1
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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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2
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Ye J, Wang Y, Zeng W, Li Y, Yao B, Wang S, Wu J, Hou J. Local Injection of Rapamycin-Loaded Pcl-Peg Nanoparticles for Enhanced Tendon Healing in Rotator Cuff Tears via Simultaneously Reducing Fatty Infiltration and Drug Toxicity. Adv Healthc Mater 2024; 13:e2300612. [PMID: 37931903 DOI: 10.1002/adhm.202300612] [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: 06/20/2023] [Revised: 10/20/2023] [Indexed: 11/08/2023]
Abstract
As a common cause of shoulder pain, rotator cuff tears (RCTs) are difficult to treat clinically because of their unsatisfactory prognosis due to the fatty infiltration caused by muscle-derived stem cells (MDSCs). Previous studies have found that rapamycin (RAPA) can inhibit fatty infiltration. However, systemic administration of RAPA may cause complications such as infection and nausea, while local administration of RAPA may lead to the cytotoxicity of tendon cells, affecting the healing of rotator cuffs. In this study, biocompatible and clinically approved polycaprolactone-polyethylene glycol (PCL-PEG) is formulated into an injectable nanoparticle for the sustained release of RAPA. The results indicate that the RAPA/PCL-PEG nanoparticles (NPs) can efficiently prolong the release of RAPA and significantly reduce the cytotoxicity of tendon cells caused by RAPA. The study of the fatty infiltration model in rats with delayed rotator cuff repair shows that weekly intraarticular injection of RAPA/PCL-PEG NPs can more effectively reduce the fatty infiltration and muscle atrophy of rat rotator cuffs and leads to better mechanical properties and gait improvements than a daily intraarticular injection of RAPA. These findings imply that local injection of RAPA/PCL-PEG NPs in the shoulder joints can be a potential clinical option for RCTs patients with fatty infiltration.
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Affiliation(s)
- Jichao Ye
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Yongbo Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
- Bioscience and Biomedical Engineering Thrust, The Hong Kong University of Science and Technology (Guangzhou), Nansha, Guangzhou, 511458, China
| | - Weike Zeng
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, China
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Yuxiang Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Bin Yao
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Siheng Wang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, P. R. China
| | - Jun Wu
- Bioscience and Biomedical Engineering Thrust, The Hong Kong University of Science and Technology (Guangzhou), Nansha, Guangzhou, 511458, China
- Division of Life Science, Hong Kong University of Science and Technology, Hong Kong, SAR, 999077, P. R. China
| | - Jingyi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
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3
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Saveh-Shemshaki N, Barajaa MA, Otsuka T, Mirdamadi ES, Nair LS, Laurencin CT. Electroconductivity, a regenerative engineering approach to reverse rotator cuff muscle degeneration. Regen Biomater 2023; 10:rbad099. [PMID: 38020235 PMCID: PMC10676522 DOI: 10.1093/rb/rbad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Muscle degeneration is one the main factors that lead to the high rate of retear after a successful repair of rotator cuff (RC) tears. The current surgical practices have failed to treat patients with chronic massive rotator cuff tears (RCTs). Therefore, regenerative engineering approaches are being studied to address the challenges. Recent studies showed the promising outcomes of electroactive materials (EAMs) on the regeneration of electrically excitable tissues such as skeletal muscle. Here, we review the most important biological mechanism of RC muscle degeneration. Further, the review covers the recent studies on EAMs for muscle regeneration including RC muscle. Finally, we will discuss the future direction toward the application of EAMs for the augmentation of RCTs.
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Affiliation(s)
- Nikoo Saveh-Shemshaki
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Mohammed A Barajaa
- Department of Biomedical Engineering, Imam Abdulrahman Bin Faisal University, Dammam 31451, Saudi Arabia
| | - Takayoshi Otsuka
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
| | - Elnaz S Mirdamadi
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Lakshmi S Nair
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Cato T Laurencin
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
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4
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Zhao W, Yang J, Kang Y, Hu K, Jiao M, Zhao B, Jiang Y, Liu C, Ding F, Yuan B, Ma B, Zhang K, Mikos AG, Zhang X. Animal Models of Rotator Cuff Injury and Repair: A Systematic Review. TISSUE ENGINEERING. PART B, REVIEWS 2022; 28:1258-1273. [PMID: 35972750 DOI: 10.1089/ten.teb.2022.0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are a large number of animal studies on rotator cuff injury and repair, but a lack of detailed research and evaluation on the animal models. This systematic review aims to provide a framework for animal studies and repair patches for rotator cuff injury. Four hundred nine animal studies were included, of which the most common animal model of rotator cuff injury is rat (53.56%), the most common site of rotator cuff injury is the supraspinatus tendon (62.10%), and the most common injury type (degree) is acute tear (full thickness) (48.41%). The most common research purpose is to evaluate the repair effect of the patch (24.94%), followed by the observation of pathophysiological changes after rotator cuff injury (20.87%). Among the five types of repair patch materials including nondegradable and degradable synthetic materials, autologous and allogeneic tissues, and naturally derived biomaterial, the last one is the mostly used (52.74%). For different animal models, the rodent models (rat and mouse) are the most commonly used and probably the most suitable species for preliminary studies of rotator cuff injury; the rabbit, canine, sheep, and goat models are more suitable for biomechanical performance testing, rehabilitation training, and validation of surgical methods; and the nonhuman primate models (monkey and baboon) are the closest to human, but it is more difficult to carry out the animal studies on them because of ethical issues, high feeding cost, and management difficulties.
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Affiliation(s)
- Wanlu Zhao
- College of Biomedical Engineering and Sichuan University, Chengdu, People's Republic of China.,National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, People's Republic of China
| | - Jinwei Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China.,Reproductive Medicine Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, People's Republic of China
| | - Yuhao Kang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Kaiyan Hu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Mingyue Jiao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Bing Zhao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Yanbiao Jiang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China.,The First Hospital of Lanzhou University, Lanzhou, People's Republic of China
| | - Chen Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Fengxing Ding
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Bo Yuan
- College of Biomedical Engineering and Sichuan University, Chengdu, People's Republic of China.,National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, People's Republic of China
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, People's Republic of China
| | - Kai Zhang
- College of Biomedical Engineering and Sichuan University, Chengdu, People's Republic of China.,National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, People's Republic of China.,Institute of Regulatory Science for Medical Devices, Sichuan University, Chengdu, People's Republic of China
| | - Antonios G Mikos
- Department of Bioengineering, Chemical and Biomolecular Engineering, Rice University, Houston, Texas, USA
| | - Xingdong Zhang
- College of Biomedical Engineering and Sichuan University, Chengdu, People's Republic of China.,National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, People's Republic of China.,Institute of Regulatory Science for Medical Devices, Sichuan University, Chengdu, People's Republic of China
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5
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Muscle degeneration in chronic massive rotator cuff tears of the shoulder: Addressing the real problem using a graphene matrix. Proc Natl Acad Sci U S A 2022; 119:e2208106119. [PMID: 35939692 PMCID: PMC9388153 DOI: 10.1073/pnas.2208106119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Massive rotator cuff tears (MRCTs) of the shoulder cause disability and pain among the adult population. In chronic injuries, the tendon retraction and subsequently the loss of mechanical load lead to muscle atrophy, fat accumulation, and fibrosis formation over time. The intrinsic repair mechanism of muscle and the successful repair of the torn tendon cannot reverse the muscle degeneration following MRCTs. To address these limitations, we developed an electroconductive matrix by incorporating graphene nanoplatelets (GnPs) into aligned poly(l-lactic acid) (PLLA) nanofibers. This study aimed to understand 1) the effects of GnP matrices on muscle regeneration and inhibition of fat formation in vitro and 2) the ability of GnP matrices to reverse muscle degenerative changes in vivo following an MRCT. The GnP matrix significantly increased myotube formation, which can be attributed to enhanced intracellular calcium ions in myoblasts. Moreover, the GnP matrix suppressed adipogenesis in adipose-derived stem cells. These results supported the clinical effects of the GnP matrix on reducing fat accumulation and muscle atrophy. The histological evaluation showed the potential of the GnP matrix to reverse muscle atrophy, fat accumulation, and fibrosis in both supraspinatus and infraspinatus muscles at 24 and 32 wk after the chronic MRCTs of the rat shoulder. The pathological evaluation of internal organs confirmed the long-term biocompatibility of the GnP matrix. We found that reversing muscle degenerative changes improved the morphology and tensile properties of the tendon compared with current surgical techniques. The long-term biocompatibility and the ability of the GnP matrix to treat muscle degeneration are promising for the realization of MRCT healing and regeneration.
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Wang L, Zhu T, Kang Y, Zhang J, Du J, Gao H, Chen S, Jiang J, Zhao J. Crimped nanofiber scaffold mimicking tendon-to-bone interface for fatty-infiltrated massive rotator cuff repair. Bioact Mater 2022; 16:149-161. [PMID: 35386329 PMCID: PMC8958472 DOI: 10.1016/j.bioactmat.2022.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
Electrospun fibers, with proven ability to promote tissue regeneration, are widely being explored for rotator cuff repairing. However, without post treatment, the microstructure of the electrospun scaffold is vastly different from that of natural extracellular matrix (ECM). Moreover, during mechanical loading, the nanofibers slip that hampers the proliferation and differentiation of migrating stem cells. Here, electrospun nanofiber scaffolds, with crimped nanofibers and welded joints to biomimic the intricate natural microstructure of tendon-to-bone insertion, were prepared using poly(ester-urethane)urea and gelatin via electrospinning and double crosslinking by a multi-bonding network densification strategy. The crimped nanofiber scaffold (CNS) features bionic tensile stress and induces chondrogenic differentiation, laying credible basis for in vivo experimentation. After repairing a rabbit massive rotator cuff tear using a CNS for 3 months, the continuous translational tendon-to-bone interface was fully regenerated, and fatty infiltration was simultaneously inhibited. Instead of micro-CT, μCT was employed to visualize the integrity and intricateness of the three-dimensional microstructure of the CNS-induced-healed tendon-to-bone interface at an ultra-high resolution of less than 1 μm. This study sheds light on the correlation between nanofiber post treatment and massive rotator cuff repair and provides a general strategy for crimped nanofiber preparation and tendon-to-bone interface imaging characterization. Electrospun scaffold mimicking the microstructure of ECM was fabricated. The translational microstructure of tendon-to-bone interface was regenerated. Tendon-to-bone interface was 3D visualized with resolution less than 1 μm. Muscle fatty infiltration was inhibited for massive rotator cuff tear.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China.,Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, 200025, China
| | - Tonghe Zhu
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Yuhao Kang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China.,Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, 200025, China
| | - Jianguang Zhang
- Department of Medgen Group Research Laboratory, 18 Qinglan 3 Rd, Shenzhen, 518118, China
| | - Juan Du
- Biofunctional Materials Research Group, College of Chemistry and Chemical Engineering, Multidisciplinary Center for Advanced Materials, Institute of Advanced Studies, Shanghai University of Engineering Science, No. 333 Longteng Rd, Shanghai, 201620, China
| | - Haihan Gao
- Biofunctional Materials Research Group, College of Chemistry and Chemical Engineering, Multidisciplinary Center for Advanced Materials, Institute of Advanced Studies, Shanghai University of Engineering Science, No. 333 Longteng Rd, Shanghai, 201620, China.,Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, 200025, China
| | - Sihao Chen
- Biofunctional Materials Research Group, College of Chemistry and Chemical Engineering, Multidisciplinary Center for Advanced Materials, Institute of Advanced Studies, Shanghai University of Engineering Science, No. 333 Longteng Rd, Shanghai, 201620, China
| | - Jia Jiang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China.,Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People' Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China.,Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People' Hospital, No. 600 Yishan Road, Shanghai, 200233, China
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7
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Takada Y, Matsumura N, Shirasawa H, Yoda M, Matsumoto M, Nakamura M, Horiuchi K. Aging Aggravates the Progression of Muscle Degeneration After Rotator Cuff Tears in Mice. Arthroscopy 2022; 38:752-760. [PMID: 34571183 DOI: 10.1016/j.arthro.2021.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of aging on muscle degeneration after rotator cuff tear (RCT) in mice. METHODS Young (12-week-old) and aged (50-to-60-week-old) female C57BL/6 mice were used (n = 29 for each group). The rotator cuff was transected, and the proximal humerus was removed to induce degeneration of the rotator cuff muscles. The mice were euthanized 4 and 12 weeks after the procedure (referred to as RCT-4wk mice and RCT-12wk mice, respectively) and compared with the sham-treated mice. The supraspinatus muscles were collected for histology, Western blot analysis, and gene expression analyses. RESULTS There was a significant increase in fat tissue in aged RCT-4wk mice (P = .001) and aged RCT-12wk mice (P < .001) compared with sham-treated aged mice, and aged RCT-12wk mice had a significantly increased fat area ratio compared with aged RCT-4wk mice (P < .001). The fat area was significantly larger in both the aged RCT-4wk (P = .002) and RCT-12wk mice (P < .001) than in the corresponding young mice. Muscular fibrosis was significantly increased in aged RCT-12wk mice compared with aged sham-treated mice (P = .005) and young RCT-12wk mice (P = .016). There were also significant increases in the expression of perilipin and transcripts of adipogenic and fibrogenic differentiation markers in aged RCT mice compared with young RCT mice. CONCLUSION The present results show that aging is critically involved in the pathology of muscular fatty infiltration and fibrosis after RCT, and muscular degeneration progresses over time in aged mice. CLINICAL RELEVANCE Aging promotes the progression of muscle degeneration in a mouse RCT model. Furthermore, this study shows that muscle degeneration occurs in aged mice even without denervation and that the model described in the present study is a useful tool for studying the pathology of muscle degeneration.
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Affiliation(s)
- Yuhei Takada
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Hideyuki Shirasawa
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaki Yoda
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Horiuchi
- Department of Orthopedic Surgery, National Defense Medical College, Saitama, Japan
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8
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Lu V, Tennyson M, Zhang J, Khan W. Mesenchymal Stem Cell-Derived Extracellular Vesicles in Tendon and Ligament Repair-A Systematic Review of In Vivo Studies. Cells 2021; 10:cells10102553. [PMID: 34685532 PMCID: PMC8533909 DOI: 10.3390/cells10102553] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022] Open
Abstract
Tendon and ligament injury poses an increasingly large burden to society. This systematic review explores whether mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) can facilitate tendon/ligament repair in vivo. On 26 May 2021, a systematic search was performed on PubMed, Web of Science, Cochrane Library, Embase, to identify all studies that utilised MSC-EVs for tendon/ligament healing. Studies administering EVs isolated from human or animal-derived MSCs into in vivo models of tendon/ligament injury were included. In vitro, ex vivo, and in silico studies were excluded, and studies without a control group were excluded. Out of 383 studies identified, 11 met the inclusion criteria. Data on isolation, the characterisation of MSCs and EVs, and the in vivo findings in in vivo models were extracted. All included studies reported better tendon/ligament repair following MSC-EV treatment, but not all found improvements in every parameter measured. Biomechanics, an important index for tendon/ligament repair, was reported by only eight studies, from which evidence linking biomechanical alterations to functional improvement was weak. Nevertheless, the studies in this review showcased the safety and efficacy of MSC-EV therapy for tendon/ligament healing, by attenuating the initial inflammatory response and accelerating tendon matrix regeneration, providing a basis for potential clinical use in tendon/ligament repair.
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Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (V.L.); (J.Z.)
| | - Maria Tennyson
- Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK;
| | - James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (V.L.); (J.Z.)
| | - Wasim Khan
- Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK;
- Correspondence: ; Tel.: +44-(0)-7791-025554
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9
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Polydeoxyribonucleotide and Polynucleotide Improve Tendon Healing and Decrease Fatty Degeneration in a Rat Cuff Repair Model. Tissue Eng Regen Med 2021; 18:1009-1020. [PMID: 34387852 DOI: 10.1007/s13770-021-00378-5] [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: 05/14/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND After surgical repair of chronic rotator cuff tears, healing of the repaired tendons often fails and is accompanied by high-level fatty degeneration. Our purpose was to explore the effects of polydeoxyribonucleotide (PDRN) and polynucleotide (PN) on tendon healing and the reversal of fatty degeneration in a chronic rotator cuff tear model using a rat infraspinatus. METHODS Sixty rats were randomly assigned to the following three groups (20 rats per group: 12 for histological evaluation and 8 for mechanical testing): saline + repair (SR), PDRN + repair (PR), and PN + repair (PNR). The right shoulder was used for experimental intervention, and the left served as a control. Four weeks after detaching the infraspinatus, the torn tendon was repaired. Saline, PDRN, and PN were applied to the repair sites. Histological evaluation was performed 3 and 6 weeks after repair and biomechanical analysis was performed at 6 weeks. RESULTS Three weeks after repair, the PR and PNR groups had more CD168-stained cells than the SR group. The PR group showed a larger cross-sectional area (CSA) of muscle fibers than the SR and PNR groups. Six weeks after repair, the PR and PNR groups showed more adipose cells, less CD68-stained cells, and more parallel tendon collagen fibers than the SR group. The PR group had more CD 68-stained cells than the PNR group. The PR group showed a larger CSA than the SR group. The mean load-to-failure values of the PR and PNR groups were higher than that of the SR group, although these differences were not significant. CONCLUSION PDRN and PN may improve tendon healing and decrease fatty degeneration after cuff repair.
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10
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Gupta R, Rao R, Johnston TR, Uong J, Yang DS, Lee TQ. Muscle stem cells and rotator cuff injury. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:186-193. [PMID: 37588948 PMCID: PMC10426486 DOI: 10.1016/j.xrrt.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The incidence of reinjury after treatment of rotator cuff tears (RCTs) remains very high despite the variety of nonoperative treatments and the high volume of surgical interventions performed. Muscle stem cells (MuSCs), also known as satellite cells, have risen to the forefront of rotator cuff tear research as a potential adjuvant therapy to aid unsatisfactory surgical outcomes. MuSCs are adult stem cells exhibiting the capacity to proliferate and self-renew, both symmetrically and asymmetrically. As part of this niche, they have been shown to adopt an activated phenotype in response to musculoskeletal injury and decrease their cellular populations during aging, implicating them as key players in both pathologic and normal physiological processes. While commonly connected to the regenerative phase of muscle healing, MuSCs also have the potential to differentiate into adverse morphologies. For instance, if MuSCs differentiate into adipocytes, the ensuing fatty infiltration serves as an obstacle to proper muscle healing and has been associated with the failure of surgical management of RCTs. With the potential to both harm and heal, we have identified MuSCs as a key player in RCT repair. To better understand this dichotomy, the following review will identify key studies regarding the morphology, function, and behavior of MuSCs with respect to RCTs and healing.
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Affiliation(s)
- Ranjan Gupta
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Rohan Rao
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Tyler R. Johnston
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Jennifer Uong
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Daniel S. Yang
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Thay Q. Lee
- Congress Medical Foundation, Pasadena, CA, USA
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Ki SY, Lee YS, Kim JY, Lho T, Chung SW. Relationship between fatty infiltration and gene expression in patients with medium rotator cuff tear. J Shoulder Elbow Surg 2021; 30:387-395. [PMID: 32603896 DOI: 10.1016/j.jse.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fatty infiltration (FI) is a key prognostic factor that affects outcomes after rotator cuff repair and is radiologically evaluated using the Goutallier classification. The purpose of this study was to assess alterations in gene and protein expression according to the Goutallier classification in the supraspinatus muscle and any relationships among various gene expression profiles. METHODS Twenty-four samples of the supraspinatus muscle from 12 patients with a high FI grade (grade 3 or 4) and 12 patients with a low FI grade (grade 1 or 2) with medium-sized tears were acquired during arthroscopic surgery. Alterations in the expression of genes and proteins associated with adipogenesis, fibrosis, inflammation, and muscle atrophy were compared between the high- and low-FI groups using reverse-transcription quantitative polymerase chain reaction, Western blotting, and immunohistochemistry. RESULTS mRNA expression of not only the adipogenic genes (peroxisome proliferator-activated receptor γ and CCAAT/enhancer-binding protein α; P < .001 and P = .020) but also the fibrosis-related gene (α-smooth muscle actin; P < .001), inflammation-related genes (interleukin [IL]-1β and tumor necrosis factor α; P = .041 and P = .039), and muscle atrophy-related genes (atrogin 1 and myostatin; P = .006 and P < .001) was higher in the high-FI group compared with that in the low-FI group. In addition, adipogenic gene expression was significantly correlated with the expression of other categories of genes (all P < .05, except atrogin 1). A correlation of gene and protein expression was observed for IL-1β (P = .027) and myostatin (P = .029). CONCLUSIONS The radiologic grading of FI was associated with the expression of various genes, including adipogenic, fibrotic, inflammatory, and atrophy-related genes, and these genes were closely correlated with each other in terms of expression. This information could be helpful in patient counseling.
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Affiliation(s)
- Se-Young Ki
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong-Soo Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea; Joint Center, Barunsesang Hospital, Seongnam, Republic of Korea
| | - Ja-Yeon Kim
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Taewoo Lho
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea.
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Fabiś J, Danilewicz M, Niedzielski KR, Waszczykowski M, Fabiś-Strobin A, Bogucki A. The eccentric mechanotransduction, neuro-muscular transmission, and structural reversibility of muscle fatty infiltration. An experimental advanced disuse muscle-wasting model of rabbit supraspinatus. Arch Med Sci 2021; 17:1400-1407. [PMID: 34522269 PMCID: PMC8425242 DOI: 10.5114/aoms/131956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Full-thickness rotator cuff tear is present in almost 50% of patients over age 65 years, and its degree is known to be a good predictor of the severity of muscle-wasting (MW) sarcopaenia, also known as fatty degeneration (FD). A FD CT grade > 2° is recognized as a borderline of its reversibility. A disuse model of supraspinatus FD (grade 2) in rabbits provides clinically relevant data. Therefore, the present study evaluates the correlation between eccentric mechanotransduction, neuromuscular transmission (NT), and reversibility of muscle fatty infiltration (MFI) in rabbit supraspinatus FD > 2°. MATERIAL AND METHODS The supraspinatus tendon was detached from the greater tubercle, infraspinatus, and subscapularis in 16 rabbits. The tendon was reinserted after 12 weeks, and the animals were euthanized 24 weeks after reconstruction. MFI was measured in the middle part of the supraspinatus. Single-fibre EMG (SFEMG) examination of the supraspinatus NT was performed on 4 animals. RESULTS The power of analysis was 99%. Significant differences in MFI volume were found between the operated (4.6 ±1.1%) and the opposite control sides (2.91 ±0.61%) (p < 0.001). SFEMG revealed no significant differences between the disuse and the control supraspinatus muscles (p > 0.05); however, 6.5% of the examined muscle fibres exhibited NT disorders combined with blockade of conduction in 2.5% of muscle fibres. CONCLUSIONS Critical MFI in a disuse model of rabbit supraspinatus FD, CT grade > 2°, is substantially reversible by eccentric training despite subclinical impairment of neuromuscular transmission. In addition, 0.63% reversal of MFI is correlated with 1% hypertrophy of type I and II muscle fibre diameter.
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Affiliation(s)
- Jarosław Fabiś
- Department of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology Medical University of Lodz, Lodz, Poland
| | - Marian Danilewicz
- Morphometry Division, Department of Pathology, Medical University of Lodz, Lodz, Poland
| | - Kryspin R. Niedzielski
- Clinic of Orthopaedic and Traumatology Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Michał Waszczykowski
- Department of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology Medical University of Lodz, Lodz, Poland
| | - Anna Fabiś-Strobin
- Clinic of Orthopaedic and Traumatology Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Andrzej Bogucki
- Department of Extrapyramidal Diseases, Medical University of Lodz, Lodz, Poland
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Kuwahara Y, Kishimoto KN, Itoigawa Y, Okuno H, Hatta T, Matsuzawa G, Itoi E. Fatty degeneration and wnt10b expression in the supraspinatus muscle after surgical repair of torn rotator cuff tendon. J Orthop Surg (Hong Kong) 2020; 27:2309499019864817. [PMID: 31382826 DOI: 10.1177/2309499019864817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE In the torn rotator cuff muscles, decreased expression of wnt10b prior to elevation of peroxisome proliferator-activated receptor γ (PPARγ) and CCAAT/enhancer-binding protein α (C/EBPα) has previously been reported. The purpose of this study is to elucidate the expression profiles of these adipogenesis-related genes after rotator cuff detachment and reattachment in a rabbit model. METHODS We investigated gene expression profiles of PPARγ, C/EBPα, and wnt10b in different parts of rabbit supraspinatus (SSP) muscle after tendon detachment (n = 6 for each time point). In addition, we assessed expression of the same genes after SSP reattachment with different intervals from initial detachment (n = 6). Fatty degeneration of the SSP muscle was examined by Oil red-O staining. Gene expression profiles were examined by quantitative real-time polymerase chain reaction. RESULTS After SSP detachment, Oil red-O-positive oil deposits increased after 3 weeks. In the SSP reattachment model, numerous Oil red-O-positive cells were present at 5-week reattachment, following 2- and 3-week detachment. PPARγ and C/EBPα messenger ribonucleic acid expression exhibited a significant increase at 2 and 3 weeks after SSP detachment and remained increased at 5-week reattachment after 2- and 3-week detachment. A decreased expression of wnt10b was observed from 1 week after SSP detachment. Expression of wnt10b was recovered not in the central area of the SSP muscle but in the periphery after reattachment. Adipogenic change was not observed when SSP tendon was reattached after 1-week detachment. CONCLUSIONS These results may suggest that once the adipogenic transcription factors, PPARγ and C/EBPα, were elevated, repair surgery after rotator cuff tear could not prevent the emergence of fat in the SSP muscle.
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Affiliation(s)
- Yoshiyuki Kuwahara
- 1 Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Koshi N Kishimoto
- 1 Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.,2 Department of Orthopaedic Surgery, Tohoku Kosai Hospital, Sendai, Japan
| | - Yoshiaki Itoigawa
- 3 Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Hiroshi Okuno
- 1 Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Taku Hatta
- 1 Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Gaku Matsuzawa
- 1 Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- 1 Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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Lee C, Liu M, Agha O, Kim HT, Liu X, Feeley BT. Beige fibro-adipogenic progenitor transplantation reduces muscle degeneration and improves function in a mouse model of delayed repair of rotator cuff tears. J Shoulder Elbow Surg 2020; 29:719-727. [PMID: 31784382 PMCID: PMC7085983 DOI: 10.1016/j.jse.2019.09.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Muscle atrophy and fatty infiltration (FI) are common occurrences following rotator cuff (RC) tears. Tears of all sizes are subject to muscle degeneration. The degree of muscle degeneration following RC tears is highly correlated with repair success and functional outcomes. We have recently discovered that muscle fibro-adipogenic progenitors (FAPs) can differentiate into uncoupling protein 1 (UCP-1)-expressing beige adipocytes and induce muscle regeneration. This study evaluated the potential of local cell transplantation of beige adipose FAPs (BAT-FAPs) to treat RC muscle degeneration in a murine model of RC repair. METHODS BAT-FAPs were isolated from muscle in UCP-1 reporter mice by flow cytometry as UCP-1+/Sca1+/PDGFR+/CD31-/CD45-/integrin α7-. C57/BL6J mice underwent supraspinatus tendon tear with suprascapular nerve transection followed by repair 2 or 6 weeks after the initial injury. At the time of repair, mice received either no additional treatment, phosphate-buffered saline injection, or BAT-FAP injection. Functional outcomes were assessed by gait analysis. Mice were humanely killed at 6 weeks after cell transplantation. Supraspinatus muscle FI, fibrosis, muscle fiber size, and vascularity were analyzed and quantified via ImageJ. Analysis of variance with post hoc Tukey test and P <.05 was used to determine statistical significance. RESULTS Cell transplantation diminished fibrosis, FI, and atrophy and enhanced vascularization in both delayed repair models. Cell transplantation resulted in improved shoulder function as assessed with gait analysis in both the delayed repair models. CONCLUSIONS BAT-FAPs significantly reduced muscle degeneration and improved shoulder function after RC repair. BAT-FAPs hold significant promise as a therapeutic adjunct to repair for patients with advanced RC pathology.
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Affiliation(s)
- Carlin Lee
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mengyao Liu
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Obiajulu Agha
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Hubert T Kim
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Xuhui Liu
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Brian T Feeley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Lee YS, Kim JY, Ki SY, Chung SW. Influence of Smoking on the Expression of Genes and Proteins Related to Fat Infiltration, Inflammation, and Fibrosis in the Rotator Cuff Muscles of Patients With Chronic Rotator Cuff Tears: A Pilot Study. Arthroscopy 2019; 35:3181-3191. [PMID: 31785743 DOI: 10.1016/j.arthro.2019.06.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/13/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the altered gene and protein expression patterns in the rotator cuff muscles of smokers and non-smokers with rotator cuff tears and to identify the smoking-associated key genetic factor(s) involved in rotator cuff muscle physiology. METHODS Twenty-four samples of rotator cuff muscle from 12 current heavy smokers (mean age 61.8 ± 5.1 years) and age- and sex-matched 12 non-smokers (mean age 61.8 ± 6.9 years) with medium-sized tears were acquired during arthroscopic surgery. As a statistical method, the propensity score matching technique was used to select control group by 1:1 matching for age and sex. Inclusion criteria were patients who underwent arthroscopic repair for medium-sized full-thickness rotator cuff tears and those that were current smokers with a smoking history >20 packs/year. Patients lacking medium-sized tears, those with recent steroid injection history, isolated subscapularis tear, preoperative stiff shoulder, acute traumatic tear, or previous surgery on the same shoulder, or those that declined to participate were excluded. Alterations in the expression of genes and proteins associated with myogenesis, inflammation, adipogenesis, and muscle fibrosis were compared between smokers and non-smokers with reverse-transcription quantitative polymerase chain reaction, western blotting, and immunohistochemistry. RESULTS Histologic analysis revealed increased inflammation and remarkable fat accumulation and fibrogenesis in the rotator cuff muscle from smokers compared with that from non-smokers. The mRNA expression levels of inflammatory high mobility group box 1 (HMGB1; P = .043), adipogenic CCAAT/enhancer-binding protein alpha (P = .046) and peroxisome proliferator-activated receptor gamma (PPARγ; P = .048), myogenic differentiation 1 (P = .032), fibrogenic alpha-smooth muscle actin (α-SMA; P = .033), and metalloproteinase 9 (P = .036) were significantly greater in samples from smokers than from non-smokers. A correlation was observed between gene and protein expression of HMGB1 (P = .034), PPARγ (P = .021), and α-SMA (P = .021). CONCLUSIONS Smokers with rotator cuff tears showed high inflammation, large fat infiltration, and fibrosis in rotator cuff muscle that is associated with the increased expression of HMGB1, PPARγ, and α-SMA, respectively. LEVEL OF EVIDENCE Case control study (Prognostic level III).
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Affiliation(s)
- Yong-Soo Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ja-Yeon Kim
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Se-Young Ki
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea.
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Lee YS, Kim JY, Kim KI, Ki SY, Chung SW. Effect of Fatty Acid-Binding Protein 4 Inhibition on Rotator Cuff Muscle Quality: Histological, Biomechanical, and Biomolecular Analysis. Am J Sports Med 2019; 47:3089-3099. [PMID: 31518157 DOI: 10.1177/0363546519873856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A rotator cuff tear (RCT) induces fatty acid-binding protein 4 (FABP4) expression, resulting in ectopic fat accumulation in the rotator cuff muscle. PURPOSE To evaluate whether FABP4 inhibition reduces fatty infiltration and improves muscle physiology after RCT in a rat model. STUDY DESIGN Controlled laboratory study. METHODS Human supraspinatus muscle and deltoid muscle tissues were acquired from patients with RCTs during arthroscopic surgery, and FABP4 expression in the supraspinatus muscle was evaluated as compared with the intact deltoid muscle. A rat RCT model was established by detaching the supraspinatus tendon, after which a specific FABP4 inhibitor was locally injected into the supraspinatus muscle 4 times at 3-day intervals starting 2 weeks after the surgery. Body weight and blood glucose levels were measured at 2 and 4 weeks after the RCT, and the mRNA and protein expressions of various target molecules (including FABP4), histological changes, and biomechanical tensile strength were assessed in the supraspinatus muscles at 4 weeks after the RCT. RESULTS The expression of human FABP4 was significantly increased in the torn rotator cuff muscle as compared with the intact deltoid muscle. In the rat model, the mRNA and protein expressions of FABP4 and HIF1α were significantly increased by the RCT as compared with the control. The FABP4 inhibitor treatment significantly decreased FABP4 expression when compared with the vehicle treatment; however, HIF1α expression was not significantly decreased versus the vehicle treatment. Histologically, RCT induced noticeable muscle fatty infiltration, which was remarkably reduced by the local injection of the FABP4 inhibitor. Biomechanically, the tensile strength of the rotator cuff muscle after the RCT was significantly improved by the FABP4 inhibitor in terms of load to failure and total energy to failure. CONCLUSION RCT induces FABP4 expression in human and rat rotator cuff muscles. The FABP4 inhibitor drastically decreased the histological fatty infiltration caused by RCT and improved the tensile strength of the rotator cuff muscle. CLINICAL RELEVANCE FABP4 inhibitor may have a beneficial effect on the muscle quality after RCT.
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Affiliation(s)
- Yong-Soo Lee
- Department of Orthopedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Ja-Yeon Kim
- Department of Orthopedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Kwang Il Kim
- Department of Orthopedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Se-Young Ki
- Department of Orthopedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
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Gene Expression Patterns Analysis in the Supraspinatus Muscle after a Rotator Cuff Tear in a Mouse Model. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5859013. [PMID: 30671462 PMCID: PMC6323466 DOI: 10.1155/2018/5859013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022]
Abstract
Rotator cuff tear is a muscle-tendinous injury representative of various musculoskeletal disorders. In general, rotator cuff tear occurs in the tendon, but it causes unloading of the muscle resulting in muscle degeneration including fatty infiltration. These muscle degenerations lead to muscle weakness, pain, and loss of shoulder function and are well known as important factors for poor functional outcome after rotator cuff repair. Given that rotator cuff tear in various animal species results in similar pathological changes seen in humans, the animal model can be considered a good approach to understand the many aspects of the molecular changes in injured muscle. To comprehensively analyze changes in gene expression with time following a rotator cuff tear, we established a rotator cuff tear in mouse supraspinatus tendon of shoulder. At weeks 1 and 4 after the tear, the injured muscles were harvested for RNA isolation, and microarray analysis was performed. Expression patterns of genes belonging to 10 muscle physiology-related categories, including aging, apoptosis, atrophy, and fatty acid transport, were analyzed and further validated using real-time PCR. A total of 39,429 genes were analyzed, and significant changes in expression were observed for 12,178 genes at 1 week and 2,370 genes at 4 weeks after the tear. From the list of top 10 significantly up- and downregulated genes at the 2 time periods and the network evaluation of relevant genes according to the 10 categories, several important genes in each category were observed. In this study, we found that various genes are significantly altered after rotator cuff tear, and these genes may play key roles in controlling muscle degeneration after a rotator cuff tear.
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Hoberman AR, Cirino C, McCarthy MB, Cote MP, Pauzenberger L, Beitzel K, Mazzocca AD, Dyrna F. Bone Marrow-Derived Mesenchymal Stromal Cells Enhanced by Platelet-Rich Plasma Maintain Adhesion to Scaffolds in Arthroscopic Simulation. Arthroscopy 2018; 34:872-881. [PMID: 29146168 DOI: 10.1016/j.arthro.2017.08.291] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the response of bone marrow-derived mesenchymal stromal cells (bMSCs) enhanced by platelet-rich plasma (PRP) in the setting of a normal human tendon (NHT), a demineralized bone matrix (DBM), and a fibrin scaffold (FS) with simulated arthroscopic mechanical washout stress. METHODS Bone marrow was aspirated from the humeral head and concentrated. BMSCs were counted, plated, and grown to confluence. Cells were seeded onto 3 different scaffolds: (1) NHT, (2) DBM, and (3) FS. Each scaffold was treated with a combination of (+)/(-) PRP and (+)/(-) arthroscopic washout simulation. A period of 60 minutes was allotted before arthroscopic washout. Adhesion, proliferation, and differentiation assays were performed to assess cellular activity in each condition. RESULTS Significant differences were seen in mesenchymal stromal cell adhesion, proliferation, and differentiation among the scaffolds. DBM and FS showed superior results to NHT for cell adhesion, proliferation, and differentiation. PRP significantly enhanced cellular adhesion, proliferation, and differentiation. Arthroscopic simulation did not significantly decrease bMSC adhesion. CONCLUSIONS We found that the type of scaffold impacts bMSCs' behavior. Both scaffolds (DBM and FS) were superior to NHT. The use of an arthroscopic simulator did not significantly decrease the adhesion of bMSCs to the scaffolds nor did it decrease their biologic differentiation potential. In addition, PRP enhanced cellular adhesion, proliferation, and differentiation. CLINICAL RELEVANCE Improved healing after tendon repair can lead to better clinical outcomes. BMSCs are attractive for enhancing healing given their accessibility and regenerative potential. Application of bMSCs using scaffolds as cell carriers relies on arthroscopic feasibility.
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Affiliation(s)
- Alexander R Hoberman
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A..
| | - Carl Cirino
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Leo Pauzenberger
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Felix Dyrna
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
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Yoon JP, Jung JW, Lee CH, Kim YG, Chung SW, Kim JY, Lee HJ, Yoon JW, Lee H. Fatty Degeneration of the Rotator Cuff Reflects Shoulder Strength Deficits in Patients With Rotator Cuff Tears. Orthopedics 2018; 41:e15-e21. [PMID: 29136253 DOI: 10.3928/01477447-20171106-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/19/2017] [Indexed: 02/03/2023]
Abstract
Fatty degeneration is an important clinical factor in patients with rotator cuff tears. Goutallier grade, occupation ratio, and tangent sign help identify fatty degeneration; however, little is known about how closely these measurement techniques correlate with actual muscle strength deficits. The authors evaluated each method's ability to determine the correlation between fatty degeneration and muscle strength deficits. The authors included 203 patients who underwent full-thickness rotator cuff repair (mean age, 61.29±7.92 years). All patients were evaluated with preoperative magnetic resonance imaging to identify fatty degeneration and with an isokinetic test to determine actual shoulder strength. Fatty degeneration was evaluated using Goutallier grade, occupation ratio, and tangent sign. The actual shoulder strength deficit was evaluated by abduction, whereas external and internal rotation were tested using the isokinetic test. More severe fatty degeneration was correlated with lower degrees of abduction, external rotation, and internal rotation. The occupation ratio was more closely correlated with actual muscle strength deficits. However, in patients with massive tears, the correlation between fatty degeneration and muscle strength was less pronounced. Tangent sign (+) findings had a significantly lower strength of external rotation and abduction. The fatty degeneration of the rotator cuff muscle measured by each method was correlated with actual shoulder strength deficits in patients with rotator cuff tears. However, the correlations were less clear in patients with massive rotator cuff tears. Therefore, in cases of massive rotator cuff tears, fatty degeneration was correlated with muscle strength deficits but was not directly proportional to their extent. [Orthopedics. 2018; 41(1):e15-e21.].
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Shah SA, Kormpakis I, Cavinatto L, Killian ML, Thomopoulos S, Galatz LM. Rotator cuff muscle degeneration and tear severity related to myogenic, adipogenic, and atrophy genes in human muscle. J Orthop Res 2017; 35:2808-2814. [PMID: 28470887 PMCID: PMC5671367 DOI: 10.1002/jor.23593] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/17/2017] [Indexed: 02/04/2023]
Abstract
Large rotator cuff tear size and advanced muscle degeneration can affect reparability of tears and compromise tendon healing. Clinicians often rely on direct measures of rotator cuff tear size and muscle degeneration from magnetic resonance imaging (MRI) to determine whether the rotator cuff tear is repairable. The objective of this study was to identify the relationship between gene expression changes in rotator cuff muscle degeneration to standard data available to clinicians. Radiographic assessment of preoperative rotator cuff tear severity was completed for 25 patients with varying magnitudes of rotator cuff tears. Tear width and retraction were measured using MRI, and Goutallier grade, tangent (tan) sign, and Thomazeau grade were determined. Expression of myogenic-, adipogenic-, atrophy-, and metabolism-related genes in biopsied muscles were correlated with tear width, tear retraction, Goutallier grade, tan sign, and Thomazeau grade. Tear width positively correlated with Goutallier grade in both the supraspinatus (r = 0.73) and infraspinatus (r = 0.77), along with tan sign (r = 0.71) and Thomazeau grade (r = 0.68). Decreased myogenesis (Myf5), increased adipogenesis (CEBPα, Lep, Wnt10b), and decreased metabolism (PPARα) correlated with radiographic assessments. Gene expression changes suggest that rotator cuff tears lead to a dramatic molecular response in an attempt to maintain normal muscle tissue, increase adipogenesis, and decrease metabolism. Fat accumulation and muscle atrophy appear to stem from endogenous changes rather than from changes mediated by infiltrating cells. Results suggest that chronic unloading of muscle, induced by rotator cuff tear, disrupts muscle homeostasis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2808-2814, 2017.
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Affiliation(s)
- Shivam A. Shah
- Department of Orthopaedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
| | - Ioannis Kormpakis
- Department of Orthopaedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
| | - Leonardo Cavinatto
- Department of Orthopaedic Surgery, Icahn School of Medicine, Mount Sinai Health System, 5 East 98th St, 9th floor, New York, New York 10029
| | - Megan L. Killian
- Department of Orthopaedic Surgery, Washington University in St. Louis, Saint Louis, Missouri,Department of Biomedical Engineering, University of Delaware, Newark, Delaware
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, Black Building 1408, 650 W 168 ST, New York, New York 10032
| | - Leesa M. Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine, Mount Sinai Health System, 5 East 98th St, 9th floor, New York, New York 10029
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Lee YS, Kim JY, Oh KS, Chung SW. Fatty acid-binding protein 4 regulates fatty infiltration after rotator cuff tear by hypoxia-inducible factor 1 in mice. J Cachexia Sarcopenia Muscle 2017; 8:839-850. [PMID: 28382782 PMCID: PMC5659062 DOI: 10.1002/jcsm.12203] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/02/2017] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Fatty infiltration in skeletal muscle is directly linked to loss of muscle strength and is associated with various adverse physical outcomes such as muscle atrophy, inflammation, insulin resistance, mobility impairments, and even mortality in the elderly. Aging, mechanical unloading, muscle injury, and hormonal imbalance are main causes of muscle fat accumulation, and the fat cells are derived from muscle stem cells via adipogenic differentiation. However, the pathogenesis and molecular mechanisms of fatty infiltration in muscles are still not fully defined. Fatty acid-binding protein 4 (FABP4) is a carrier protein for fatty acids and is involved in fatty acid uptake, transport, and lipid metabolism. Rotator cuff tear (RCT) usually occurs in the elderly and is closely related with fatty infiltration in injured muscle. To investigate potential mechanisms for fatty infiltration other than adipogenic differentiation of muscle stem cells, we examined the role of FABP4 in muscle fatty infiltration in an RCT mouse model. METHODS In the RCT model, we evaluated the expression of FABP4 by qRT-PCR, western blotting, and immunohistochemical analyses. Histological changes such as inflammation and fat accumulation in the injured muscles were examined immunohistochemically. To evaluate whether hypoxia induces FABP4 expression, the levels of FABP4 mRNA and protein in C3H10T1/2 cells after hypoxia were examined. Using a transient transfection assay in 293T cells, we assessed the promoter activity of FABP4 by hypoxia-inducible factors (HIFs). Additionally, we evaluated the reduction in FABP4 expression and fat accumulation using specific inhibitors for HIF1 and FABP4, respectively. RESULTS FABP4 expression was significantly increased after RCT in mice, and its expression was localized in the intramuscular fatty region. Rotator cuff tear-induced FABP4 expression was up-regulated by hypoxia. HIF1α, which is activated by hypoxia, augmented the promoter activity of FABP4, together with HIF1β. Hypoxia-induced FABP4 expression was significantly decreased by HIF1 inhibitor treatment. Furthermore, in RCT model mice, fat accumulation was remarkably reduced by FABP4 inhibitor treatment. CONCLUSIONS This study shows that RCT induces FABP4 expression, leading to fat accumulation in injured muscle. FABP4 transcription is regulated by the direct binding of HIF1 to the FABP4 promoter in the hypoxic condition induced by RCT. Fat accumulation in injured muscle was reduced by the inhibition of FABP4. Ultimately, in the RCT model, we identified a novel mechanism for fatty infiltration by FABP4, which differs from adipogenic differentiation of muscle stem cells, and we found that fatty infiltration might be regulated by inhibition of HIF1 or FABP4.
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Affiliation(s)
- Yong-Soo Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Korea
| | - Ja-Yeon Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Korea
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23
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Kuenzler MB, Nuss K, Karol A, Schär MO, Hottiger M, Raniga S, Kenkel D, von Rechenberg B, Zumstein MA. Neer Award 2016: reduced muscle degeneration and decreased fatty infiltration after rotator cuff tear in a poly(ADP-ribose) polymerase 1 (PARP-1) knock-out mouse model. J Shoulder Elbow Surg 2017; 26:733-744. [PMID: 28131694 DOI: 10.1016/j.jse.2016.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/02/2016] [Accepted: 11/11/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Disturbed muscular architecture, atrophy, and fatty infiltration remain irreversible in chronic rotator cuff tears even after repair. Poly (adenosine 5'-diphosphate-ribose) polymerase 1 (PARP-1) is a key regulator of inflammation, apoptosis, muscle atrophy, muscle regeneration, and adipocyte development. We hypothesized that the absence of PARP-1 would lead to a reduction in damage to the muscle subsequent to combined tenotomy and neurectomy in a PARP-1 knockout (KO) mouse model. METHODS PARP-1 KO and wild-type C57BL/6 (WT group) mice were analyzed at 1, 6, and 12 weeks (total n = 84). In all mice, the supraspinatus and infraspinatus muscles of the left shoulder were detached and denervated. Macroscopic analysis, magnetic resonance imaging, gene expression analysis, immunohistochemistry, and histology were used to assess the differences in PARP-1 KO and WT mice. RESULTS The muscles in the PARP-1 KO group had significantly less retraction, atrophy, and fatty infiltration after 12 weeks than in the WT group. Gene expression of inflammatory, apoptotic, adipogenic, and muscular atrophy genes was significantly decreased in PARP-1 KO mice in the first 6 weeks. DISCUSSION Absence of PARP-1 leads to a reduction in muscular architectural damage, early inflammation, apoptosis, atrophy, and fatty infiltration after combined tenotomy and neurectomy of the rotator cuff muscle. Although the macroscopic reaction to injury is similar in the first 6 weeks, the ability of the muscles to regenerate was much greater in the PARP-1 KO group, leading to a near-normalization of the muscle after 12 weeks.
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Affiliation(s)
- Michael B Kuenzler
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Musculoskeletal Research Unit (MSRU), Equine Department, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Katja Nuss
- Musculoskeletal Research Unit (MSRU), Equine Department, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Agnieszka Karol
- Musculoskeletal Research Unit (MSRU), Equine Department, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Michael O Schär
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Hottiger
- Institute of Veterinary Biochemistry and Molecular Biology, University of Zürich, Zürich, Switzerland; Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Equine Department, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Sumit Raniga
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Kenkel
- Department of Diagnostic and Interventional Radiology, University Hospital of Zürich, Zürich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU), Equine Department, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland; Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Equine Department, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Shoulder & Elbow Unit, SportsClinic #1 AG, Bern, Switzerland.
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Eliasberg CD, Dar A, Jensen AR, Murray IR, Hardy WR, Kowalski TJ, Garagozlo CA, Natsuhara KM, Khan AZ, McBride OJ, Cha PI, Kelley BV, Evseenko D, Feeley BT, McAllister DR, Péault B, Petrigliano FA. Perivascular Stem Cells Diminish Muscle Atrophy Following Massive Rotator Cuff Tears in a Small Animal Model. J Bone Joint Surg Am 2017; 99:331-341. [PMID: 28196035 DOI: 10.2106/jbjs.16.00645] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears are a common cause of shoulder pain and often necessitate operative repair. Muscle atrophy, fibrosis, and fatty infiltration can develop after rotator cuff tears, which may compromise surgical outcomes. This study investigated the regenerative potential of 2 human adipose-derived progenitor cell lineages in a murine model of massive rotator cuff tears. METHODS Ninety immunodeficient mice were used (15 groups of 6 mice). Mice were assigned to 1 of 3 surgical procedures: sham, supraspinatus and infraspinatus tendon transection (TT), or TT and denervation via suprascapular nerve transection (TT + DN). Perivascular stem cells (PSCs) were harvested from human lipoaspirate and sorted using fluorescence-activated cell sorting into pericytes (CD146 CD34 CD45 CD31) and adventitial cells (CD146 CD34 CD45 CD31). Mice received no injection, injection with saline solution, or injection with pericytes or adventitial cells either at the time of the index procedure ("prophylactic") or at 2 weeks following the index surgery ("therapeutic"). Muscles were harvested 6 weeks following the index procedure. Wet muscle weight, muscle fiber cross-sectional area, fibrosis, and fatty infiltration were analyzed. RESULTS PSC treatment after TT (prophylactic or therapeutic injections) and after TT + DN (therapeutic injections) resulted in less muscle weight loss and greater muscle fiber cross-sectional area than was demonstrated for controls (p < 0.05). The TT + DN groups treated with pericytes at either time point or with adventitial cells at 2 weeks postoperatively had less fibrosis than the TT + DN controls. There was less fatty infiltration in the TT groups treated with pericytes at either time point or with adventitial cells at the time of surgery compared with controls. CONCLUSIONS Our findings demonstrated significantly less muscle atrophy in the groups treated with PSCs compared with controls. This suggests that the use of PSCs may have a role in the prevention of muscle atrophy without leading to increased fibrosis or fatty infiltration. CLINICAL RELEVANCE Improved muscle quality in the setting of rotator cuff tears may increase the success rates of surgical repair and lead to superior clinical outcomes.
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Affiliation(s)
- Claire D Eliasberg
- 1Hospital for Special Surgery, New York, NY 2University of California, Los Angeles, Los Angeles, California 3University of Edinburgh, Edinburgh, United Kingdom 4University of California, Davis, Davis, California 5Washington University, St. Louis, Missouri 6University of Southern California, Los Angeles, California 7University of California, San Francisco, San Francisco, California
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Rothrauff BB, Pauyo T, Debski RE, Rodosky MW, Tuan RS, Musahl V. The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:318-335. [PMID: 28084902 DOI: 10.1089/ten.teb.2016.0446] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The torn rotator cuff remains a persistent orthopedic challenge, with poor outcomes disproportionately associated with chronic, massive tears. Degenerative changes in the tissues that comprise the rotator cuff organ, including muscle, tendon, and bone, contribute to the poor healing capacity of chronic tears, resulting in poor function and an increased risk for repair failure. Tissue engineering strategies to augment rotator cuff repair have been developed in an effort to improve rotator cuff healing and have focused on three principal aims: (1) immediate mechanical augmentation of the surgical repair, (2) restoration of muscle quality and contractility, and (3) regeneration of native enthesis structure. Work in these areas will be reviewed in sequence, highlighting the relevant pathophysiology, developmental biology, and biomechanics, which must be considered when designing therapeutic applications. While the independent use of these strategies has shown promise, synergistic benefits may emerge from their combined application given the interdependence of the tissues that constitute the rotator cuff organ. Furthermore, controlled mobilization of augmented rotator cuff repairs during postoperative rehabilitation may provide mechanotransductive cues capable of guiding tissue regeneration and restoration of rotator cuff function. Present challenges and future possibilities will be identified, which if realized, may provide solutions to the vexing condition of chronic massive rotator cuff tears.
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Affiliation(s)
- Benjamin B Rothrauff
- 1 Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Thierry Pauyo
- 3 Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Richard E Debski
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Mark W Rodosky
- 3 Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Rocky S Tuan
- 1 Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Volker Musahl
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,3 Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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26
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The biology of rotator cuff healing. Orthop Traumatol Surg Res 2017; 103:S1-S10. [PMID: 28043853 DOI: 10.1016/j.otsr.2016.11.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 06/13/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023]
Abstract
Despite advances in surgical reconstruction of chronic rotator cuff (RC) tears leading to improved clinical outcomes, failure rates of 13-94% have been reported. Reasons for this rather high failure rate include compromised healing at the bone-tendon interface, as well as the musculo-tendinous changes that occur after RC tears, namely retraction and muscle atrophy, as well as fatty infiltration. Significant research efforts have focused on gaining a better understanding of these pathological changes in order to design effective therapeutic solutions. Biological augmentation, including the application of different growth factors, platelet concentrates, cells, scaffolds and various drugs, or a combination of the above have been studied. It is important to note that instead of a physiological enthesis, an abundance of scar tissue is formed. Even though cytokines have demonstrated the potential to improve rotator cuff healing in animal models, there is little information about the correct concentration and timing of the more than 1500 cytokines that interact during the healing process. There is only minimal evidence that platelet concentrates may lead to improvement in radiographic, but not clinical outcome. Using stem cells to biologically augment the reconstruction of the tears might have a great potential since these cells can differentiate into various cell types that are integral for healing. However, further studies are necessary to understand how to enhance the potential of these stem cells in a safe and efficient way. This article intends to give an overview of the biological augmentation options found in the literature.
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27
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Molecular signatures of age-associated chronic degeneration of shoulder muscles. Oncotarget 2017; 7:8513-23. [PMID: 26885755 PMCID: PMC4890983 DOI: 10.18632/oncotarget.7382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/30/2016] [Indexed: 12/13/2022] Open
Abstract
Chronic muscle diseases are highly prevalent in the elderly causing severe mobility limitations, pain and frailty. The intrinsic molecular mechanisms are poorly understood due to multifactorial causes, slow progression with age and variations between individuals. Understanding the underlying molecular mechanisms could lead to new treatment options which are currently limited. Shoulder complaints are highly common in the elderly, and therefore, muscles of the shoulder's rotator cuff could be considered as a model for chronic age-associated muscle degeneration. Diseased shoulder muscles were characterized by muscle atrophy and fatty infiltration compared with unaffected shoulder muscles. We confirmed fatty infiltration using histochemical analysis. Additionally, fibrosis and loss of contractile myosin expression were found in diseased muscles. Most cellular features, including proliferation rate, apoptosis and cell senescence, remained unchanged and genome-wide molecular signatures were predominantly similar between diseased and intact muscles. However, we found down-regulation of a small subset of muscle function genes, and up-regulation of extracellular region genes. Myogenesis was defected in muscle cell culture from diseased muscles but was restored by elevating MyoD levels. We suggest that impaired muscle functionality in a specific environment of thickened extra-cellular matrix is crucial for the development of chronic age-associated muscle degeneration.
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28
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Flück M, Ruoss S, Möhl CB, Valdivieso P, Benn MC, von Rechenberg B, Laczko E, Hu J, Wieser K, Meyer DC, Gerber C. Genomic and lipidomic actions of nandrolone on detached rotator cuff muscle in sheep. J Steroid Biochem Mol Biol 2017; 165:382-395. [PMID: 27523963 DOI: 10.1016/j.jsbmb.2016.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 01/06/2023]
Abstract
Reversal of fatty infiltration of pennate rotator cuff muscle after tendon release is hitherto impossible. The administration of nandrolone starting at the time of tendon release prevents the increase in fat content, but does not revert established fatty infiltration. We hypothesised that tendon release and myotendinous retraction cause alterations in lipid related gene expression leading to fatty muscle infiltration, which can be suppressed by nandrolone through its genomic actions if applied immediately after tendon release. The effects of infraspinatus tendon release and subsequent tendon repair at 16 weeks were studied in six Swiss Alpine sheep. In the interventional groups, 150mg nandrolone was administered weekly after tendon release until sacrifice (N22W, n=6) or starting at the time of repair (N6W, n=6). Infraspinatus volume, composition, expressed transcripts, lipids, and selected proteins were analyzed at baseline, 16 and 22 weeks. Tendon release reduced infraspinatus volume by 22% and increased fat content from 11% to 38%. These changes were not affected by repair. Fatty infiltration was associated with up-regulation of 227 lipid species, and increased levels of the adipocyte differentiation marker PPARG2 (peroxisome proliferator-activated receptor gamma 2). Nandrolone abrogated lipid accumulation, halved the loss in fiber area percentage, and up-regulated androgen receptor levels and transcript expression in the N22W but not the N6W group. The results document that nandrolone mitigates muscle-to-fat transformation after tendon release via a general down-regulation of lipid accumulation concomitantly with up-regulated expression of its nuclear receptor and downstream transcripts in skeletal muscle. Reduced responsiveness of retracted muscle to nandrolone as observed in the N6W group is reflected by a down-regulated transcript response.
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Affiliation(s)
- Martin Flück
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Balgrist Campus, Zurich, Switzerland.
| | - Severin Ruoss
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Christoph B Möhl
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Paola Valdivieso
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Mario C Benn
- Musculoskeletal Research Unit, Center for Applied Biotechnology and Molecular Medicine, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, Center for Applied Biotechnology and Molecular Medicine, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Endre Laczko
- Functional Genomics Center Zurich (FGCZ), ETH and University of Zurich, Switzerland
| | - Junmin Hu
- Functional Genomics Center Zurich (FGCZ), ETH and University of Zurich, Switzerland
| | - Karl Wieser
- Balgrist University Hospital, Department of Orthopedics, Zurich, Switzerland
| | - Dominik C Meyer
- Balgrist University Hospital, Department of Orthopedics, Zurich, Switzerland
| | - Christian Gerber
- Balgrist University Hospital, Department of Orthopedics, Zurich, Switzerland
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Voss A, McCarthy MB, Hoberman A, Cote MP, Imhoff AB, Mazzocca AD, Beitzel K. Extracellular Matrix of Current Biological Scaffolds Promotes the Differentiation Potential of Mesenchymal Stem Cells. Arthroscopy 2016; 32:2381-2392.e1. [PMID: 27353434 DOI: 10.1016/j.arthro.2016.04.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/24/2016] [Accepted: 04/26/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to quantitatively assess the ability of bone marrow-derived mesenchymal stem cells (bMSC) to differentiate toward bone, fat, cartilage, and tendon lineages when grown on commercially available scaffolds compared with control and native tendon tissue. METHODS BMSCs were cultured and analyzed by fluorescent automated cells sorting for surface markers CD73, -90, and -105. BMSCs were grown on rotator cuff tendon (RCT), decellularized human dermis patch (DDP), bilayer collagen matrix, and fibrin matrix (FM) to test their differentiation potential using quantitative polymerase chain reaction and establish markers for osteogenic, adipogenic, chondrogenic, and tenogenic lineages. Immunocytochemical testing was used to determine the specific proteins present on the scaffolds. RESULTS Alkaline phosphatase and osteocalcin gene expression was significantly higher on RCT (P < .001) and collagen scaffold (CS) (P < .001) compared with DDP and FM scaffolds (P < .001, P < .001). When differentiated toward a cartilage lineage, bMSCs grown on CS had significantly more type II collagen and aggrecan compared with DDP (P < .001, P < .001), FM (P < .001, P < .001), and RCT (P < .001, P < .001). Differentiated bMSCs grown on the CS had a significant increase in PPARγ and FABP4 gene expression compared with bMSCs grown on all other scaffolds (all P < .001). The differentiation of bMSCs into tendon on CSs had significantly more tenacin C, decorin, and type III collagen gene expression when compared with RCT, DDP, and FM (all P < .001). Decorin gene expression in the control undifferentiated CS was also significantly increased, suggesting that the matrix alone may promote a tenogenic lineage (P = .637). CONCLUSIONS Differences in the extracellular matrix composition of scaffolds significantly impact their potential to promote differentiation of bMSCs. Comparing the native RCT to the tested scaffolds showed that a high content of type I and III collagen significantly increased the potential of bMSCs to differentiate toward bone, tendon, fat, and cartilage lineages. CLINICAL RELEVANCE This in vitro study shows the differences between commercially available scaffolds for rotator cuff repairs. Therefore, these results support clinical use depending on the surgical intention and the potential of bMSCs to differentiate into bone, tendon, cartilage, and fat tissue.
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Affiliation(s)
- Andreas Voss
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Alexander Hoberman
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
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30
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Lebaschi A, Deng XH, Zong J, Cong GT, Carballo CB, Album ZM, Camp C, Rodeo SA. Animal models for rotator cuff repair. Ann N Y Acad Sci 2016; 1383:43-57. [DOI: 10.1111/nyas.13203] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/12/2016] [Accepted: 07/18/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Amir Lebaschi
- Tissue Engineering; Repair, and Regeneration Program
| | | | - Jianchun Zong
- Tissue Engineering; Repair, and Regeneration Program
| | | | | | - Zoe M. Album
- Tissue Engineering; Repair, and Regeneration Program
| | - Christopher Camp
- Tissue Engineering; Repair, and Regeneration Program
- Sports Medicine and Shoulder Service; Hospital for Special Surgery; New York New York
| | - Scott A. Rodeo
- Tissue Engineering; Repair, and Regeneration Program
- Sports Medicine and Shoulder Service; Hospital for Special Surgery; New York New York
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31
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Tabuchi K, Soejima T, Murakami H, Noguchi K, Shiba N, Nagata K. Inducement of tissue regeneration of harvested hamstring tendons in a rabbit model. Bone Joint Res 2016; 5:247-52. [PMID: 27340141 PMCID: PMC4957180 DOI: 10.1302/2046-3758.56.2000585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 04/07/2016] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The objective of this study was to determine if the use of fascia lata as a tendon regeneration guide (placed into the tendon canal following harvesting the semitendinosus tendon) would improve the incidence of tissue regeneration and prevent fatty degeneration of the semitendinosus muscle. MATERIALS AND METHODS Bilateral semitendinosus tendons were harvested from rabbits using a tendon stripper. On the inducing graft (IG) side, the tendon canal and semitendinosus tibial attachment site were connected by the fascia lata, which was harvested at the same width as the semitendinosus tendon. On the control side, no special procedures were performed. Two groups of six rabbits were killed at post-operative weeks 4 and 8, respectively. In addition, three healthy rabbits were killed to obtain normal tissue. We evaluated the incidence of tendon tissue regeneration, cross-sectional area of the regenerated tendon tissue and proportion of fatty tissue in the semitendinosus muscle. RESULTS At post-operative week 8, the distal end of the regenerated tissue reached the vicinity of the tibial insertion on the control side in two of six specimens. On the IG side, the regenerated tissue maintained continuity with the tibial insertion in all specimens. The cross-sectional area of the IG side was significantly greater than that of the control side. The proportion of fatty tissue in the semitendinosus muscle on the IG side was comparable with that of the control side, but was significantly greater than that of the normal muscle. CONCLUSIONS Tendon tissue regenerated with the fascia lata graft was thicker than naturally occurring regenerated tissue. However, the proportion of fatty tissue in the semitendinosus muscle was greater than that of normal muscle.Cite this article: K. Tabuchi, T. Soejima, H. Murakami, K. Noguchi, N. Shiba, K. Nagata. Inducement of tissue regeneration of harvested hamstring tendons in a rabbit model. Bone Joint Res 2016;5:247-252. DOI: 10.1302/2046-3758.56.2000585.
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Affiliation(s)
- K Tabuchi
- Department of Orthopaedic Surgery, Kurume University Medical Center, Kokubu-machi 155-1, Kurume 839-0863, Japan
| | - T Soejima
- Institute of Health and Sports Science, Kurume University, Mii-machi 1635, Kurume 839-8502, Japan
| | - H Murakami
- Department of Orthopedic Surgery and Sports Clinic, Murakami Hospital, Uo-machi 12-5, Tagawa 825-0014, Japan
| | - K Noguchi
- Department of Orthopaedic Surgery, Kurume University Medical Center, Kokubu-machi 155-1, Kurume 839-0863, Japan
| | - N Shiba
- Department of Orthopaedic Surgery, Kurume University, Asahi-machi 67, Kurume 830-0011, Japan
| | - K Nagata
- Department of Orthopaedic Surgery, Kurume University, Asahi-machi 67, Kurume 830-0011, Japan
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TGF-β Small Molecule Inhibitor SB431542 Reduces Rotator Cuff Muscle Fibrosis and Fatty Infiltration By Promoting Fibro/Adipogenic Progenitor Apoptosis. PLoS One 2016; 11:e0155486. [PMID: 27186977 PMCID: PMC4871364 DOI: 10.1371/journal.pone.0155486] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/29/2016] [Indexed: 12/21/2022] Open
Abstract
Rotator cuff tears represent a large burden of muscle-tendon injuries in our aging population. While small tears can be repaired surgically with good outcomes, critical size tears are marked by muscle atrophy, fibrosis, and fatty infiltration, which can lead to failed repair, frequent re-injury, and chronic disability. Previous animal studies have indicated that Transforming Growth Factor-β (TGF-β) signaling may play an important role in the development of these muscle pathologies after injury. Here, we demonstrated that inhibition of TGF-β1 signaling with the small molecule inhibitor SB431542 in a mouse model of massive rotator cuff tear results in decreased fibrosis, fatty infiltration, and muscle weight loss. These observed phenotypic changes were accompanied by decreased fibrotic, adipogenic, and atrophy-related gene expression in the injured muscle of mice treated with SB431542. We further demonstrated that treatment with SB431542 reduces the number of fibro/adipogenic progenitor (FAP) cells-an important cellular origin of rotator cuff muscle fibrosis and fatty infiltration, in injured muscle by promoting apoptosis of FAPs. Together, these data indicate that the TGF-β pathway is a critical regulator of the degenerative muscle changes seen after massive rotator cuff tears. TGF-β promotes rotator cuff muscle fibrosis and fatty infiltration by preventing FAP apoptosis. TGF-β regulated FAP apoptosis may serve as an important target pathway in the future development of novel therapeutics to improve muscle outcomes following rotator cuff tear.
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Thankam FG, Dilisio MF, Agrawal DK. Immunobiological factors aggravating the fatty infiltration on tendons and muscles in rotator cuff lesions. Mol Cell Biochem 2016; 417:17-33. [PMID: 27160936 DOI: 10.1007/s11010-016-2710-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/23/2016] [Indexed: 12/14/2022]
Abstract
Rotator cuff lesions (RCLs) are a common cause of shoulder pain and dysfunction. The rotator cuff tendons can degenerate and/or tear from the greater tuberosity of the humerus, which is associated with several anatomical, physiological, biochemical, and molecular changes in tendon and muscle. In this article, these pathways are critically reviewed and discussed with various management strategies of RCLs. The article also highlights the immunobiological responses following the RCL and the inherent repair mechanisms elicited by the body. The greatest difficulty in treating this pathology is that the muscle can undergo irreversible fatty infiltration in the setting of chronic tears that is associated with poor surgical outcomes. The article also investigates the key molecular pathways of the muscle homeostasis (mTOR, Rho kinase, AMPK, and Ca(2+)) with the energy metabolism to propose a possible mechanism for fatty infiltration. Future research is warranted to target the key players of these pathways in the management of fatty infiltration and thus RCL.
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Affiliation(s)
- Finosh G Thankam
- Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA
| | - Matthew F Dilisio
- Department of Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Devendra K Agrawal
- Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA.
- Department of Clinical & Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA.
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Development of an Arthroscopic Joint Capsule Injury Model in the Canine Shoulder. PLoS One 2016; 11:e0147949. [PMID: 26808837 PMCID: PMC4725771 DOI: 10.1371/journal.pone.0147949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The natural history of rotator cuff tears can be unfavorable as patients develop fatty infiltration and muscle atrophy that is often associated with a loss of muscle strength and shoulder function. To facilitate study of possible biologic mechanisms involved in early degenerative changes to rotator cuff muscle and tendon tissues, the objective of this study was to develop a joint capsule injury model in the canine shoulder using arthroscopy. METHODS Arthroscopic surgical methods for performing a posterior joint capsulectomy in the canine shoulder were first defined in cadavers. Subsequently, one canine subject underwent bilateral shoulder joint capsulectomy using arthroscopy, arthroscopic surveillance at 2, 4 and 8 weeks, and gross and histologic examination of the joint at 10 weeks. RESULTS The canine subject was weight-bearing within eight hours after index and follow-up surgeries and had no significant soft tissue swelling of the shoulder girdle or gross lameness. Chronic synovitis and macroscopic and microscopic evidence of pathologic changes to the rotator cuff bony insertions, tendons, myotendinous junctions and muscles were observed. CONCLUSIONS This study demonstrates feasibility and proof-of-concept for a joint capsule injury model in the canine shoulder. Future work is needed to define the observed pathologic changes and their role in the progression of rotator cuff disease. Ultimately, better understanding of the biologic mechanisms of early progression of rotator cuff disease may lead to clinical interventions to halt or slow this process and avoid the more advanced and often irreversible conditions of large tendon tears with muscle fatty atrophy.
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Cho E, Zhang Y, Pruznak A, Kim HM. Effect of tamoxifen on fatty degeneration and atrophy of rotator cuff muscles in chronic rotator cuff tear: An animal model study. J Orthop Res 2015; 33:1846-53. [PMID: 26121952 DOI: 10.1002/jor.22964] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/03/2015] [Indexed: 02/04/2023]
Abstract
Fatty degeneration of the rotator cuff muscles is an irreversible change resulting from chronic rotator cuff tear and is associated with poor clinical outcomes following rotator cuff repair. We evaluated the effect of Tamoxifen, a competitive estrogen receptor inhibitor, on fatty degeneration using a mouse model for chronic rotator cuff tear. Sixteen adult mice were divided into two diet groups (Tamoxifen vs. Regular) and subjected to surgical creation of a large rotator cuff tear and suprascapular nerve transection in their left shoulder with the right shoulder serving as a control. The rotator cuff muscles were harvested at 16 weeks and subjected to histology and RT-PCR for adipogenic and myogenic markers. Histology showed substantially decreased atrophy and endomysial inflammation in Tamoxifen group, but no significant differences in the amount of intramuscular adipocytes and lipid droplets compared to the Regular group. With RT-PCR, the operated shoulders showed significant upregulation of myogenin and PPAR-γ, and downregulation of myostatin compared to the nonsurgical shoulder. No significant differences of gene expression were found between the two diet groups. Our study demonstrated that tamoxifen diet leads to decreased muscle atrophy and inflammatory changes following chronic rotator cuff tear, but has no apparent effect on adipogenesis.
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Affiliation(s)
- Edward Cho
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Yue Zhang
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Anne Pruznak
- Cellular and Molecular Physiology, Penn State College of Medicine, Hershey, Pennsylvania
| | - H Mike Kim
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
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Stein T, Buckup J, Efe T, von Eisenhart-Rothe R, Hoffmann R, Zimmermann E, Welsch F. Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique. Arch Orthop Trauma Surg 2015; 135:369-82. [PMID: 25663019 DOI: 10.1007/s00402-015-2158-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Muscular recovery of structural integrity after arthroscopic Bankart repair using the para- and trans-musculotendinous three-portal technique has not been investigated. MATERIALS AND METHODS Twenty-seven athletes [mean age 26.9 years, (group 1; G1)] were prospectively and longitudinally monitored after arthroscopic Bankart repair using the three-portal technique by magnetic resonance imaging (MRI) and specific clinical muscular testing. The muscular integrity was assessed at the subscapularis (SSC) for the para-tendinous anteroinferior portal, the supraspinatus (SSP) for the trans-tendinous suprabicipital portal, and the infraspinatus (ISP) for the trans-tendinous posterior portal. Muscular atrophy was assessed by standardized ratios of transverse and vertical diameters for the SSC and ISP, as defined by cross-sectional area ratios for the SSP. Fatty infiltration was assessed by signal intensity analysis for the upper and lower SSC, SSP, and upper ISP as a ratio with the lower ISP. These parameters were analyzed for pre-operative (T0), 1-year (T1), and 2-year status (T2), and compared to 27 healthy volunteers [mean age 29.4 years, (group 2, G2)]. RESULTS The structural integrity assessments were performed after 14.8 (T1) and 32.0 months (T2). The SSC analysis revealed no muscular impairments in the upper and lower portions between T0 and T2 or compared to G2. MRI analysis for SSP and ISP showed full muscular recovery without any changes between T0 and T2 or deficits compared to G2. The number of pre-operative dislocations had no influence on the muscular integrity. MR analysis detected signs of overuse syndrome in 15 % at T0, 41 % at T1, and 63 % at T2; 77, 22, and 26 % of patients at T0, T1, and T2, respectively, were symptomatic. CONCLUSIONS Arthroscopic Bankart repair using the three-portal technique prevents full muscular integrity for para-tendinous anteroinferior portals at the SSC, the trans-tendinous suprabicipital portal through the SSP, and the trans-tendinous portal through the ISP.
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Affiliation(s)
- T Stein
- Department of Sporttraumatology, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany,
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Simvastatin reduces fibrosis and protects against muscle weakness after massive rotator cuff tear. J Shoulder Elbow Surg 2015; 24:280-7. [PMID: 25213828 PMCID: PMC4291297 DOI: 10.1016/j.jse.2014.06.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/14/2014] [Accepted: 06/27/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic rotator cuff tears are a common source of shoulder pain and disability, and patients with chronic cuff tears often have substantial weakness, fibrosis, inflammation, and fat accumulation. Identifying therapies to prevent the development of these pathologic processes will likely have a positive impact on clinical outcomes. Simvastatin is a drug with demonstrated anti-inflammatory and antifibrotic effects in many tissues but had not previously been studied in the context of rotator cuff tears. We hypothesized that after the induction of a massive supraspinatus tear, simvastatin would protect muscles from a loss of force production and fibrosis. METHODS We measured changes in muscle fiber contractility, histology, and biochemical markers of fibrosis and fatty infiltration in rats that received a full-thickness supraspinatus tear and were treated with either carrier alone or simvastatin. RESULTS Compared with vehicle-treated controls, simvastatin did not have an appreciable effect on muscle fiber size, but treatment did increase muscle fiber specific force by 20%. Simvastatin also reduced collagen accumulation by 50% but did not affect triglyceride content of muscles. Several favorable changes in the expression of genes and other markers of inflammation, fibrosis, and regeneration were also observed. CONCLUSIONS Simvastatin partially protected muscles from the weakness that occurs as a result of chronic rotator cuff tear. Fibrosis was also markedly reduced in simvastatin-treated animals. Whereas further studies are necessary, statin medication could potentially help improve outcomes for patients with rotator cuff tears.
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Kim SH, Chung SW, Oh JH. Expression of insulin-like growth factor type 1 receptor and myosin heavy chain in rabbit's rotator cuff muscle after injection of adipose-derived stem cell. Knee Surg Sports Traumatol Arthrosc 2014; 22:2867-73. [PMID: 23736255 DOI: 10.1007/s00167-013-2560-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 05/29/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE This study was performed to evaluate the effects of adipose-derived mesenchymal stem cells (ADMSC) in a subacute rotator cuff tear model of a rabbit by way of comparing the expression of insulin-like growth factor 1 receptor (IGF-1R) and myosin heavy chain (MyHC) in the ADMSC injected muscle and control. METHODS Supraspinatus tears were created in both shoulders of 11 rabbits, and rotator cuff repair was performed after 3 weeks. At the time of repair, each side of the shoulders was randomly selected, and the injection of the ADMSCs at the muscle belly near musculotendinous junction (injection side) and saline to the contralateral side (control side) was performed. After 3 weeks, we randomly assigned 5 rabbits to the immunohistochemistric analysis and 6 to Western blot analysis. RESULTS Expression of both IGF-1R (95 kD) and MyHC (200 kD) at the injection side was significantly elevated compared to control side (both p = 0.028). Immunohistochemistry showed that staining areas of both IGF-1R and MyHC were overlapped with staining of ADMSCs. CONCLUSION The injection of ADMSCs resulted in high expression of IGF-1R and MyHC in subacute rotator cuff tear and repaired model in rabbit compared to control side. Therefore, the injected ADMSCs may assist in regeneration of the rotator cuff muscle by way of insulin-like growth factor 1 (IGF-1) signalling pathway. This result may suggest another solution to facilitate the recovery of rotator cuff muscle and to improve the result of rotator cuff repair by ADMSC injection via IGF-1 pathway, which is one of the potent anabolic pathways.
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Affiliation(s)
- Sae Hoon Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Choo A, McCarthy M, Pichika R, Sato EJ, Lieber RL, Schenk S, Lane JG, Ward SR. Muscle gene expression patterns in human rotator cuff pathology. J Bone Joint Surg Am 2014; 96:1558-65. [PMID: 25232080 PMCID: PMC4159966 DOI: 10.2106/jbjs.m.01585] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff pathology is a common source of shoulder pain with variable etiology and pathoanatomical characteristics. Pathological processes of fatty infiltration, muscle atrophy, and fibrosis have all been invoked as causes for poor outcomes after rotator cuff tear repair. The aims of this study were to measure the expression of key genes associated with adipogenesis, myogenesis, and fibrosis in human rotator cuff muscle after injury and to compare the expression among groups of patients with varied severities of rotator cuff pathology. METHODS Biopsies of the supraspinatus muscle were obtained arthroscopically from twenty-seven patients in the following operative groups: bursitis (n = 10), tendinopathy (n = 7), full-thickness rotator cuff tear (n = 8), and massive rotator cuff tear (n = 2). Quantitative polymerase chain reaction (qPCR) was performed to characterize gene expression pathways involved in myogenesis, adipogenesis, and fibrosis. RESULTS Patients with a massive tear demonstrated downregulation of the fibrogenic, adipogenic, and myogenic genes, indicating that the muscle was not in a state of active change and may have difficulty responding to stimuli. Patients with a full-thickness tear showed upregulation of fibrotic and adipogenic genes; at the tissue level, these correspond to the pathologies most detrimental to outcomes of surgical repair. Patients with bursitis or tendinopathy still expressed myogenic genes, indicating that the muscle may be attempting to accommodate the mechanical deficiencies induced by the tendon tear. CONCLUSIONS Gene expression in human rotator cuff muscles varied according to tendon injury severity. Patients with bursitis and tendinopathy appeared to be expressing pro-myogenic genes, whereas patients with a full-thickness tear were expressing genes associated with fatty atrophy and fibrosis. In contrast, patients with a massive tear appeared to have downregulation of all gene programs except inhibition of myogenesis. CLINICAL RELEVANCE These data highlight the difficulty in treating massive tears and suggest that the timing of treatment may be important for muscle recovery. Specifically, earlier interventions to address tendon injury may allow muscles to respond more appropriately to mechanical stimuli.
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Affiliation(s)
- Alexander Choo
- Departments of Orthopaedic Surgery (A.C., M.M., R.P., S.S., and J.G.L.), Bioengineering (E.J.S. and R.L.L.), and Radiology (S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Meagan McCarthy
- Departments of Orthopaedic Surgery (A.C., M.M., R.P., S.S., and J.G.L.), Bioengineering (E.J.S. and R.L.L.), and Radiology (S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Rajeswari Pichika
- Departments of Orthopaedic Surgery (A.C., M.M., R.P., S.S., and J.G.L.), Bioengineering (E.J.S. and R.L.L.), and Radiology (S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Eugene J. Sato
- Departments of Orthopaedic Surgery (A.C., M.M., R.P., S.S., and J.G.L.), Bioengineering (E.J.S. and R.L.L.), and Radiology (S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Richard L. Lieber
- Departments of Orthopaedic Surgery (A.C., M.M., R.P., S.S., and J.G.L.), Bioengineering (E.J.S. and R.L.L.), and Radiology (S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Simon Schenk
- Departments of Orthopaedic Surgery (A.C., M.M., R.P., S.S., and J.G.L.), Bioengineering (E.J.S. and R.L.L.), and Radiology (S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - John G. Lane
- Departments of Orthopaedic Surgery (A.C., M.M., R.P., S.S., and J.G.L.), Bioengineering (E.J.S. and R.L.L.), and Radiology (S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Samuel R. Ward
- Departments of Orthopaedic Surgery (A.C., M.M., R.P., S.S., and J.G.L.), Bioengineering (E.J.S. and R.L.L.), and Radiology (S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
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Gumucio J, Flood M, Harning J, Phan A, Roche S, Lynch E, Bedi A, Mendias C. T lymphocytes are not required for the development of fatty degeneration after rotator cuff tear. Bone Joint Res 2014; 3:262-72. [PMID: 25185444 PMCID: PMC4220170 DOI: 10.1302/2046-3758.39.2000294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives Rotator cuff tears are among the most common and debilitating
upper extremity injuries. Chronic cuff tears result in atrophy and
an infiltration of fat into the muscle, a condition commonly referred
to as ‘fatty degeneration’. While stem cell therapies hold promise
for the treatment of cuff tears, a suitable immunodeficient animal
model that could be used to study human or other xenograft-based
therapies for the treatment of rotator cuff injuries had not previously
been identified. Methods A full-thickness, massive supraspinatus and infraspinatus tear
was induced in adult T-cell deficient rats. We hypothesised that,
compared with controls, 28 days after inducing a tear we would observe
a decrease in muscle force production, an accumulation of type IIB
fibres, and an upregulation in the expression of genes involved
with muscle atrophy, fibrosis and inflammation. Results Chronic cuff tears in nude rats resulted in a 30% to 40% decrease
in muscle mass, a 23% reduction in production of muscle force, and
an induction of genes that regulate atrophy, fibrosis, lipid accumulation,
inflammation and macrophage recruitment. Marked large lipid droplet
accumulation was also present. Conclusions The extent of degenerative changes in nude rats was similar to
what was observed in T-cell competent rats. T cells may not play
an important role in regulating muscle degeneration following chronic
muscle unloading. The general similarities between nude and T-cell
competent rats suggest the nude rat is likely an appropriate preclinical
model for the study of xenografts that have the potential to enhance
the treatment of chronically torn rotator cuff muscles. Cite this article: Bone Joint Res 2014;3:262–72.
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Affiliation(s)
- J Gumucio
- University of Michigan, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, Michigan, 48109-2200, USA
| | - M Flood
- University of Michigan, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, Michigan, 48109-2200, USA
| | - J Harning
- University of Michigan, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, Michigan, 48109-2200, USA
| | - A Phan
- University of Michigan, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, Michigan, 48109-2200, USA
| | - S Roche
- University of Michigan, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, Michigan, 48109-2200, USA
| | - E Lynch
- University of Michigan, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, Michigan, 48109-2200, USA
| | - A Bedi
- University of Michigan, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, Michigan, 48109-2200, USA
| | - C Mendias
- University of Michigan, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, Michigan, 48109-2200, USA
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Abstract
Objectives Although many clinical and experimental investigations have shed
light on muscle atrophy and intramuscular accumulation of fat after
rotator cuff disruption, none have reported on their onset in the
absence of muscle retraction. Methods In 30 rabbits, we detached one supraspinatus (SSP) tendon and
repaired it immediately, thus preventing muscle retraction. The
animals were killed in groups of 10 at one, two and six weeks. Both
shoulders of 15 non-operated rabbits served as controls. We measured
the weight and volume of SSP muscles and quantified the cross-sectional
area of intramuscular fat (i-fat) histologically. Results There was significant loss of muscle weight and volume after
one week (p = 0.004 and 0.003, respectively), and two weeks (both
p < 0.001) in the experimental group; which recovered to control
values after six weeks. I-fat accumulated one week after immediate repair,
greater than in the control group and statistically significant
at the mid-part of the muscle (mean 2.7% vs 1.5%,
p = 0.008). I-fat continued to accumulate up to six weeks at all sites
of the SSP muscle (all 3, p < 0.001). More fat accumulated closer
to the musculotendinous junction than at the mid-part after two
and six weeks (p = 0.012 and 0.019, respectively). Conclusion Muscle atrophy and i-fat accumulation occur early after SSP tendon
tear and immediate repair. While early repair benefitted muscle
recovery, it did not prevent fat accumulation. SSP muscle retraction
was not essential to the muscle alterations. The divergent evolution
of muscle and fat points to different pathophysiologies.
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Affiliation(s)
- H K Uhthoff
- University of Ottawa, Boneand Joint Research Lab, 451 Smyth Rd, Room 1319, Ottawa, Ontario, K1H8M5, Canada
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Shi LL, Boykin RE, Lin A, Warner JJP. Association of suprascapular neuropathy with rotator cuff tendon tears and fatty degeneration. J Shoulder Elbow Surg 2014; 23:339-46. [PMID: 24054975 DOI: 10.1016/j.jse.2013.06.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 05/22/2013] [Accepted: 06/01/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The mutual influence of suprascapular neuropathy (SSN) and rotator cuff tendon tears on muscle pathology is unclear. Debate continues as to how retracted cuff tears can lead to SSN and whether SSN or tendon retraction causes muscle fatty degeneration. METHODS A cohort of 87 patients suspected of having SSN was identified from a prospectively collected registry. All underwent electromyography/nerve conduction velocity study (EMG/NCV) and magnetic resonance imaging (MRI) of their shoulders. EMG/NCVs were performed and interpreted by electrodiagnosticians, and MRI cuff tendon quality and muscle fatty degeneration were interpreted by two surgeons. RESULTS Out of 87 patients, 32 patients had SSN on EMG/NCV, and 55 patients had normal suprascapular nerve. MRI showed that 59 of 87 supraspinatus had no fatty degeneration or mild fatty streaks (Goutallier grades 0 and 1), and 28 patients had significant fatty degeneration (grades 2-4); infraspinatus fatty degeneration was similar. Review of supraspinatus tendon showed 41 patients with intact tendons or partial tears, and 46 with full tears. Infraspinatus tendons pathology was similar. Tendon pathology and fatty degeneration were related (P-value<.001), with more severe tendon pathology leading to higher degree of fatty degeneration. Infraspinatus tendon tears were associated with SSN (P = .01), but SSN was not related to fatty degeneration of either supraspinatus or infraspinatus (P-values .65, .54). CONCLUSION The exact association and etiology of SSN in patients with rotator cuff pathology remain unclear. SSN is correlated to tendon tear size, but it does not have significant influence on fatty degeneration of either supraspinatus or infraspinatus.
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Affiliation(s)
- Lewis L Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Albert Lin
- Division of Shoulder Surgery and Sports Medicine, University of Pittsburgh UPMC, Center for Sports Medicine, Pittsburgh, PA, USA
| | - Jon J P Warner
- Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA, USA.
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Plate JF, Pace LA, Seyler TM, Moreno RJ, Smith TL, Tuohy CJ, Mannava S. Age-related changes affect rat rotator cuff muscle function. J Shoulder Elbow Surg 2014; 23:91-8. [PMID: 23791493 DOI: 10.1016/j.jse.2013.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 01/08/2013] [Accepted: 04/17/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of age on rotator cuff function and muscle structure remains poorly understood. We hypothesize that normal aging influences rotator cuff function, muscle structure, and regulatory protein expression in an established rat model of aging. METHODS Seventeen rats were obtained from the National Institute on Aging. The supraspinatus muscles in 11 middle-aged (12 months old) and 6 old (28 months old) rats were studied for age-related changes in rotator cuff neuromuscular function by in vivo muscle force testing and electromyography (EMG). Changes in muscle structure and molecular changes were assessed with quantitative immunohistochemistry for myogenic determination factor 1 (MyoD) and myogenic factor 5 (Myf5) expression. RESULTS Old animals revealed significantly decreased peak tetanic muscle force at 0.5 N and 0.7 N preload tension (P < .05). The age of the animal accounted for 20.9% of variance and significantly influenced muscle force (P = .026). Preload tension significantly influenced muscle force production (P < .001) and accounted for 12.7% of total variance. There was regional heterogeneity in maximal compound motor action potential (CMAP) amplitude in the supraspinatus muscle; the proximal portion had a significantly higher CMAP than the middle and distal portions (P < .05). The expression of muscle regulatory factors MyoD and Myf5 was significantly decreased in old animals compared with middle-aged animals (P < .05). CONCLUSIONS The normal aging process in this rat model significantly influenced contractile strength of the supraspinatus muscle and led to decreased expression of muscle regulatory factors. High preload tensions led to a significant decrease in force production in both middle-aged and old animals.
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Affiliation(s)
- Johannes F Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA; The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC, USA.
| | - Lauren A Pace
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Ramon J Moreno
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Christopher J Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
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Seron-Ferre M, Reynolds H, Mendez NA, Mondaca M, Valenzuela F, Ebensperger R, Valenzuela GJ, Herrera EA, Llanos AJ, Torres-Farfan C. Impact of Maternal Melatonin Suppression on Amount and Functionality of Brown Adipose Tissue (BAT) in the Newborn Sheep. Front Endocrinol (Lausanne) 2014; 5:232. [PMID: 25610428 PMCID: PMC4285176 DOI: 10.3389/fendo.2014.00232] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/15/2014] [Indexed: 11/23/2022] Open
Abstract
In human and sheep newborns, brown adipose tissue (BAT) accrued during fetal development is used for newborn thermogenesis. Here, we explored the role of maternal melatonin during gestation on the amount and functionality of BAT in the neonate. We studied BAT from six lambs gestated by ewes exposed to constant light from 63% gestation until delivery to suppress melatonin (LL), six lambs gestated by ewes exposed to LL but receiving daily oral melatonin (12 mg at 1700 h, LL + Mel) and another six control lambs gestated by ewes maintained in 12 h light:12 h dark (LD). Lambs were instrumented at 2 days of age. At 4-6 days of age, they were exposed to 24°C (thermal neutrality conditions) for 1 h, 4°C for 1 h, and 24°C for 1 h. Afterward, lambs were euthanized and BAT was dissected for mRNA measurement, histology, and ex vivo experiments. LL newborns had lower central BAT and skin temperature under thermal neutrality and at 4°C, and higher plasma norepinephrine concentration than LD newborns. In response to 4°C, they had a pronounced decrease in skin temperature and did not increase plasma glycerol. BAT weight in LL newborns was about half of that of LD newborns. Ex vivo, BAT from LL newborns showed increased basal lipolysis and did not respond to NE. In addition, expression of adipogenic/thermogenic genes (UCP1, ADBR3, PPARγ, PPARα, PGC1α, C/EBPβ, and perilipin) and of the clock genes Bmal1, Clock, and Per2 was increased. Remarkably, the effects observed in LL newborns were absent in LL + Mel newborns. Thus, our results support that maternal melatonin during gestation is important in determining amount and normal functionality of BAT in the neonate.
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Affiliation(s)
- Maria Seron-Ferre
- Facultad de Medicina, Laboratorio de Cronobiología, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
| | - Henry Reynolds
- Facultad de Medicina, Laboratorio de Cronobiología, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
| | - Natalia Andrea Mendez
- Facultad de Medicina, Laboratorio de Cronobiología del Desarrollo, Universidad Austral de Chile, Valdivia, Chile
| | - Mauricio Mondaca
- Facultad de Medicina, Laboratorio de Cronobiología, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
| | - Francisco Valenzuela
- Facultad de Medicina, Laboratorio de Cronobiología, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
| | - Renato Ebensperger
- Facultad de Medicina, Laboratorio de Cronobiología, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
| | | | - Emilio A. Herrera
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
| | - Anibal J. Llanos
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
| | - Claudia Torres-Farfan
- Facultad de Medicina, Laboratorio de Cronobiología del Desarrollo, Universidad Austral de Chile, Valdivia, Chile
- *Correspondence: Claudia Torres-Farfan, Edificio Ciencias Biomédicas, Facultad de Medicina, Universidad Austral de Chile, Isla Teja S/N, P.O. Box 567, Valdivia, Chile e-mail:
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Gumucio JP, Korn MA, Saripalli AL, Flood MD, Phan AC, Roche SM, Lynch EB, Claflin DR, Bedi A, Mendias CL. Aging-associated exacerbation in fatty degeneration and infiltration after rotator cuff tear. J Shoulder Elbow Surg 2014; 23:99-108. [PMID: 23790676 PMCID: PMC3785561 DOI: 10.1016/j.jse.2013.04.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 03/27/2013] [Accepted: 04/17/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears are one of the most common musculoskeletal complaints and a substantial source of morbidity in elderly patients. Chronic cuff tears are associated with muscle atrophy and an infiltration of fat to the area, a condition known as "fatty degeneration." To improve the treatment of cuff tears in elderly patients, a greater understanding of the changes in the contractile properties of muscle fibers and the molecular regulation of fatty degeneration is essential. METHODS Using a full-thickness, massive supraspinatus and infraspinatus tear model in elderly rats, we measured fiber contractility and determined changes in fiber type distribution that develop 30 days after tear. We also measured the expression of messenger RNA and micro-RNA transcripts involved in muscle atrophy, lipid accumulation, and matrix synthesis. We hypothesized that a decrease in specific force of muscle fibers, an accumulation of type IIb fibers, and an upregulation in atrophic, fibrogenic, and inflammatory gene expression would occur in torn cuff muscles. RESULTS Thirty days after the tear, we observed a reduction in muscle fiber force and an induction of RNA molecules that regulate atrophy, fibrosis, lipid accumulation, inflammation, and macrophage recruitment. A marked accumulation of advanced glycation end products and a significant accretion of macrophages in areas of fat accumulation were observed. CONCLUSIONS The extent of degenerative changes in old rats was greater than that observed in adults. In addition, we identified that the ectopic fat accumulation that occurs in chronic cuff tears does not occur by activation of canonical intramyocellular lipid storage and synthesis pathways.
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Affiliation(s)
- Jonathan P Gumucio
- Department Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael A Korn
- Department Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anjali L Saripalli
- Department Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael D Flood
- Department Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anthony C Phan
- Department Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stuart M Roche
- Department Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Evan B Lynch
- Department Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Dennis R Claflin
- Department of Biomedical Engineering, University of Michigan Medical School, Ann Arbor, MI, USA; Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Asheesh Bedi
- Department Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher L Mendias
- Department Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA.
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46
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Wang KCW, Lim CH, McMillen IC, Duffield JA, Brooks DA, Morrison JL. Alteration of cardiac glucose metabolism in association to low birth weight: experimental evidence in lambs with left ventricular hypertrophy. Metabolism 2013; 62:1662-72. [PMID: 23928106 DOI: 10.1016/j.metabol.2013.06.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 06/24/2013] [Accepted: 06/29/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Intrauterine growth restriction that results in low birth weight (LBW) has been linked to the onset of pathological cardiac hypertrophy. An altered transition from a fetal to an adult energy metabolism phenotype, with increased reliance on glucose rather than fatty acids for energy production, could help explain this connection. We have therefore investigated cardiac metabolism in relation to left ventricular hypertrophy in LBW lambs, at 21days after birth. MATERIALS/METHODS The expression of regulatory molecules involved in cardiac glucose and fatty acid metabolism was measured using real-time PCR and Western blotting. A section of the left ventricle was fixed for Periodic Acid Schiff staining to determine tissue glycogen content. RESULTS There was increased abundance of insulin signalling pathway proteins (phospho-insulin receptor, insulin receptor and phospho-Akt) and the glucose transporter (GLUT)-1, but no change in GLUT-4 or glycogen content in the heart of LBW compared to ABW lambs. There was, however, increased abundance of cardiac pyruvate dehydrogenase kinase 4 (PDK-4) in LBW compared to ABW lambs. There were no significant changes in the mRNA expression of components of the peroxisome proliferator activated receptor regulatory complex or proteins involved in fatty acid metabolism. CONCLUSION We concluded that LBW induced left ventricular hypertrophy was associated with increased GLUT-1 and PDK-4, suggesting increased glucose uptake, but decreased efficacy for the conversion of glucose to ATP. A reduced capacity for energy conversion could have significant implications for vulnerability to cardiovascular disease in adults who are born LBW.
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Affiliation(s)
- Kimberley C W Wang
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
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Killian ML, Lim CT, Thomopoulos S, Charlton N, Kim HM, Galatz LM. The effect of unloading on gene expression of healthy and injured rotator cuffs. J Orthop Res 2013; 31:1240-8. [PMID: 23508698 PMCID: PMC3690165 DOI: 10.1002/jor.22345] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/12/2013] [Indexed: 02/04/2023]
Abstract
Tendon unloading following rupture of one of the rotator cuff tendons can induce alterations in muscle physiology and tendon structure, which can subsequently affect reparability and healing potential. Yet little is known about the effects of muscle and tendon unloading on the molecular response of the rotator cuff. We determined the effect of mechanical unloading on gene expression and morphology of healthy supraspinatus tendons and muscles, and the same muscles after acute injury and repair. Mechanical unloading was achieved by tenotomy and/or botulinum toxin A (BTX) chemical denervation in a rat rotator cuff model of injury and repair. Gene expression profiles varied across regions of the muscle, with the greatest changes seen in the distal aspect of the muscle for most genes. Myogenic and adipogenic genes were upregulated in muscle when unloaded (tenotomy and BTX). Tendon injury, with and without repair, resulted in upregulation of fibrosis- and tendon-specific gene expression. The expression of scleraxis, a transcription factor necessary for tendon development, was upregulated in response to injury and repair. In summary, tendon detachment and repair had the greatest effect on tendon gene expression, while unloading had the greatest effect on muscle gene expression.
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Affiliation(s)
- ML Killian
- Department of Orthopaedic Surgery, Washington University, St Louis, MO
| | - CT Lim
- Department of Orthopaedic Surgery, Sung-Ji Hospital, Gangwon-do, South Korea
| | - S Thomopoulos
- Department of Orthopaedic Surgery, Washington University, St Louis, MO
| | - N Charlton
- Department of Orthopaedic Surgery, Washington University, St Louis, MO
| | - HM Kim
- Department of Orthopaedic Surgery, Penn State University Hershey, Hershey, PA
| | - LM Galatz
- Department of Orthopaedic Surgery, Washington University, St Louis, MO
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48
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The science of rotator cuff tears: translating animal models to clinical recommendations using simulation analysis. Knee Surg Sports Traumatol Arthrosc 2013; 21:1610-9. [PMID: 22842677 DOI: 10.1007/s00167-012-2145-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 07/16/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this article is to review basic science studies using various animal models for rotator cuff research and to describe structural, biomechanical, and functional changes to muscle following rotator cuff tears. The use of computational simulations to translate the findings from animal models to human scale is further detailed. METHODS A comprehensive review was performed of the basic science literature describing the use of animal models and simulation analysis to examine muscle function following rotator cuff injury and repair in the ageing population. RESULTS The findings from various studies of rotator cuff pathology emphasize the importance of preventing permanent muscular changes with detrimental results. In vivo muscle function, electromyography, and passive muscle-tendon unit properties were studied before and after supraspinatus tenotomy in a rodent rotator cuff injury model (acute vs chronic). Then, a series of simulation experiments were conducted using a validated computational human musculoskeletal shoulder model to assess both passive and active tension of rotator cuff repairs based on surgical positioning. CONCLUSION Outcomes of rotator cuff repair may be improved by earlier surgical intervention, with lower surgical repair tensions and fewer electromyographic neuromuscular changes. An integrated approach of animal experiments, computer simulation analyses, and clinical studies may allow us to gain a fundamental understanding of the underlying pathology and interpret the results for clinical translation.
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49
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Joshi SK, Liu X, Samagh SP, Lovett DH, Bodine SC, Kim HT, Feeley BT. mTOR regulates fatty infiltration through SREBP-1 and PPARγ after a combined massive rotator cuff tear and suprascapular nerve injury in rats. J Orthop Res 2013; 31:724-30. [PMID: 23239524 PMCID: PMC4393845 DOI: 10.1002/jor.22254] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/04/2012] [Indexed: 02/04/2023]
Abstract
Rotator cuff tears (RCTs) are among the most common injuries seen in orthopedic patients. Chronic tears can result in the development of muscular atrophy and fatty infiltration. Despite the prevalence of RCTs, little is known about the underlying molecular pathways that produce these changes. Recently, we have shown that mammalian target of rapamycin (mTOR) signaling plays an important role in muscle atrophy that results from massive RCTs in a rat model. The purpose of this study was therefore to extend our understanding of mTOR signaling and evaluate its role in fatty infiltration after a combined tendon transection and suprascapular nerve denervation surgery. Akt/mTOR signaling was significantly increased and resulted in the up-regulation of two transcription factors: SREBP-1 and PPARγ. We also saw an increase in expression of adipogenic markers: C/EBP-α and FASN. Upon treatment with rapamycin, an inhibitor of mTOR, we observed a decrease in mTOR signaling, activity of transcription factors, and reduction in fatty infiltration. Therefore, our study suggests that mTOR signaling mediates rotator cuff fatty infiltration via SREBP-1 and PPARγ. Clinically, our finding may alter current treatment methods to address rotator cuff fatty infiltration.
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Affiliation(s)
- Sunil K. Joshi
- San Francisco Veterans Affairs Medical Center, Department of Veterans Affairs, University of California, 1500 Owens Avenue, San Francisco, California 94153
| | - Xuhui Liu
- San Francisco Veterans Affairs Medical Center, Department of Veterans Affairs, University of California, 1500 Owens Avenue, San Francisco, California 94153,Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Sanjum P. Samagh
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - David H. Lovett
- San Francisco Veterans Affairs Medical Center, Department of Veterans Affairs, University of California, 1500 Owens Avenue, San Francisco, California 94153,Department of Medicine, University of California, San Francisco, California
| | - Sue C. Bodine
- Department of Physiology and Membrane Biology, University of California, Davis, California
| | - Hubert T. Kim
- San Francisco Veterans Affairs Medical Center, Department of Veterans Affairs, University of California, 1500 Owens Avenue, San Francisco, California 94153,Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Brian T. Feeley
- San Francisco Veterans Affairs Medical Center, Department of Veterans Affairs, University of California, 1500 Owens Avenue, San Francisco, California 94153,Department of Orthopaedic Surgery, University of California, San Francisco, California
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50
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Samagh SP, Kramer EJ, Melkus G, Laron D, Bodendorfer BM, Natsuhara K, Kim HT, Liu X, Feeley BT. MRI quantification of fatty infiltration and muscle atrophy in a mouse model of rotator cuff tears. J Orthop Res 2013; 31:421-6. [PMID: 22991068 DOI: 10.1002/jor.22233] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 08/27/2012] [Indexed: 02/04/2023]
Abstract
Rotator cuff pathology is the most common shoulder problem seen by orthopedic surgeons. Rotator cuff muscle fatty infiltration and muscle atrophy are common in larger tears and are considered predicting factors for the prognosis of cuff repair. Clinically, MRI is the gold standard in determining fatty infiltration and muscle atrophy; however, analysis for MRI imaging is primarily qualitative in nature with the results lacking further validation. We have recently developed a mouse model of rotator cuff tears. The goal of this study is to quantify and verify rotator cuff muscle atrophy and fatty infiltration using high-resolution MRI in our mouse model. The rotator cuff muscles were analyzed for fat using a triglyceride quantification assay (TQA), muscle volume was measured through water displacement (WD), and histology. The study revealed that MRI had a high correlation with fat as measured with histology and TQA (R(2) =098). MRI also correlated well with atrophy measured with WD and wet weight. This suggests that MRI is a reliable modality in evaluating the progression of fatty infiltration and muscle atrophy following rotator cuff tears in a small animal model.
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Affiliation(s)
- Sanjum P Samagh
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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