1
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Ligorio C, Mata A. Synthetic extracellular matrices with function-encoding peptides. NATURE REVIEWS BIOENGINEERING 2023; 1:1-19. [PMID: 37359773 PMCID: PMC10127181 DOI: 10.1038/s44222-023-00055-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 06/28/2023]
Abstract
The communication of cells with their surroundings is mostly encoded in the epitopes of structural and signalling proteins present in the extracellular matrix (ECM). These peptide epitopes can be incorporated in biomaterials to serve as function-encoding molecules to modulate cell-cell and cell-ECM interactions. In this Review, we discuss natural and synthetic peptide epitopes as molecular tools to bioengineer bioactive hydrogel materials. We present a library of functional peptide sequences that selectively communicate with cells and the ECM to coordinate biological processes, including epitopes that directly signal to cells, that bind ECM components that subsequently signal to cells, and that regulate ECM turnover. We highlight how these epitopes can be incorporated in different biomaterials as individual or multiple signals, working synergistically or additively. This molecular toolbox can be applied in the design of biomaterials aimed at regulating or controlling cellular and tissue function, repair and regeneration.
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Affiliation(s)
- Cosimo Ligorio
- Biodiscovery Institute, University of Nottingham, Nottingham, UK
- Department of Chemical and Environmental Engineering, University of Nottingham, Nottingham, UK
| | - Alvaro Mata
- Biodiscovery Institute, University of Nottingham, Nottingham, UK
- Department of Chemical and Environmental Engineering, University of Nottingham, Nottingham, UK
- School of Pharmacy, University of Nottingham, Nottingham, UK
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2
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Alini M, Diwan AD, Erwin WM, Little CB, Melrose J. An update on animal models of intervertebral disc degeneration and low back pain: Exploring the potential of artificial intelligence to improve research analysis and development of prospective therapeutics. JOR Spine 2023; 6:e1230. [PMID: 36994457 PMCID: PMC10041392 DOI: 10.1002/jsp2.1230] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 02/03/2023] Open
Abstract
Animal models have been invaluable in the identification of molecular events occurring in and contributing to intervertebral disc (IVD) degeneration and important therapeutic targets have been identified. Some outstanding animal models (murine, ovine, chondrodystrophoid canine) have been identified with their own strengths and weaknesses. The llama/alpaca, horse and kangaroo have emerged as new large species for IVD studies, and only time will tell if they will surpass the utility of existing models. The complexity of IVD degeneration poses difficulties in the selection of the most appropriate molecular target of many potential candidates, to focus on in the formulation of strategies to effect disc repair and regeneration. It may well be that many therapeutic objectives should be targeted simultaneously to effect a favorable outcome in human IVD degeneration. Use of animal models in isolation will not allow resolution of this complex issue and a paradigm shift and adoption of new methodologies is required to provide the next step forward in the determination of an effective repairative strategy for the IVD. AI has improved the accuracy and assessment of spinal imaging supporting clinical diagnostics and research efforts to better understand IVD degeneration and its treatment. Implementation of AI in the evaluation of histology data has improved the usefulness of a popular murine IVD model and could also be used in an ovine histopathological grading scheme that has been used to quantify degenerative IVD changes and stem cell mediated regeneration. These models are also attractive candidates for the evaluation of novel anti-oxidant compounds that counter inflammatory conditions in degenerate IVDs and promote IVD regeneration. Some of these compounds also have pain-relieving properties. AI has facilitated development of facial recognition pain assessment in animal IVD models offering the possibility of correlating the potential pain alleviating properties of some of these compounds with IVD regeneration.
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Affiliation(s)
- Mauro Alini
- AO Research Institute Davos Platz Switzerland
| | - Ashish D. Diwan
- Spine Service, Department of Orthopedic Surgery, St. George & Sutherland Campus, Clinical School University of New South Wales Sydney New South Wales Australia
| | - W. Mark Erwin
- Department of Surgery University of Toronto Ontario Canada
| | - Chirstopher B. Little
- Raymond Purves Bone and Joint Research Laboratory Kolling Institute, Sydney University Faculty of Medicine and Health, Northern Sydney Area Health District, Royal North Shore Hospital St. Leonards New South Wales Australia
| | - James Melrose
- Raymond Purves Bone and Joint Research Laboratory Kolling Institute, Sydney University Faculty of Medicine and Health, Northern Sydney Area Health District, Royal North Shore Hospital St. Leonards New South Wales Australia
- Graduate School of Biomedical Engineering The University of New South Wales Sydney New South Wales Australia
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3
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Guo T, Zhang X, Hu Y, Lin M, Zhang R, Chen X, Yu D, Yao X, Wang P, Zhou H. New Hope for Treating Intervertebral Disc Degeneration: Microsphere-Based Delivery System. Front Bioeng Biotechnol 2022; 10:933901. [PMID: 35928951 PMCID: PMC9343804 DOI: 10.3389/fbioe.2022.933901] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
Intervertebral disc (IVD) degeneration (IVDD) has been considered the dominant factor in low back pain (LBP), and its etiological mechanisms are complex and not yet fully elucidated. To date, the treatment of IVDD has mainly focused on relieving clinical symptoms and cannot fundamentally solve the problem. Recently, a novel microsphere-based therapeutic strategy has held promise for IVD regeneration and has yielded encouraging results with in vitro experiments and animal models. With excellent injectability, biocompatibility, and biodegradability, this microsphere carrier allows for targeted delivery and controlled release of drugs, gene regulatory sequences, and other bioactive substances and supports cell implantation and directed differentiation, aiming to improve the disease state of IVD at the source. This review discusses the possible mechanisms of IVDD and the limitations of current therapies, focusing on the application of microsphere delivery systems in IVDD, including targeted delivery of active substances and drugs, cellular therapy, and gene therapy, and attempts to provide a new understanding for the treatment of IVDD.
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Affiliation(s)
- Taowen Guo
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, China
| | - Xiaobo Zhang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Haiyu Zhou, ; Xiaobo Zhang,
| | - Yicun Hu
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, China
| | - Maoqiang Lin
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, China
| | - Ruihao Zhang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, China
| | - Xiangyi Chen
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, China
| | - Dechen Yu
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, China
| | - Xin Yao
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, China
| | - Peng Wang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, China
| | - Haiyu Zhou
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, China
- Xigu District People’s Hospital, Lanzhou, China
- *Correspondence: Haiyu Zhou, ; Xiaobo Zhang,
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4
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Tang L, Xu C, Xuan A, Zhu Z, Ruan D. Functionalized self-assembling peptide RADKPS hydrogels promote regenerative repair of degenerated intervertebral discs. Biomater Sci 2022; 10:5134-5145. [PMID: 35820128 DOI: 10.1039/d2bm00634k] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: the aim of this study was to investigate whether the functionalized self-assembling peptide hydrogel RADKPS is safe and effective for regenerative repair of degenerative intervertebral discs. Methods: an in vitro degenerative model of human nucleus pulposus cells was constructed by serum starvation culture, and their proliferation, apoptosis and viability were examined after three-dimensional culture with the RADKPS hydrogel. An in vivo degenerative model of the rabbit intervertebral disc was constructed by annulus fibrosus puncture, and the degeneration of the intervertebral disc was evaluated by imaging, histology, immunohistochemistry, and biomechanics after RADKPS hydrogel intervention. Results: through in vitro cell experiments it is shown that human degenerated nucleus pulposus cells after three-dimensional culture with the RADKPS hydrogel still exhibited better proliferation, viability, and low apoptosis rate. Through in vivo animal experiments we found that rabbit degenerated intervertebral discs intervened with the RADKPS hydrogel had higher water content, better histological morphology, more extracellular matrix synthesis, and better biomechanical properties. It is demonstrated that the RADKPS hydrogel may initiate the endogenous repair process through the sustained recruitment and enrichment of nucleus pulposus progenitor cells. Conclusion: it is verified from both in vitro cellular experiments and in vivo animal experiments that the regenerative repair effect of RADKPS, a functionalized self-assembling peptide hydrogel, on degenerated intervertebral discs is safe and effective. It is shown that it would be a new therapeutic approach for the regenerative repair action of intervertebral discs.
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Affiliation(s)
- Liang Tang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Orthopedic Surgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China. .,Department of Orthopedic Surgery, Hengyang Central Hospital, Hunan, 421001, China
| | - Cheng Xu
- Department of Orthopedic Surgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China.
| | - Anwu Xuan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Zhenbiao Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Orthopedic Surgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China.
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5
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Effects of Changes in Osmolarity on the Biological Activity of Human Normal Nucleus Pulposus Mesenchymal Stem Cells. Stem Cells Int 2022; 2022:1121064. [PMID: 35502327 PMCID: PMC9056247 DOI: 10.1155/2022/1121064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 02/22/2022] [Accepted: 03/28/2022] [Indexed: 01/10/2023] Open
Abstract
The expansion and maintenance of the NPMSC (nucleus pulposus mesenchymal stem cell) phenotype are considered as potential therapeutic tools for clinical applications in intervertebral disc tissue engineering and regenerative medicine. However, the harsh microenvironment within the intervertebral disc is the main limitation of its regeneration. The osmolarity of the intervertebral disc is higher than that of other tissues, which has an important influence on the biological characteristics of NPMSCs. In this study, we observed the effect of different osmolarities on the biological characteristics of human normal NPMSCs cultured in vitro and explored the role of osmolarity in intervertebral disc degeneration. Our data demonstrated that the change in osmotic pressure has an important effect on the biological activity of NPMSCs, and this effect may occur through the P16INK4A/Rb pathway. This study provides a theoretical basis for the future treatment of intervertebral disc degeneration.
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6
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Ligorio C, Hoyland JA, Saiani A. Self-Assembling Peptide Hydrogels as Functional Tools to Tackle Intervertebral Disc Degeneration. Gels 2022; 8:gels8040211. [PMID: 35448112 PMCID: PMC9028266 DOI: 10.3390/gels8040211] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/16/2022] Open
Abstract
Low back pain (LBP), caused by intervertebral disc (IVD) degeneration, is a major contributor to global disability. In its healthy state, the IVD is a tough and well-hydrated tissue, able to act as a shock absorber along the spine. During degeneration, the IVD is hit by a cell-driven cascade of events, which progressively lead to extracellular matrix (ECM) degradation, chronic inflammation, and pain. Current treatments are divided into palliative care (early stage degeneration) and surgical interventions (late-stage degeneration), which are invasive and poorly efficient in the long term. To overcome these limitations, alternative tissue engineering and regenerative medicine strategies, in which soft biomaterials are used as injectable carriers of cells and/or biomolecules to be delivered to the injury site and restore tissue function, are currently being explored. Self-assembling peptide hydrogels (SAPHs) represent a promising class of de novo synthetic biomaterials able to merge the strengths of both natural and synthetic hydrogels for biomedical applications. Inherent features, such as shear-thinning behaviour, high biocompatibility, ECM biomimicry, and tuneable physiochemical properties make these hydrogels appropriate and functional tools to tackle IVD degeneration. This review will describe the pathogenesis of IVD degeneration, list biomaterials requirements to attempt IVD repair, and focus on current peptide hydrogel materials exploited for this purpose.
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Affiliation(s)
- Cosimo Ligorio
- Department of Materials, School of Natural Sciences, Faculty of Science and Engineering, The University of Manchester, Manchester M1 3BB, UK;
- Manchester Institute of Biotechnology (MIB), The University of Manchester, Manchester M1 7DN, UK
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PG, UK;
- Correspondence:
| | - Judith A. Hoyland
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PG, UK;
| | - Alberto Saiani
- Department of Materials, School of Natural Sciences, Faculty of Science and Engineering, The University of Manchester, Manchester M1 3BB, UK;
- Manchester Institute of Biotechnology (MIB), The University of Manchester, Manchester M1 7DN, UK
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7
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Malli SE, Kumbhkarn P, Dewle A, Srivastava A. Evaluation of Tissue Engineering Approaches for Intervertebral Disc Regeneration in Relevant Animal Models. ACS APPLIED BIO MATERIALS 2021; 4:7721-7737. [PMID: 35006757 DOI: 10.1021/acsabm.1c00500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Translation of tissue engineering strategies for the regeneration of intervertebral disc (IVD) requires a strong understanding of pathophysiology through the relevant animal model. There is no relevant animal model due to differences in disc anatomy, cellular composition, extracellular matrix components, disc physiology, and mechanical strength from humans. However, available animal models if used correctly could provide clinically relevant information for the translation into humans. In this review, we have investigated different types of strategies for the development of clinically relevant animal models to study biomaterials, cells, biomolecular or their combination in developing tissue engineering-based treatment strategies. Tissue engineering strategies that utilize various animal models for IVD regeneration are summarized and outcomes have been discussed. The understanding of animal models for the validation of regenerative approaches is employed to understand and treat the pathophysiology of degenerative disc disease (DDD) before proceeding for human trials. These animal models play an important role in building a therapeutic regime for IVD tissue regeneration, which can serve as a platform for clinical applications.
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Affiliation(s)
- Sweety Evangeli Malli
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-Ahmedabad), Gandhinagar, Gujarat 382355, India
| | - Pranav Kumbhkarn
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-Ahmedabad), Gandhinagar, Gujarat 382355, India
| | - Ankush Dewle
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-Ahmedabad), Gandhinagar, Gujarat 382355, India
| | - Akshay Srivastava
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-Ahmedabad), Gandhinagar, Gujarat 382355, India
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8
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Yao M, Zhang J, Li Z, Bai X, Ma J, Li Y. Liraglutide Protects Nucleus Pulposus Cells Against High-Glucose Induced Apoptosis by Activating PI3K/Akt/ mTOR/Caspase-3 and PI3K/Akt/GSK3β/Caspase-3 Signaling Pathways. Front Med (Lausanne) 2021; 8:630962. [PMID: 33681258 PMCID: PMC7933515 DOI: 10.3389/fmed.2021.630962] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/25/2021] [Indexed: 12/11/2022] Open
Abstract
Background and Objective: Diabetes mellitus (DM) is reportedly a significant risk factor for intervertebral disc degeneration (IDD). Incretin system and particularly glucagon-like peptide 1 (GLP-1) because of its glucose-lowering effects has become an important target in therapeutic strategies of type 2 diabetes (T2D). Liraglutide is a GLP-1 receptor (GLP-1R) agonist with glucoregulatory and insulinotropic functions as well as regulatory functions on cell proliferation, differentiation, and apoptosis. However, little is known on the roles and signaling pathways of apoptosis protecting effects of liraglutide in IDD. This study aimed to investigate the potential protective effects of liraglutide against high glucose-induced apoptosis of nucleus pulposus cells (NPCs) and the possible involved signaling pathways. Methods: The human NPCs were incubated with 100 nM liraglutide alone or in combination with LY294002 (PI3K inhibitor), rapamycin (mTOR inhibitor), and SB216763 (GSK3β inhibitor) in a high glucose culture for 48 h. The four groups were assessed further for apoptosis and genes expressions. The apoptotic effect was evaluated by flow cytometry and further confirmed by cell death detection enzyme-linked immunoassay plus (ELISAPLUS). The gene and protein expression levels were assessed by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting techniques. The results were comparatively assessed between the four groups. Results: The results confirmed the presence of GLP-1R in the NPCs indicating that liraglutide inhibited the high glucose-induced apoptosis, which was blocked by silencing GLP-1R with siRNA. Moreover, liraglutide stimulated the phosphorylation of Akt, mTOR and GSK3β. Treatment with LY294002 significantly increased the apoptosis of NPCs and reduced the levels of their downstream substrates (p-AKT, p-mTOR, and p-GSK3β). Further assessments revealed that activation of mTOR and GSK3β was almost completely inhibited by rapamycin and SB216763, respectively, which significantly increased the caspase-3 levels. Conclusion: Liraglutide could protect NPCs against high glucose-induced apoptosis by activating the PI3K/AKT/mTOR/caspase-3 and PI3K/AKT/GSK3β/caspase-3 signaling pathways.
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Affiliation(s)
- Mingyan Yao
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Endocrinology, Baoding No.1 Central Hospital, Baoding, China
| | - Jing Zhang
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, China
| | - Zhihong Li
- Department of Endocrinology, Baoding No.1 Central Hospital, Baoding, China
| | - Xiaoliang Bai
- Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, China
| | - Jinhui Ma
- Department of Endocrinology, Affiliated Hospital of Hebei University, Baoding, China
| | - Yukun Li
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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9
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Wang Y, Che M, Xin J, Zheng Z, Li J, Zhang S. The role of IL-1β and TNF-α in intervertebral disc degeneration. Biomed Pharmacother 2020; 131:110660. [PMID: 32853910 DOI: 10.1016/j.biopha.2020.110660] [Citation(s) in RCA: 253] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022] Open
Abstract
Low back pain (LBP), a prevalent and costly disease around the world, is predominantly caused by intervertebral disc (IVD) degeneration (IDD). LBP also presents a substantial burden to public health and the economy. IDD is mainly caused by aging, trauma, genetic susceptibility, and other factors. It is closely associated with changes in tissue structure and function, including progressive destruction of the extracellular matrix (ECM), enhanced senescence, disc cell death, and impairment of tissue biomechanical function. The inflammatory process, exacerbated by cytokines interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α), are considered to be the key mediators of IDD and LBP. IL-1β and TNF-α are the most important proinflammatory cytokines, as they have powerful proinflammatory activities and can promote the secretion of a variety of proinflammatory mediators. They are also upregulated in the degenerative IVDs, and they are closely related to various pathological IDD processes, including inflammatory response, matrix destruction, cellular senescence, autophagy, apoptosis, pyroptosis, and proliferation. Therefore, anti-IL-1β and anti-TNF-α therapies may have the potential to alleviate disc degeneration and LBP. In this paper, we reviewed the expression pattern and signal transduction pathways of IL-1β and TNF-α, and we primarily focused on their similar and different roles in IDD. Because IL-1β and TNF-α inhibition have the potential to alleviate IDD, an in-depth understanding of the role of IL-1β and TNF-α in IDD will benefit the development of new treatment methods for disc degeneration with IL-1β and TNF-α at the core.
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Affiliation(s)
- Yongjie Wang
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Mingxue Che
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jingguo Xin
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Zhi Zheng
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jiangbi Li
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Shaokun Zhang
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, 130021, China.
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Yang T, Li R, Liang N, Li J, Yang Y, Huang Q, Li Y, Cao W, Wang Q, Zhang H. The application of key feature extraction algorithm based on Gabor wavelet transformation in the diagnosis of lumbar intervertebral disc degenerative changes. PLoS One 2020; 15:e0227894. [PMID: 32101549 PMCID: PMC7043753 DOI: 10.1371/journal.pone.0227894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/31/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Based on the theoretical basis of Gabor wavelet transformation, the application effects of feature extraction algorithm in Magnetic Resonance Imaging (MRI) and the role of feature extraction algorithm in the diagnosis of lumbar vertebra degenerative diseases were explored. METHOD The structure of lumbar vertebra and degenerative changes were respectively introduced to clarify the onset mechanism and pathological changes of lumbar vertebra degenerative changes. Most importantly, the theoretical basis of Gabor wavelet transformation and the extraction effect of feature information in lumbar vertebra MRI images were introduced. The differentiation effects of feature information extraction algorithm on annulus fibrosus and nucleus pulposus were analyzed. In this study, the data of lumbar spine MRI was randomly selected from the Wenzhou Lumbar Spine Research Database as research objects. A total of 130 discs were successfully fitted, and 109 images were graded by a doctor after observation, which was compared with the results of the artificial diagnosis. Through the comparison with the results of observation and diagnosis by professional doctors, the accuracy of feature extraction algorithm based on Gabor wavelet transformation in the diagnosis of lumbar vertebra degenerative changes was analyzed. RESULTS 1. Compared with the results of the manual diagnosis, the accuracy of the classification method was 88.3%. In addition, the specificity (SPE), accuracy (ACC), and sensitivity (SEN) of the classification method were respectively 89.5%, 92.4%, and 87.6%. 2. The mutual information method and the KLT algorithm were utilized for vertebral body tracking. The maximum mutual information method was more effective in the case of fewer image sequences; however, with the increase of image frames, the accumulation of errors would make the tracking effects of images get worse. Based on the KLT algorithm, the enhanced vertebral boundary information was selected; the soft tissues showed in the obtained images were smooth, the boundary information of vertebral body was enhanced, and the results were more accurate. CONCLUSION The feature extraction algorithm based on Gabor wavelet transformation could easily and quickly realize the localization of the lumbar intervertebral disc, and the accuracy of the results was ensured. In addition, from the aspect of vertebral body tracking, the tracking effects based on the KLT algorithm were better and faster than those based on the maximum mutual information method.
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Affiliation(s)
- Tao Yang
- Department of Pain Treatment, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Renzhi Li
- The 31638 Troops of The Chinese People’s Liberation Army, Kunming, China
- Department of Radiology, The 75th Group Army Hospital, Dali, China
| | - Ning Liang
- Department of General Surgery, The 75th Group Army Hospital, Dali, China
| | - Jing Li
- College and Hospital of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Yi Yang
- Department of Pain Treatment, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Qian Huang
- Department of Obstetrics and Gynecology, The 75th Group Army Hospital, Dali, China
| | - Yuedan Li
- Department of Pharmacy, General Hospital of Central Theater Command, Wuhan, China
| | - Wei Cao
- Department of Pain Treatment, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Qian Wang
- Department of Anorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongxin Zhang
- Department of Pain Treatment, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
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11
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Chiang ER, Ma HL, Wang JP, Chang MC, Liu CL, Chen TH, Hung SC. Use of Allogeneic Hypoxic Mesenchymal Stem Cells For Treating Disc Degeneration in Rabbits. J Orthop Res 2019; 37:1440-1450. [PMID: 31062869 DOI: 10.1002/jor.24342] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 04/09/2019] [Indexed: 02/04/2023]
Abstract
Intervertebral discs (IVDs) are important biomechanical components of the spine. Once degenerated, mesenchymal stem cell (MSC)-based therapies may aid in the repair of these discs. Although hypoxic preconditioning enhances the chondrogenic potential of MSCs, it is unknown whether bone marrow MSCs expanded under hypoxic conditions (1% O2 , here referred to as hypoxic MSCs) are better than bone marrow MSCs expanded under normoxic conditions (air, here referred to as normoxic MSCs) with regards to disc regeneration capacity. The purpose of this study was to compare the therapeutic effects of hypoxic and normoxic MSCs in a rabbit needle puncture degenerated disc model after intra-disc injection. Six weeks after needle puncture, MSCs were injected into the IVD. A vehicle-treated group and an un-punctured sham-control group were included as controls. The tissues were analyzed by histological and immunohistochemical methods 6 and 12 weeks post-injection. At 6 and 12 weeks, less disc space narrowing was evident in the hypoxic MSC-treated group compared to the normoxic MSC-treated group. Significantly better histological scores were observed in the hypoxic MSC group. Discs treated with hypoxic MSCs also demonstrated significantly better extracellular matrix deposition in type II and XI collagen. Increased CD105 and BMP-7 expression were also observed upon injection of hypoxic MSCs. In conclusion, hypoxic MSC injection was more effective than normoxic MSC injection for reducing IVD degeneration progression in vivo. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1440-1450, 2019.
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Affiliation(s)
- En-Rung Chiang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Hsiao-Li Ma
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Jung-Pan Wang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Ming-Chau Chang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Chien-Lin Liu
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Tain-Hsiung Chen
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Shih-Chieh Hung
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan.,Integrative Stem Cell Center, China Medical University Hospital, Taichung, 404, Taiwan.,Institute of New Drug Development, China Medical University, Taichung, 404, Taiwan
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12
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Osteogenic protein-1 attenuates nucleus pulposus cell apoptosis through activating the PI3K/Akt/mTOR pathway in a hyperosmotic culture. Biosci Rep 2018; 38:BSR20181708. [PMID: 30459239 PMCID: PMC6294645 DOI: 10.1042/bsr20181708] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background: Previous studies have indicated that osteogenic protein-1 has protective effects on the biological functions of intervertebral disc cells. Hyperosmolarity is an important physicochemical factor within the disc nucleus pulposus (NP) region, which obviously promotes NP cell apoptosis. Objective: To study the effects of osteogenic protein-1 (OP-1) on NP cell apoptosis induced by hyperosmolarity and the potential signaling transduction pathway. Methods: Rat NP cells were cultured in a hyperosmotic medium with or without OP-1 addition for 7 days. Inhibitor 294002 and inhibitor FK-506 were used to investigate the role of the PI3K/Akt/mTOR pathway in this process. NP cell apoptosis were evaluated by cell apoptosis ratio, activity of caspase-3/9 and gene/protein expression of apoptosis-related molecules (Bax, Bcl-2, caspase-3/cleaved caspase-3 and cleaved PARP). Results: OP-1 addition obviously decreased cell apoptosis ratio and caspase-3/9 activity, down-regulated gene/protein expression of pro-apoptosis molecules (Bax, caspase-3/cleaved casepase-3 and cleaved PARP), up-regulated gene/protein expression of anti-apoptosis molecule (Bcl-2) in a hyperosmotic culture. Moreover, OP-1 addition significantly increased protein expression of p-Akt and p-mTOR. Further analysis showed that addition of LY294002 and FK-506 partly attenuated these protective effects of OP-1 against NP cell apoptosis and activation of the PI3K/Akt/mTOR pathway in a hyperosmotic culture. Conclusion: OP-1 can attenuate NP cell apoptosis through activating the PI3K/Akt/mTOR pathway in a hyperosmotic culture. The present study sheds a new light on the protective role of OP-1 in regulating disc cell biology and provides some theoretical basis for the application of OP-1 in retarding/regenerating disc degeneration.
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13
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Thompson K, Moore S, Tang S, Wiet M, Purmessur D. The chondrodystrophic dog: A clinically relevant intermediate-sized animal model for the study of intervertebral disc-associated spinal pain. JOR Spine 2018; 1:e1011. [PMID: 29984354 PMCID: PMC6018624 DOI: 10.1002/jsp2.1011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 12/16/2022] Open
Abstract
Low back pain (LBP) is the leading cause of disability worldwide, with an estimated 80% of the American population suffering from a painful back condition at some point during their lives. The most common cause of LBP is intervertebral disc (IVD) degeneration (IVDD), a condition that can be difficult to treat, either surgically or medically, with current available therapies. Thus, understanding the pathological mechanisms of IVDD and developing novel treatments are critical for improving outcome and quality of life in people living with LBP. While experimental animal models provide valuable mechanistic insight, each model has limitations that complicate translation to the clinical setting. This review focuses on the chondrodystrophic canine clinical model of IVDD as a promising model to assess IVD‐associated spinal pain and translational therapeutic strategies for LBP. The canine IVD, while smaller in size than human, goat, ovine, and bovine IVDs, is larger than most other small animal IVDD models and undergoes maturational changes similar to those of the human IVD. Furthermore, both dogs and humans develop painful IVDD as a spontaneous process, resulting in similar characteristic pathologies and clinical signs. Future exploration of the canine model as a model of IVD‐associated spinal pain and biological treatments using the canine clinical model will further demonstrate its translational capabilities with the added ethical benefit of treating an existing veterinary patient population with IVDD.
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Affiliation(s)
- Kelly Thompson
- Department of Veterinary Clinical Sciences The Ohio State University Columbus Ohio
| | - Sarah Moore
- Department of Veterinary Clinical Sciences The Ohio State University Columbus Ohio
| | - Shirley Tang
- Department of Biomedical Engineering, College of Engineering The Ohio State University Columbus Ohio
| | - Matthew Wiet
- Department of Biomedical Engineering, College of Engineering The Ohio State University Columbus Ohio
| | - Devina Purmessur
- Department of Biomedical Engineering, College of Engineering The Ohio State University Columbus Ohio.,Department of Orthopedics, College of Medicine The Ohio State University Columbus Ohio
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14
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Li X, Cheng S, Wu Y, Ying J, Wang C, Wen T, Bai X, Ji W, Wang D, Ruan D. Functional self-assembled peptide scaffold inhibits tumor necrosis factor-alpha-induced inflammation and apoptosis in nucleus pulposus cells by suppressing nuclear factor-κB signaling. J Biomed Mater Res A 2017; 106:1082-1091. [PMID: 29164771 DOI: 10.1002/jbm.a.36301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/28/2017] [Accepted: 11/14/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Xiaochuan Li
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
- Department of Orthopedic Surgery; The People's Hospital of Gaozhou; Guangdong People's Republic of China
| | - Shi Cheng
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
| | - Yaohong Wu
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
- Department of Spinal Surgery; The Affiliated Ganzhou Hospital of Nanchang University; Ganzhou Jiangxi People's Republic of China
| | - Jingwei Ying
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
| | - Chaofeng Wang
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
| | - Tianyong Wen
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
| | - Xuedong Bai
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
| | - Wei Ji
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
| | - Deli Wang
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
| | - Dike Ruan
- Department of Orthopedic Surgery; Navy General Hospital; Beijing People's Republic of China
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15
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The Quantitative Structural and Compositional Analyses of Degenerating Intervertebral Discs Using Magnetic Resonance Imaging and Contrast-Enhanced Micro-Computed Tomography. Ann Biomed Eng 2017; 45:2626-2634. [PMID: 28744842 DOI: 10.1007/s10439-017-1891-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/20/2017] [Indexed: 01/31/2023]
Abstract
The intervertebral disc (IVD) is susceptible to degenerative changes that are associated with low back pain. Murine models are often used to investigate the mechanistic changes in the development, aging, and diseased states of the IVD, yet the detection of early degenerative changes in structure is challenging because of the minute size of the murine IVDs. Histology is the gold standard for examining the IVD structure, but it is susceptible to sectioning artifacts, spatial biases, and requires the destructive preparation of the sample. We have previously demonstrated the feasibility of using Ioversol for the contrast-enhanced micro-computed tomography (microCT) to visualize and quantitate the intact healthy murine IVD. In this work, we demonstrate utility of this approach to monitor the longitudinal changes of in vitro nucleolytic- and mechanical injury- degeneration models of the murine discs and introduce novel quantitative metrics to characterize the structure and composition of the IVD. Moreover, we compared the imaging quality and quantitation of these in vitro models to magnetic resonance imaging (MRI) and histology. Stab puncture, trypsin injection, and collagenase injection all induced detectable and significant changes in structure and composition of the discs overtime. Compared to MRI and histology, contrast-enhanced microCT produced superior images that capture the degenerative progression in these models. Contrast-enhanced microCT was also capable of monitoring the structural deteriorations via the changes in disc height and volume, and novel the nucleus pulposus intensity/disc intensity (NI/DI) parameter provides a surrogate measure of proteoglycan composition (R = 0.96). Overall, this approach allows for the nondestructive monitoring of the structure and composition of the IVD at very high resolutions.
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16
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Wang C, Yu X, Yan Y, Yang W, Zhang S, Xiang Y, Zhang J, Wang W. Tumor necrosis factor-α: a key contributor to intervertebral disc degeneration. Acta Biochim Biophys Sin (Shanghai) 2017; 49:1-13. [PMID: 27864283 DOI: 10.1093/abbs/gmw112] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/13/2016] [Indexed: 12/11/2022] Open
Abstract
Intervertebral disc (IVD) degeneration (IDD) is the most common cause leading to low back pain (LBP), which is a highly prevalent, costly, and crippling condition worldwide. Current treatments for IDD are limited to treat the symptoms and do not target the pathophysiology. Tumor necrosis factor-α (TNF-α) is one of the most potent pro-inflammatory cytokines and signals through its receptors TNFR1 and TNFR2. TNF-α is highly expressed in degenerative IVD tissues, and it is deeply involved in multiple pathological processes of disc degeneration, including matrix destruction, inflammatory responses, apoptosis, autophagy, and cell proliferation. Importantly, anti-TNF-α therapy has shown promise for mitigating disc degeneration and relieving LBP. In this review, following a brief description of TNF-α signal transduction, we mainly focus on the expression pattern and roles of TNF-α in IDD, and summarize the emerging progress regarding its inhibition as a promising biological therapeutic approach to disc degeneration and associated LBP. A better understanding will help to develop novel TNF-α-centered therapeutic interventions for degenerative disc disease.
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Affiliation(s)
- Cheng Wang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang 421001, China
| | - Xiaohua Yu
- Medical Research Center, University of South China, Hengyang 421001, China
| | - Yiguo Yan
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang 421001, China
| | - Wei Yang
- Department of Hand and Micro-surgery, The First Affiliated Hospital, University of South China, Hengyang 421001, China
| | - Shujun Zhang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang 421001, China
| | - Yongxiao Xiang
- Department of Hand and Micro-surgery, The First Affiliated Hospital, University of South China, Hengyang 421001, China
| | - Jian Zhang
- Department of Hand and Micro-surgery, The First Affiliated Hospital, University of South China, Hengyang 421001, China
| | - Wenjun Wang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang 421001, China
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17
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Li XC, Wu YH, Bai XD, Ji W, Guo ZM, Wang CF, He Q, Ruan DK. BMP7-Based Functionalized Self-Assembling Peptides Protect Nucleus Pulposus-Derived Stem Cells From Apoptosis In Vitro. Tissue Eng Part A 2016; 22:1218-1228. [PMID: 27582519 DOI: 10.1089/ten.tea.2016.0230] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Tissue engineering has shown great success in the treatment of intervertebral disk degeneration (IVDD) in the past decade. However, the adverse and harsh microenvironment associated in the intervertebral disks remains a great obstacle for the survival of transplanted cells. Although increasing numbers of new materials have been created or modified to overcome this hurdle, a new effective strategy of biological therapy is still required. In this study, bone morphogenic protein 7 (BMP7)-based functionalized self-assembling peptides were developed by conjugating a bioactive motif from BMP-7 (RKPS) onto the C-terminal of the peptide RADARADARADARADA (RADA16-I) at a ratio of 1:1 to form a new RADARKPS peptide. Human nucleus pulposus-derived stem cells (NPDCs) were cultured in the presence of RADA-RKPS or RADA16-I in an apoptosis-promoting environment that was induced by tumor necrosis factor-alpha, and cells were cultured with RADA16-I in normal medium that served as the control group. After 48 h of apoptosis induction, the viability, proliferation, apoptosis rate, and expression of apoptosis-related genes of NPDCs in the different groups were evaluated, and the differentiation of NPDCs toward nucleus pulposus-like cells was tested. The results showed that the RADA-RKPS peptide could significantly protect the survival and proliferation of NPDCs. In addition, the application of RADA-RKPS decreased the rate of cell apoptosis, as detected by TUNEL-positive staining. Furthermore, our in vitro study confirmed the apoptosis-protecting effects of RADA-RKPS peptides, which significantly reduced the BAX/BCL-2 ratio of NPDCs and upregulated the gene expression of collagen II a1, aggrecan, and Sox-9 after 48 h of apoptosis induction. Collectively, these lines of evidence suggest that RADA-RKPS peptides confer a protective effect to NPDCs in an apoptosis environment, suggesting their potential application in the development of new biological treatment strategies for IVDD.
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Affiliation(s)
- Xiao-Chuan Li
- 1 The Third Affiliated Hospital of Southern Medical University , Guangzhou, China .,2 Department of Orthopedic Surgery, Navy General Hospital , Beijing, People's Republic of China .,3 Department of Orthopedic Surgery, The People's Hospital of Gaozhou, Guangdong, People's Republic of China
| | - Yao-Hong Wu
- 2 Department of Orthopedic Surgery, Navy General Hospital , Beijing, People's Republic of China
| | - Xue-Dong Bai
- 2 Department of Orthopedic Surgery, Navy General Hospital , Beijing, People's Republic of China
| | - Wei Ji
- 2 Department of Orthopedic Surgery, Navy General Hospital , Beijing, People's Republic of China
| | - Zi-Ming Guo
- 2 Department of Orthopedic Surgery, Navy General Hospital , Beijing, People's Republic of China
| | - Chao-Feng Wang
- 2 Department of Orthopedic Surgery, Navy General Hospital , Beijing, People's Republic of China
| | - Qing He
- 2 Department of Orthopedic Surgery, Navy General Hospital , Beijing, People's Republic of China
| | - Di-Ke Ruan
- 1 The Third Affiliated Hospital of Southern Medical University , Guangzhou, China .,2 Department of Orthopedic Surgery, Navy General Hospital , Beijing, People's Republic of China
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18
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Xu J, E X, Wang N, Wang M, Xie H, Cao Y, Sun L, Tian J, Chen H, Yan J. BMP
7 enhances the effect of
BMSC
s on extracellular matrix remodeling in a rabbit model of intervertebral disc degeneration. FEBS J 2016; 283:1689-700. [PMID: 26929154 DOI: 10.1111/febs.13695] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/28/2016] [Accepted: 02/25/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Jun Xu
- Department of Orthopaedics The Second Affiliated Hospital of Harbin Medical University China
| | - Xiao‐Qiang E
- Department of Orthopaedics The First Affiliated Hospital of Harbin Medical University China
| | - Nan‐Xiang Wang
- Department of Orthopaedics The Second Affiliated Hospital of Harbin Medical University China
| | - Mo‐Nan Wang
- Robotics Institute Harbin University of Science and Technology China
| | - Huan‐Xin Xie
- Department of Orthopaedics The Second Affiliated Hospital of Harbin Medical University China
| | - Yan‐Hui Cao
- Department of Intensive Care Unit (ICU) The First Affiliated Hospital of Harbin Medical University China
| | - Li‐Hua Sun
- Department of Pharmacology State/Province Key Laboratories of Biomedicine/Pharmaceutics of China Harbin Medical University China
| | - Jun Tian
- Department of Orthopaedics The Second Affiliated Hospital of Harbin Medical University China
| | - Hua‐Jiang Chen
- Department of Orthopaedic Surgery Changzheng Hospital Second Military Medical University Shanghai China
| | - Jing‐Long Yan
- Department of Orthopaedics The Second Affiliated Hospital of Harbin Medical University China
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