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Hao S, Yao C, Meng P, Jia Y, Liu L, Zhang C. Effects of T-2 and deoxynivalenol mycotoxins on mouse spinal bone growth and integrity. Toxicon 2024; 250:108079. [PMID: 39214350 DOI: 10.1016/j.toxicon.2024.108079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/13/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
Kashin-Beck Disease (KBD), an osteoarticular disorder, is influenced by various factors, including exposure to Deoxynivalenol (DON) and T-2 mycotoxins. This study systematically explored the impact of these mycotoxins on the development and structural resilience of spinal structures in mice, examining both isolated and combined effects. The experiment involved 72 male mice divided into nine groups, each subjected to varying concentrations of T-2, DON, or their combinations over four weeks. Rigorous monitoring included body weight, key indicators of bone metabolism, and cellular activities essential to bone health. Comprehensive evaluations using biomechanical analysis, x-ray, and micro-computed tomography (micro-CT) were conducted to assess alterations in spinal structure. The findings revealed a pivotal aspect: mice exhibited a dose-dependent decline in body weight when exposed to individual mycotoxins, while simultaneous exposure produced an unanticipated antagonistic effect. Moreover, decreases were noted in levels of calcium, phosphorus, and vitamin D, coupled with changes in the activities of osteoblasts (increased) and osteoclasts (decreased), all intricately tied to the toxins' dosages and combinations. Notably, variations in the biomechanical properties corresponded with the mycotoxin dosage and blend, showing a decline in biomechanical strength. Micro-CT analyses further substantiated the profound toxic impact of the toxin dosage and mixtures on both the cortical and trabecular components of the spinal structures. In summary, this investigation unequivocally illuminates the dose- and ratio-dependent deleterious impacts of DON and T-2 mycotoxins on the growth and structural soundness of spinal structures in mice. These findings highlight the urgent need for a comprehensive understanding of the potential hazards these toxins pose to bone health, providing invaluable guidance for future toxicological research and public health strategies.
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Affiliation(s)
- Shuichu Hao
- Department of Orthopaedics, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Cong Yao
- Nursing Department, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Peilin Meng
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, 710061, Shaanxi, China
| | - Yumen Jia
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, 710061, Shaanxi, China
| | - Li Liu
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, 710061, Shaanxi, China
| | - Chun Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Yao C, Hao S, Zhang C, Liu L, Jia Y, Meng P, Wu C, Guo X. Modulatory interactions of T-2 and deoxynivalenol mycotoxins on murine femoral development and osteological integrity. Food Chem Toxicol 2024; 188:114630. [PMID: 38604577 DOI: 10.1016/j.fct.2024.114630] [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: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
In this study, we conducted a systematic assessment of the effectsof deoxynivalenol (DON) and T-2 mycotoxins (T-2) on the developmental processes and structural integrity of murine femurs, considering both the isolated and synergistic effects of these toxins. To this end, we divided 72 male mice into nine groups, each subjected to varying dosages of T-2, DON, or their combinations. Over a four-week experimental period, meticulous monitoring was undertaken regarding the mice's body weight, biochemical markers of bone formation and resorption, and the activity of relevant cells. To comprehensively evaluate alterations in bone structure, we employed biomechanical analysis, micro-computed tomography (micro-CT), and transmission electron microscopy.Our findings unveiled a significant revelation: the mice exhibited a dose-dependent decrease in body weight upon exposure to individual mycotoxins, while the combined use of these toxins manifested an atypical antagonistic effect. Furthermore, we observed variations in the levels of calcium, phosphorus, and vitamin D, as well as adjustments in the activities of osteoblasts and osteoclasts, all intricately linked to the dosage and ratio of the toxins. Alterations in biomechanical properties were also noted to correlate with the dosage and combination of toxins. Analyses via micro-CT and transmission electron microscopy further corroborated the substantial impact of toxin dosage and combinations on both cortical and trabecular bone structures.In summation, our research unequivocally demonstrates the dose- and ratio-dependent detrimental effects of DON and T-2 mycotoxins on the growth and structural integrity of murine femurs. These insights accentuate the importance of a profound understanding of the potential risks these toxins pose to bone health, offering pivotal guidance for future toxicological research and public health preventative strategies.
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Affiliation(s)
- Cong Yao
- School of Public Health, Health Science Center, Xi'an Jiaotong University; NHC Key Laboratory of Environment and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, PR China; Nursing Department, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Shuichu Hao
- Department of Orthopaedics, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Chun Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Li Liu
- School of Public Health, Health Science Center, Xi'an Jiaotong University; NHC Key Laboratory of Environment and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, PR China
| | - Yumeng Jia
- School of Public Health, Health Science Center, Xi'an Jiaotong University; NHC Key Laboratory of Environment and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, PR China
| | - Peilin Meng
- School of Public Health, Health Science Center, Xi'an Jiaotong University; NHC Key Laboratory of Environment and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, PR China
| | - Cuiyan Wu
- School of Public Health, Health Science Center, Xi'an Jiaotong University; NHC Key Laboratory of Environment and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, PR China.
| | - Xiong Guo
- School of Public Health, Health Science Center, Xi'an Jiaotong University; NHC Key Laboratory of Environment and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, PR China.
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Ning Y, Zhang P, Zhang F, Chen S, Liu Y, Chen F, Wu Y, Li S, Wang C, Gong Y, Hu M, Huang R, Zhao H, Guo X, Wang X, Yang L. Abnormal expression of TSG-6 disturbs extracellular matrix homeostasis in chondrocytes from endemic osteoarthritis. Front Genet 2022; 13:1064565. [DOI: 10.3389/fgene.2022.1064565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background and aims: Kashin-Beck disease (KBD) is a unique endemic osteochondropathy with unclear pathogenesis in China. T-2 toxin exposure has been identified as a significant risk factor of KBD. However, the mechanism of articular cartilage damage induced by T-2 toxin is a conundrum. We explored the role of the extracellular matrix-related gene TSG-6 in the articular chondrocyte damage process under the exposure of HT-2 toxin.Methods: TSG-6 was identified as a candidate gene by mining our previous gene expression profiling of KBD and verified by qRT-PCR and immunohistochemistry. Then, TSG-6 was silenced by RNA interference technology and overexpressed induction by TNF-α. Gradient concentrations of HT-2 toxin were added to intervene with C28/I2 chondrocytes. MTT was used to observe the proliferation and cell viability of chondrocytes, and qRT-PCR was utilized to detect the expression changes of MMP1, MMP3, MMP13, COL2A1, and proteoglycan before and after treatments for verification.Results: TSG-6 was upregulated in KBD chondrocytes at the mRNA level and upregulated in the superficial, middle, and deep zones of KBD cartilage. After TSG-6 silencing, the expression of MMP1, MMP3, MMP13, and proteoglycan was significantly decreased while COL2A1 expression was significantly increased, which was reversed after the overexpression of TSG-6 induced by TNF-α (p < 0.05). The survival rate of chondrocytes was correspondingly reduced with an increase in the HT-2 toxin concentration. Compared with the blank control group, the expression of MMPs was increased in the intervention group of HT-2 toxin, while the expression of proteoglycan and COL2A1 decreased (p < 0.05).Conclusion: The upregulation of the TSG-6 gene may play a role in promoting the damage and degradation of the extracellular matrix in KBD chondrocytes under the exposure of HT-2 toxin.
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Fu Y, Yin S, Zhao C, Fan L, Hu H. Combined toxicity of food-borne mycotoxins and heavy metals or pesticides. Toxicon 2022; 217:148-154. [PMID: 35995097 DOI: 10.1016/j.toxicon.2022.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/21/2022] [Accepted: 08/14/2022] [Indexed: 10/15/2022]
Abstract
Food can be contaminated by multiple classes of toxic substances, mainly including mycotoxins, heavy metals and pesticides, which leads to a possibility of simultaneous exposure to two or more food contaminants for humans. Thus, it is necessary to examine whether the combined exposure could result in enhanced toxicity. Initially, the studies on the combined toxicity of food contaminants mainly focus on the mixtures of same classes of food contaminants due to their co-occurrence feature in foodstuffs, such as mixtures of mycotoxins or mixtures of heavy metals. Given the possibility that consumers are likely exposed to mixtures of different classes of food contaminants, recently, studies on the combined toxicity of different classes of food contaminants have been receiving increasing attentions. In this review article, we summarize the findings of combined toxicity studies related to co-exposure to food-borne mycotoxins and other classes of food contaminants mainly heavy metals or pesticides, and propose issues that need to be addressed in future studies for more accurately performing risk assessment of co-exposure to mycotoxins and other classes of food contaminants.
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Affiliation(s)
- Yuhan Fu
- College of Food Science and Nutritional Engineering, China Agricultural University, No.17 Qinghua East Road, Haidian District, Beijing, 100083, China
| | - Shutao Yin
- College of Food Science and Nutritional Engineering, China Agricultural University, No.17 Qinghua East Road, Haidian District, Beijing, 100083, China
| | - Chong Zhao
- College of Food Science and Nutritional Engineering, China Agricultural University, No.17 Qinghua East Road, Haidian District, Beijing, 100083, China
| | - Lihong Fan
- College of Veterinary Medicine, China Agricultural University, No2 Yunamingyuan West Road, Haidian District, Beijing, 100193, China.
| | - Hongbo Hu
- College of Food Science and Nutritional Engineering, China Agricultural University, No.17 Qinghua East Road, Haidian District, Beijing, 100083, China
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Augustin Mihalache O, Dellafiora L, Dall'Asta C. A systematic review of natural toxins occurrence in plant commodities used for plant-based meat alternatives production. Food Res Int 2022; 158:111490. [DOI: 10.1016/j.foodres.2022.111490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022]
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Taroncher M, Pigni MC, Diana MN, Juan-García A, Ruiz MJ. Does low concentration mycotoxin exposure induce toxicity in HepG2 cells through oxidative stress? Toxicol Mech Methods 2020; 30:417-426. [PMID: 32306886 DOI: 10.1080/15376516.2020.1757000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to determine whether exposure to low concentrations of deoxynivalenol (DON), T-2 toxin (T-2) and patulin (PAT) in a human hepatocellular carcinoma cell line (HepG2) exerts toxic effects through mechanisms related to oxidative stress, and how cells deal with such exposure. Cell viability was determined by the MTT and protein content (PC) assays over 24, 48 and 72 h. The IC50 values detected ranged from >10 to 2.53 ± 0.21 μM (DON), 0.050 ± 0.025 to 0.034 ± 0.007 μM (T-2) and 2.66 ± 0.66 to 1.17 ± 0.21 µM (PAT). The key players in oxidative stress are the generation of reactive oxygen species (ROS), lipid peroxidation (LPO) and mitochondrial membrane potential (MMP) dysfunction. The results obtained showed that PAT, DON and T-2 did not significantly increase LPO or ROS production with respect to the controls. Moreover, PAT and DON did not alter MMP, though T-2 increased MMP at the higher concentrations tested (17 and 34 nM). In conclusion, the exposure of HepG2 cells to nontoxic concentrations of T-2 condition them against subsequent cellular oxidative conditions induced by even higher concentrations of mycotoxin.
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Affiliation(s)
- Mercedes Taroncher
- Laboratory of Toxicology, Faculty of Pharmacy, University of Valencia, Valencia, Spain
| | - Maria-Chiari Pigni
- Laboratory of Toxicology, Faculty of Pharmacy, University of Valencia, Valencia, Spain
| | - Maria-Natalia Diana
- Laboratory of Toxicology, Faculty of Pharmacy, University of Valencia, Valencia, Spain
| | - Ana Juan-García
- Laboratory of Toxicology, Faculty of Pharmacy, University of Valencia, Valencia, Spain
| | - Maria-Jose Ruiz
- Laboratory of Toxicology, Faculty of Pharmacy, University of Valencia, Valencia, Spain
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Assessing the Effect of Mycotoxin Combinations: Which Mathematical Model Is (the Most) Appropriate? Toxins (Basel) 2020; 12:toxins12030153. [PMID: 32121330 PMCID: PMC7150917 DOI: 10.3390/toxins12030153] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022] Open
Abstract
In the past decades, many studies have examined the nature of the interaction between mycotoxins in biological models classifying interaction effects as antagonisms, additive effects, or synergisms based on a comparison of the observed effect with the expected effect of combination. Among several described mathematical models, the arithmetic definition of additivity and factorial analysis of variance were the most commonly used in mycotoxicology. These models are incorrectly based on the assumption that mycotoxin dose-effect curves are linear. More appropriate mathematical models for assessing mycotoxin interactions include Bliss independence, Loewe’s additivity law, combination index, and isobologram analysis, Chou-Talalays median-effect approach, response surface, code for the identification of synergism numerically efficient (CISNE) and MixLow method. However, it seems that neither model is ideal. This review discusses the advantages and disadvantages of these mathematical models.
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Tran VN, Viktorova J, Augustynkova K, Jelenova N, Dobiasova S, Rehorova K, Fenclova M, Stranska-Zachariasova M, Vitek L, Hajslova J, Ruml T. In Silico and In Vitro Studies of Mycotoxins and Their Cocktails; Their Toxicity and Its Mitigation by Silibinin Pre-Treatment. Toxins (Basel) 2020; 12:E148. [PMID: 32121188 PMCID: PMC7150870 DOI: 10.3390/toxins12030148] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 12/31/2022] Open
Abstract
Mycotoxins found in randomly selected commercial milk thistle dietary supplement were evaluated for their toxicity in silico and in vitro. Using in silico methods, the basic physicochemical, pharmacological, and toxicological properties of the mycotoxins were predicted using ACD/Percepta. The in vitro cytotoxicity of individual mycotoxins was determined in mouse macrophage (RAW 264.7), human hepatoblastoma (HepG2), and human embryonic kidney (HEK 293T) cells. In addition, we studied the bioavailability potential of mycotoxins and silibinin utilizing an in vitro transwell system with differentiated human colon adenocarcinoma cells (Caco-2) simulating mycotoxin transfer through the intestinal epithelial barrier. The IC50 values for individual mycotoxins in studied cells were in the biologically relevant ranges as follows: 3.57-13.37 nM (T-2 toxin), 5.07-47.44 nM (HT-2 toxin), 3.66-17.74 nM (diacetoxyscirpenol). Furthermore, no acute toxicity was obtained for deoxynivalenol, beauvericin, zearalenone, enniatinENN-A, enniatin-A1, enniatin-B, enniatin-B1, alternariol, alternariol-9-methyl ether, tentoxin, and mycophenolic acid up to the 50 nM concentration. The acute toxicity of these mycotoxins in binary combinations exhibited antagonistic effects in the combinations of T-2 with DON, ENN-A1, or ENN-B, while the rest showed synergistic or additive effects. Silibinin had a significant protective effect against both the cytotoxicity of three mycotoxins (T-2 toxin, HT-2 toxin, DAS) and genotoxicity of AME, AOH, DON, and ENNs on HEK 293T. The bioavailability results confirmed that AME, DAS, ENN-B, TEN, T-2, and silibinin are transported through the epithelial cell layer and further metabolized. The bioavailability of silibinin is very similar to mycotoxins poor penetration.
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Affiliation(s)
- Van Nguyen Tran
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (V.N.T.); (J.V.); (K.A.); (N.J.); (S.D.); (K.R.)
| | - Jitka Viktorova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (V.N.T.); (J.V.); (K.A.); (N.J.); (S.D.); (K.R.)
| | - Katerina Augustynkova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (V.N.T.); (J.V.); (K.A.); (N.J.); (S.D.); (K.R.)
| | - Nikola Jelenova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (V.N.T.); (J.V.); (K.A.); (N.J.); (S.D.); (K.R.)
| | - Simona Dobiasova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (V.N.T.); (J.V.); (K.A.); (N.J.); (S.D.); (K.R.)
| | - Katerina Rehorova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (V.N.T.); (J.V.); (K.A.); (N.J.); (S.D.); (K.R.)
| | - Marie Fenclova
- Department of Food Analysis and Nutrition, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (M.F.); (M.S.-Z.); (J.H.)
| | - Milena Stranska-Zachariasova
- Department of Food Analysis and Nutrition, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (M.F.); (M.S.-Z.); (J.H.)
| | - Libor Vitek
- First Faculty of Medicine, Charles University, Katerinska 32, 12108 Prague 2, Czech Republic;
- Faculty General Hospital, U Nemocnice 2, 12808 Praha 2, Czech Republic
| | - Jana Hajslova
- Department of Food Analysis and Nutrition, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (M.F.); (M.S.-Z.); (J.H.)
| | - Tomas Ruml
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Technicka 3, 16628 Prague 6, Czech Republic; (V.N.T.); (J.V.); (K.A.); (N.J.); (S.D.); (K.R.)
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Wang X, Jin Z, Chen M, Duan D, Lammi MJ, Guo X, Chang Y. Inhibiting the aberrant activation of Wnt/β-catenin signaling by selenium supplementation ameliorates deoxynivalenol-induced toxicity and catabolism in chondrocytes. J Cell Physiol 2019; 235:4434-4442. [PMID: 31808557 DOI: 10.1002/jcp.29319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/30/2019] [Indexed: 11/11/2022]
Abstract
Kashin-Beck disease (KBD) is an endemic degenerative osteoarticular disorder associated with physical disability and a heavy economic burden. Contamination by mycotoxin deoxynivalenol (DON) and selenium deficiency have been proposed to be key etiological factors for KBD, and can work together to aggravate the progression of KBD. Nevertheless, the mechanism of DON in KBD remains elusive. In the present study, exposure to DON dose-dependently suppressed cell viability and expression of pro-proliferation marker PCNA in human chondrocytes, whereas it enhanced lactate dehydrogenase release, cell apoptosis, and caspase-3/9 activity. In addition, DON incubation shifted metabolism homeostasis towards catabolism by suppressing the transcription of collagen II and aggrecan, and the production of sulphated glycosaminoglycans and TIMP-1, while increasing matrix metalloproteinase levels (MMP-1 and MMP-13). Mechanistically, DON exposure induced the activation of Wnt/β-catenin signaling. Intriguingly, blocking this pathway reversed the adverse effects of DON on cytotoxic damage and metabolism disruption to catabolism. Notably, supplementation with selenium reduced DON-induced activation of the Wnt/β-catenin pathway. Moreover, selenium addition abrogated cytotoxic injury and excessive pro-catabolic gene expression in chondrocytes upon DON conditions. These findings confirm that DON may facilitate the development of KBD by inducing cell injury, inhibiting matrix synthesis, and increasing cellular catabolism by activating the Wnt/β-catenin signaling, which were partially reversed by selenium supplementation. Thus, the current study may presents a new viewpoint for how selenium supplementation ameliorates the development of KBD by inhibiting DON-induced cytotoxic injury and metabolism imbalance in chondrocytes.
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Affiliation(s)
- Xiaoqing Wang
- Outpatient Service Office, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Zhankui Jin
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Ming Chen
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Dapeng Duan
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Mikko J Lammi
- Department of Integrative Medical Biology, University of Umeå, Umeå, Sweden
| | - Xiong Guo
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yanhai Chang
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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