicineStanford University School of Medicine, Stanford, California, United States
| | - Euan A Ashley
- Division of Cardiovascular MedicineStanford University School of Medicine, Stanford, California, United States
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11
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Aoyagi K, Rivas E, Shababi R, Edwards R, LaValley M, Lechuga J, Napadow V, Neogi T. Safety and preliminary efficacy of transcutaneous auricular vagus nerve stimulation on chronic knee pain: A pilot trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100545. [PMID: 39687279 PMCID: PMC11647485 DOI: 10.1016/j.ocarto.2024.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 11/19/2024] [Indexed: 12/18/2024] Open
Abstract
Objective Transcutaneous auricular vagus nerve stimulation (tVNS) may be an innovative treatment for symptoms of knee osteoarthritis (OA) due to possible shared pathological mechanisms between diminished parasympathetic function, central pain mechanisms, and knee pain. Thus, we sought to test the safety and preliminary efficacy of tVNS in people with knee OA. Design A pilot trial in which participants received a 60-min tVNS was conducted. At baseline, immediately after, and 15 min after tVNS, we assessed knee pain, pressure pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM), and high-frequency power of heart rate variability (HF). We examined the extent to which these outcome measures changed after tVNS using linear mixed models. Results 30 participants with knee OA were included, and all completed the intervention without any major side effects. Compared to baseline, knee pain was reduced by 1.27 (95 % CI, -1.74, -0.80) immediately after and by 1.87 (-2.33, -1.40) 15 min after tVNS; CPM improved by 0.11 (0.04, 0.19) and 0.07 (-0.01, 0.15); and HF improved by 213.29 (-0.38, 426.96) and 234.17 (20.49, 447.84). PPT and TS were not changed after tVNS. Conclusions Our preliminary data demonstrated that tVNS may be a safe pain-relieving treatment for people with knee OA. Our findings suggest that improvement of knee pain might be derived from improvement of parasympathetic function and central pain mechanisms as no local therapy was applied. A large study is needed to confirm that tVNS is a novel intervention to ameliorate knee pain in people with knee OA. Clinical Trial ClinicalTrials.gov (NCT05625178).
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Affiliation(s)
- Kosaku Aoyagi
- Department of Physical Therapy and Movement Sciences, University of Texas at El Paso, United States
| | - Elias Rivas
- Department of Physical Therapy and Movement Sciences, University of Texas at El Paso, United States
| | - Roxanna Shababi
- Department of Physical Therapy and Movement Sciences, University of Texas at El Paso, United States
| | - Robert Edwards
- Brigham and Women's Hospital, Harvard Medical School, United States
| | | | - Julia Lechuga
- Department of Physical Therapy and Movement Sciences, University of Texas at El Paso, United States
| | - Vitaly Napadow
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States
| | - Tuhina Neogi
- Section of Rheumatology Boston University Chobanian & Avedisian School of Medicine, United States
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12
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Weaver SR, Arnold KM, Peralta-Herrera E, Oviedo M, Zars EL, Bradley EW, Westendorf JJ. Postnatal deletion of Phlpp1 in chondrocytes delays post-traumatic osteoarthritis in male mice. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100525. [PMID: 39811690 PMCID: PMC11732534 DOI: 10.1016/j.ocarto.2024.100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 09/24/2024] [Indexed: 01/16/2025] Open
Abstract
Objective Osteoarthritis is a chronic, debilitating disease that causes long-term pain and immobility. Germline deletion of Phlpp1 or administration of small molecules that inhibit Phlpp1 prevents post-traumatic osteoarthritis (PTOA) in mice. However, the chondrocyte-intrinsic role of Phlpp1 in PTOA progression is unknown. The objective of this study was to determine how postnatal, chondrocyte-directed deletion of Phlpp1 affects PTOA progression in the presence or absence of Phlpp inhibitors. Design Phlpp1fl/fl; Agc-CreERT2 and Agc-CreERT2 mice were injected with tamoxifen at 12 weeks of age to generate Phlpp1-CKOAgcERT and control (AgcERT) groups. Male mice underwent surgery to destabilize the medial meniscus (DMM) at 17 weeks of age. A separate cohort of male Phlpp1-CKOAgcERT mice were administered an intra-articular injection of NSC117079, a Phlpp1/2 inhibitor, or saline seven weeks after DMM surgery. Activity and mechanical allodynia were monitored throughout the experiment and cartilage damage was evaluated 12 weeks post-surgery. Results Phlpp1-CKOAgcERT mice had less cartilage damage than AgcERT littermates 12 weeks after DMM surgery but exhibited no differences in activity. Prg4 expression was also higher in articular chondrocytes of Phlpp1-CKOAgcERT mice. Intra-articular administration of NSC117079 to Phlpp1-CKOAgcERT mice improved cartilage structure, subchondral bone sclerosis, and mechanical allodynia at 12 weeks post-DMM. Conclusions Postnatal deletion of Phlpp1 in chondrocytes attenuates DMM-induced cartilage damage and subchondral bone sclerosis but does not prevent pain-related behaviors. Intra-articular injection of Phlpp inhibitors delays mechanical allodynia in Phlpp1-CKOAgcERT mice. These data indicate that Phlpp1 in chondrocytes affects articular cartilage structure after injury, but pain-related behaviors are controlled by Phlpp1 or Phlpp2 in other cell types.
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Affiliation(s)
| | | | | | - Manuela Oviedo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Elizabeth W. Bradley
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer J. Westendorf
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
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Chen K, Stotter C, Lepenik C, Klestil T, Salzlechner C, Nehrer S. Frontal plane mechanical leg alignment estimation from knee x-rays using deep learning. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100551. [PMID: 39811691 PMCID: PMC11729668 DOI: 10.1016/j.ocarto.2024.100551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 11/21/2024] [Indexed: 01/16/2025] Open
Abstract
Objective Lower limb malalignment can complicate symptoms and accelerate knee osteoarthritis (OA), necessitating consideration in study population selection. In this study, we develop and validate a deep learning model that classifies leg alignment as "normal" or "malaligned" from knee antero-posterior (AP)/postero-anterior (PA) radiographs alone, using an adjustable hip-knee-ankle (HKA) angle threshold. Material and methods We utilized 8878 digital radiographs, including 6181 AP/PA full-leg x-rays (LLRs) and 2697 AP/PA knee x-rays (2292 with positioning frame, 405 without). The model's evaluation involved two steps: In step 1, the model's predictions on knee images cropped from LLRs were compared against the ground truth from the original LLRs. In step 2, the model was tested on knee AP radiographs, using corresponding same-day LLRs as a proxy for ground truth. Results The model effectively classified alignment, with step one achieving sensitivity and specificity of 0.92 for a threshold of 7.5°, and 0.90 and 0.85 for 5°. For positioning frame images, step two showed a sensitivity of 0.85 and specificity of 0.81 for 7.5°, and 0.79 and 0.74 for 5°. For non-positioning frame images, sensitivity and specificity were 0.91 and 0.83 for 7.5°, and 0.9 and 0.86 for 5°. Conclusion The model developed in this study accurately classifies lower limb malalignment from AP/PA knee radiographs using adjustable thresholds, offering a practical alternative to LLRs. This can enhance the precision of study population selection and patient management.
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Affiliation(s)
- Kenneth Chen
- Department for Health Sciences, Medicine and Research, University of Continuing Education Krems, Krems, Austria
- Department for Orthopedics and Traumatology, Landesklinikum Waidhofen/Ybbs, Austria
| | - Christoph Stotter
- Department for Orthopedics and Traumatology, Landesklinikum Baden-Mödling, Austria
| | | | - Thomas Klestil
- Department for Orthopedics and Traumatology, Landesklinikum Baden-Mödling, Austria
| | | | - Stefan Nehrer
- Department for Health Sciences, Medicine and Research, University of Continuing Education Krems, Krems, Austria
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Naili JE, Ahmed AS, Hedström M, Simonsen MB, Broström EW, Harris HE, Végvári Á, Aulin C. Proteomic analysis reveals biomarkers associated with performance-based joint function and patient-reported outcomes in knee osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100543. [PMID: 39640420 PMCID: PMC11616498 DOI: 10.1016/j.ocarto.2024.100543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 11/11/2024] [Indexed: 12/07/2024] Open
Abstract
Objective This study aimed to identify proteins associated with clinical manifestations of knee osteoarthritis (KOA), including performance-based joint function and patient-reported outcome measures (PROM). Methods This cross-sectional exploratory study included thirteen individuals with KOA and eleven age-matched controls. All participants performed the 30s Single Leg Mini Squat test and 30s Sit-to-Stand test with simultaneous recording of joint kinematics. Individuals with KOA completed the Knee Injury and Osteoarthritis Outcome Score and Forgotten Joint Score-12. Proteins were determined by quantitative mass spectrometry (MS) in plasma. Principal component analysis (PCA), hierarchical cluster analysis (HCA), and Reactome enrichment analysis of the proteome were conducted to identify activated pathways and groups. Results Performance-based function was worse in individuals with KOA compared to controls, and they reported higher levels of pain. MS analysis identified 82 differentially expressed proteins (DEPs) in KOA (28 upregulated, 54 downregulated of 321 detected proteins). PCA displayed distinct features between KOA and controls, similar to HCA, which distinguished two major clusters. Enrichment analysis displayed platelet activation and degranulation, neutrophil, and extracellular matrix (ECM)-related pathways. From the proteome, 23 DEPs were associated with different aspects of joint function, and 25 DEPs with PROM. Conclusions Individuals with KOA differed from controls across all three assessment modalities; they presented worse joint function, higher levels of pain, and an altered plasma protein profile. Multiple associations were observed between up- and downregulated DEPs and clinical manifestations. The described study protocol shows promise for performing multivariate analyses for future subgrouping of individuals with KOA.
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Affiliation(s)
- Josefine E. Naili
- Dept. of Women’s and Children’s Health, Karolinska Institutet, Karolinska Vägen 37 A, QA 02:07, 171 76, Stockholm, Sweden
- Motion Analysis Lab, Karolinska University Hospital, Stockholm, Sweden
| | - Aisha S. Ahmed
- Dept. of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Hedström
- Dept. of Clinical Science, Intervention and Biotechnology, CLINTEC Karolinska Institutet, Stockholm, Sweden
- Trauma and Reparative Medicine Theme (TRM), Karolinska University Hospital, Stockholm, Sweden
| | - Morten Bilde Simonsen
- Dept. of Materials and Production, Aalborg University, Fibigerstræde 16, 9220, Aalborg, Denmark
- Center for Mathematical Modeling of Knee Osteoarthritis, Aalborg University, Denmark
| | - Eva W. Broström
- Dept. of Women’s and Children’s Health, Karolinska Institutet, Karolinska Vägen 37 A, QA 02:07, 171 76, Stockholm, Sweden
- Motion Analysis Lab, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Erlandsson Harris
- Dept. of Medicine Solna, Division of Rheumatology, Centre for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, The Laboratory Building, 5th Floor, Haukeland University Hospital, Jonas Lies Vei 87, N-5021, Bergen, Norway
| | - Ákos Végvári
- Dept. of Medical Biochemistry and Biophysics, Karolinska Institutet, Biomedicum, Solnavägen 9, 171 65, Stockholm, Sweden
| | - Cecilia Aulin
- Dept. of Medicine Solna, Division of Rheumatology, Centre for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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15
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Mathiessen A, Gaundal L, Sexton J, Sjølie D, Steen Pettersen P, Slatkowsky-Christensen B, Haugen IK. Protocol for the MERINO study: A randomized placebo-controlled trial assessing the efficacy, safety, and cost-effectiveness of methotrexate in people with erosive hand osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100558. [PMID: 39807424 PMCID: PMC11728867 DOI: 10.1016/j.ocarto.2024.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [ |