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Geng X, Tang Y, Gu C, Zeng J, Zhao Y, Zhou Q, Jia L, Zhou S, Chen X. Integrin αVβ3 antagonist-c(RGDyk) peptide attenuates the progression of ossification of the posterior longitudinal ligament by inhibiting osteogenesis and angiogenesis. Mol Med 2024; 30:57. [PMID: 38698308 PMCID: PMC11067224 DOI: 10.1186/s10020-024-00822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Ossification of the posterior longitudinal ligament (OPLL), an emerging heterotopic ossification disease, causes spinal cord compression, resulting in motor and sensory dysfunction. The etiology of OPLL remains unclear but may involve integrin αVβ3 regulating the process of osteogenesis and angiogenesis. In this study, we focused on the role of integrin αVβ3 in OPLL and explored the underlying mechanism by which the c(RGDyk) peptide acts as a potent and selective integrin αVβ3 inhibitor to inhibit osteogenesis and angiogenesis in OPLL. METHODS OPLL or control ligament samples were collected in surgery. For OPLL samples, RNA-sequencing results revealed activation of the integrin family, particularly integrin αVβ3. Integrin αVβ3 expression was detected by qPCR, Western blotting, and immunohistochemical analysis. Fluorescence microscopy was used to observe the targeted inhibition of integrin αVβ3 by the c(RGDyk) peptide on ligaments fibroblasts (LFs) derived from patients with OPLL and endothelial cells (ECs). The effect of c(RGDyk) peptide on the ossification of pathogenic LFs was detected using qPCR, Western blotting. Alkaline phosphatase staining or alizarin red staining were used to test the osteogenic capability. The effect of the c(RGDyk) peptide on angiogenesis was determined by EC migration and tube formation assays. The effects of the c(RGDyk) peptide on heterotopic bone formation were evaluated by micro-CT, histological, immunohistochemical, and immunofluorescence analysis in vivo. RESULTS The results indicated that after being treated with c(RGDyk), the osteogenic differentiation of LFs was significantly decreased. Moreover, the c(RGDyk) peptide inhibited the migration of ECs and thus prevented the nutritional support required for osteogenesis. Furthermore, the c(RGDyk) peptide inhibited ectopic bone formation in mice. Mechanistic analysis revealed that c(RGDyk) peptide could inhibit osteogenesis and angiogenesis in OPLL by targeting integrin αVβ3 and regulating the FAK/ERK pathway. CONCLUSIONS Therefore, the integrin αVβ3 appears to be an emerging therapeutic target for OPLL, and the c(RGDyk) peptide has dual inhibitory effects that may be valuable for the new therapeutic strategy of OPLL.
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Affiliation(s)
- Xiangwu Geng
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, China
| | - Yifan Tang
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, China
| | - Changjiang Gu
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, China
| | - Junkai Zeng
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, China
| | - Yin Zhao
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, China
| | - Quanwei Zhou
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, China
| | - Lianshun Jia
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, China
| | - Shengyuan Zhou
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, China.
| | - Xiongsheng Chen
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, China.
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Ye C, Shi M, Xie D, Wu H, Chen Q, Yang L. A rare case of intervertebral disc calcification combined with ossification of the posterior longitudinal ligament in a child: a case report and literature review. BMC Musculoskelet Disord 2024; 25:118. [PMID: 38336663 PMCID: PMC10854027 DOI: 10.1186/s12891-024-07218-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Intervertebral disc calcification (IDC) combined with calcification in children has been sporadically reported, while ossification of the posterior longitudinal ligament (OPLL) in the cervical spine in pediatric patients is exceedingly rare. The aim of this study is to investigate the potential prognosis and outcomes associated with this condition. CASE PRESENTATION We present an unusual case involving a 10-year-old Chinese child diagnosed with calcified cervical disc herniation and ossification of the posterior longitudinal ligament. Conservative treatment measures were implemented, and at the 1-month and 6-month follow-up, the patient's pain exhibited significant improvement. Subsequent cervical MRI and CT scans revealed the complete disappearance of OPLL and substantial absorption of the calcified disc. During the three-month follow-up, CT demonstrated slight residual disc calcification, however, the patient remained asymptomatic with no discernible limitation in cervical motion. CONCLUSIONS We conducted a comprehensive review of several cases presenting with the same diagnosis. It is noteworthy that IDC combined with OPLL in children constitutes a rare clinical entity. Despite imaging indications of potential spinal canal occupation, the majority of such cases demonstrate complete absorption following conservative treatment, with OPLL exhibiting a faster absorption rate than calcified discs.
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Affiliation(s)
- Cheng Ye
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Mingliang Shi
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Dong Xie
- Department of Orthopaedics, No. 905 Hospital of PLA Navy, Shanghai, China
| | - Hao Wu
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Qing Chen
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Lili Yang
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
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Tang Z, Chen T, Tan J, Zhang H. Impact of the K-line in patients with ossification of the posterior longitudinal ligament: Analysis of sagittal cervical curvature changes and surgical outcomes. Front Surg 2023; 10:1095391. [PMID: 36874452 PMCID: PMC9975339 DOI: 10.3389/fsurg.2023.1095391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
Objective This study aimed to investigate the relationship of the K-line with sagittal cervical curvature changes and surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods We retrospectively reviewed 84 patients with OPLL who underwent posterior cervical single-door laminoplasty. The patients were divided into a K-line-positive (+) group and a K-line-negative (-) group. Perioperative data, radiographic parameters, and clinical outcomes were compared between the two groups. Results Of 84 total patients, 50 patients were in the K (+) group and 29 patients were in the K (-) group. Neurological function improved in both groups after laminoplasty. The C2-7 Cobb angle, T1 slope, and C2-7 sagittal vertical axis were significantly changed in the K(-) group compared with those in the K (+) group before the operation and at the 3-month and final follow-ups. Conclusion Neurological function was recovered in both groups, and the clinical effect on the K (+) group was better than that on the K (-) group. The cervical curvature in patients with OPLL tends to be anteverted and kyphotic after laminoplasty and is an important factor in reducing the clinical effect.
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Affiliation(s)
- Zhongxin Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tailong Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Tan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huafeng Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Zhang H, Zhang Q, Yuan Z, Dong J. Non-coding RNAs in ossification of the posterior longitudinal ligament. Front Genet 2022; 13:1069575. [PMID: 36506306 PMCID: PMC9729789 DOI: 10.3389/fgene.2022.1069575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a kind of disease that involves a variety of factors leading to ectopic bone deposition of the spinal ligament. Although the detailed mechanism is not clear, genetic factors play important roles in the development of this disease. Noncoding RNA (ncRNA) refers to an RNA molecule that is not translated into a protein but participates in the regulation of gene expression. Functionally important types of ncRNA associated with OPLL include long noncoding RNA, microRNA, and circular RNA. We listed the differentially expressed ncRNAs in OPLL patients and normal controls to find the ncRNAs most relevant to the pathogenesis of the disease. The potential regulatory networks of ncRNA in OPLL cells were analyzed based on their most abundant signal transduction pathway data. The analysis of the highly connected ncRNAs in the regulatory network suggests that they play an important role in OPLL. These findings provide new directions for the study of OPLL pathogenesis and therapeutic targets. In this paper, we reviewed and analyzed the literature on ncRNAs in OPLL published in recent years, aiming to help doctors better understand and treat this disease.
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Won YI, Lee CH, Yuh WT, Kwon SW, Kim CH, Chung CK. Genetic Odyssey to Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Systematic Review. Neurospine 2022; 19:299-306. [PMID: 35793933 PMCID: PMC9260552 DOI: 10.14245/ns.2244038.019] [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: 01/05/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Despite numerous studies, the pathogenesis of ossification of the posterior longitudinal ligament (OPLL) is still unclear. Previous genetic studies proposed variations in genes related to bone and collagen as a cause of OPLL. It is unclear whether the upregulations of those genes are the cause of OPLL or an intermediate result of endochondral ossification process. Causal variations may be in the inflammation-related genes supported by clinical and updated genomic studies. OPLL demonstrates features of genetic diseases but can also be induced by mechanical stress by itself. OPLL may be a combination of various diseases that share ossification as a common pathway and can be divided into genetic and idiopathic. The phenotype of OPLL can be divided into continuous (including mixed) and segmental (including localized) based on the histopathology, prognosis, and appearance. Continuous OPLL shows substantial overexpression of osteoblast-specific genes, frequent upper cervical involvement, common progression, and need for surgery, whereas segmental OPLL shows moderate-to-high expression of these genes and is often clinically silent. Genetic OPLL seems to share clinical features with the continuous type, while idiopathic OPLL shares features with the segmental type. Further genomic studies are needed to elucidate the relationship between genetic OPLL and phenotype of OPLL.
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Affiliation(s)
- Young Il Won
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Corresponding Author Chang-Hyun Lee Department of Neurosurgery, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul 03080, Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Shin Won Kwon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
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Kawaguchi Y, Kitajima I, Yasuda T, Seki S, Suzuki K, Makino H, Ujihara Y, Ueno T, Canh Tung NT, Yahara Y. Serum Periostin Level Reflects Progression of Ossification of the Posterior Longitudinal Ligament. JB JS Open Access 2022; 7:JBJSOA-D-21-00111. [PMID: 35136852 PMCID: PMC8816374 DOI: 10.2106/jbjs.oa.21.00111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Ossification of the posterior longitudinal ligament (OPLL), characterized by ectopic new bone formation in the spinal ligament, causes neurological impairment due to narrowing of the spinal canal. However, the etiology has not been fully elucidated yet. Several biomarkers may be related to the pathogenesis of OPLL. The present study focused on the serum level of periostin, which is recognized as an important bone formation regulator. Methods: This study included 92 patients with OPLL and 54 control patients without OPLL. For the case-control analysis, 54 age and sex-matched patients were randomly included in the OPLL group. The serum fibroblast growth factor-23 (FGF-23), creatinine, inorganic phosphate, calcium, alkaline phosphatase, and periostin levels were assessed. Furthermore, the calcium, creatinine, and inorganic phosphate levels in urine and the percentage of tubular reabsorption of phosphate were also analyzed. Moreover, the relationship between the biomarkers and the extent of OPLL was analyzed. The data were compared between patients with OPLL progression (the progression group) and without OPLL progression (the non-progression group). Results: The mean serum FGF-23 and periostin levels in the OPLL group were higher than that in the control group. The serum inorganic phosphate level in the OPLL group was lower than that in the control group. No correlation was found between any of the biomarkers and the extent of ossification. The serum periostin level in the progression group was higher than that in the non-progression group. No significant difference in the serum FGF-23 level was noted between the progression and non-progression groups. Moreover, no correlation was found between serum periostin and FGF-23 levels. Conclusions: The serum periostin level is related to OPLL progression. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yoshiharu Kawaguchi
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
- Email for corresponding author:
| | - Isao Kitajima
- Clinical Laboratory Center, Toyama University Hospital, Toyama, Japan
| | - Taketoshi Yasuda
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
| | - Kayo Suzuki
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
| | - Hiroto Makino
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
| | - Yasuhiro Ujihara
- Clinical Laboratory Center, Toyama University Hospital, Toyama, Japan
| | - Tomohiro Ueno
- Clinical Laboratory Center, Toyama University Hospital, Toyama, Japan
| | | | - Yasuhito Yahara
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
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Schroeder ME, Gonzalez Rodriguez A, Speckl KF, Walker CJ, Midekssa FS, Grim JC, Weiss RM, Anseth KS. Collagen networks within 3D PEG hydrogels support valvular interstitial cell matrix mineralization. Acta Biomater 2021; 119:197-210. [PMID: 33181362 PMCID: PMC7738375 DOI: 10.1016/j.actbio.2020.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
Enzymatically degradable hydrogels were designed for the 3D culture of valvular interstitial cells (VICs), and through the incorporation of various functionalities, we aimed to investigate the role of the tissue microenvironment in promoting the osteogenic properties of VICs and matrix mineralization. Specifically, porcine VICs were encapsulated in a poly(ethylene glycol) hydrogel crosslinked with a matrix metalloproteinase (MMP)-degradable crosslinker (KCGPQG↓IWGQCK) and formed via a thiol-ene photoclick reaction in the presence or absence of collagen type I to promote matrix mineralization. VIC-laden hydrogels were treated with osteogenic medium for up to 15 days, and the osteogenic response was characterized by the expression of RUNX2 as an early marker of an osteoblast-like phenotype, osteocalcin (OCN) as a marker of a mature osteoblast-like phenotype, and vimentin (VIM) as a marker of the fibroblast phenotype. In addition, matrix mineralization was characterized histologically with Von Kossa stain for calcium phosphate. Osteogenic response was further characterized biochemically with calcium assays, and physically via optical density measurements. When the osteogenic medium was supplemented with calcium chloride, OCN expression was upregulated and mineralization was discernable at 12 days of culture. Finally, this platform was used to screen various drug therapeutics that were assessed for their efficacy in preventing mineralization using optical density as a higher throughput readout. Collectively, these results suggest that matrix composition has a key role in supporting mineralization deposition within diseased valve tissue.
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Affiliation(s)
- Megan E Schroeder
- Materials Science and Engineering Program, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA; The BioFrontiers Institute, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA
| | - Andrea Gonzalez Rodriguez
- Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA; The BioFrontiers Institute, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA
| | - Kelly F Speckl
- Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA; The BioFrontiers Institute, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA
| | - Cierra J Walker
- Materials Science and Engineering Program, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA; The BioFrontiers Institute, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA
| | - Firaol S Midekssa
- Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA
| | - Joseph C Grim
- Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA; The BioFrontiers Institute, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA
| | - Robert M Weiss
- Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242
| | - Kristi S Anseth
- Materials Science and Engineering Program, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA; Department of Chemical and Biological Engineering, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA; The BioFrontiers Institute, University of Colorado Boulder, 3415 Colorado Avenue, Boulder CO 80303, USA.
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Li C, Zhou H, Yang S, Zhu X, Zha G, Yang Z, Yuan F, Jiang W. Effect of K-line on posterior cervical surgery in patients with posterior longitudinal ligament ossification. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2368-2377. [PMID: 32564230 DOI: 10.1007/s00586-020-06507-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/14/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the effect of K-line on posterior single-door decompression with fusion fixation (PFF) and posterior single-door decompression with non-fusion fixation (PNF) for patients with ossification of posterior longitudinal ligament (OPLL). METHODS A total of 65 patients with OPLL were analyzed retrospectively. They consisted of 44 patients with positive K-line, designated as the K ( +) group, and 21 patients with negative K-line, designated as K (-). The patients were also divided into a PFF group (38 patients) and a PNF group (27 patients). The Japanese Orthopaedic Association (JOA) score, C2-C7 Cobb angle, improvement rate of JOA score, and complications were calculated and statistically analyzed between the groups. RESULTS In the K ( +) group, there were no significant differences in the incidence of C5 nerve root palsy and C2-C7 Cobb angle between the two groups of surgical patients, but there were significant differences in the improvement rate of JOA score and the incidence of axial pain. In the K (-) group, there were no significant differences in the incidence of axial pain, the incidence of C5 nerve root palsy, and preoperative C2-C7 Cobb angle between the two groups, but significant differences were observed in the improvement rate of JOA score and C2-C7 Cobb angle at the last follow-up. CONCLUSION In the K ( +) group, the improvement rate of JOA score was higher and the incidence of axial pain was lesser in the PNF group than in the PFF group. In the K (-) group, the improvement rate of JOA score was higher in the PFF group than in the PNF group, and there was significant loss of C2-C7 Cobb angle in the PNF group.
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Affiliation(s)
- Cheng Li
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China
| | - Hong Zhou
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China
| | - Sen Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China
| | - Xuanchen Zhu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China
| | - Guochun Zha
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Zhi Yang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Feng Yuan
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Weimin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China.
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Yuan X, Guo Y, Chen D, Luo Y, Chen D, Miao J, Chen Y. Long non-coding RNA MALAT1 functions as miR-1 sponge to regulate Connexin 43-mediated ossification of the posterior longitudinal ligament. Bone 2019; 127:305-314. [PMID: 31280017 DOI: 10.1016/j.bone.2019.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/03/2019] [Accepted: 06/20/2019] [Indexed: 01/09/2023]
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is the major cause for several deteriorate bone and joint diseases. Its development is a highly organized dynamic process as modulated by various physiological and pathophysiological factors. Both long non-coding RNAs (lncRNAs) and small non-coding RNAs (miRNAs) have been postulated to involve into almost all the biological conditions. Here, we applied high through-put transcriptome screening to unveil lncRNAs highly regulated under OPLL condition. siRNA assay in combination with western blot and quantitative PCR deciphered the lncRNA and miRNA functions in OPLL and their underlying mechanism. Here we identified an lncRNA, named Metastasis Associated Lung Adenocarcinoma Transcript 1 (MALAT1) engaged into the development of OPLL by indirectly targeting Connexin 43 (Cx43) gene. As previously reported, Cx43 is one of the main proteins contributing to OPLL partially through enhancing inflammatory signaling. On top of that, we provided another regulatory layer that MALAT1 served as the upstream effector governing the transcription of Cx43 gene. Perturbation of MALAT1 significantly inhibited Cx43 expression, inflammation, and osteogenesis. Mechanistically, in silico analysis and experimental validation both confirmed that microRNA-1 (miR-1) was the mediator connecting MALAT1-Cx43 axis: overexpression of miR-1 diminished Cx43 expression and OPLL process; meanwhile, MALAT1 acted as miR-1 sponge to inhibit its suppressive transcription effect on downstream ossification related genes. Knock-down of MALAT1 released sequestered miR-1, which repressed Cx43 expression and associated OPLL. Likewise, induced OPLL caused by overexpression of MALAT1 can be ameliorated by enhanced miR-1 function, knock-down of Cx43 or inhibition of inflammation. More importantly, further validation using patient ligament samples from non-OPLL and OPLL individuals identified MALAT1-miR-1-Cx43 regulatory axis. Collectively, we found a novel mechanism through lncRNA-miRNA interaction that provides more insights into understanding the development of OPLL.
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Affiliation(s)
- Xiaoqiu Yuan
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, China
| | - Yongfei Guo
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, China
| | - Dechun Chen
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, China
| | - Yibin Luo
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, China
| | - Deyu Chen
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, China
| | - Jinhao Miao
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, China
| | - Yu Chen
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, China.
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Closer to Nature Through Dynamic Culture Systems. Cells 2019; 8:cells8090942. [PMID: 31438519 PMCID: PMC6769584 DOI: 10.3390/cells8090942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Mechanics in the human body are required for normal cell function at a molecular level. It is now clear that mechanical stimulations play significant roles in cell growth, differentiation, and migration in normal and diseased cells. Recent studies have led to the discovery that normal and cancer cells have different mechanosensing properties. Here, we discuss the application and the physiological and pathological meaning of mechanical stimulations. To reveal the optimal conditions for mimicking an in vivo microenvironment, we must, therefore, discern the mechanotransduction occurring in cells.
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Nam DC, Lee HJ, Lee CJ, Hwang SC. Molecular Pathophysiology of Ossification of the Posterior Longitudinal Ligament (OPLL). Biomol Ther (Seoul) 2019; 27:342-348. [PMID: 31042677 PMCID: PMC6609106 DOI: 10.4062/biomolther.2019.043] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 03/31/2019] [Accepted: 04/09/2019] [Indexed: 12/20/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) can be defined as an ectopic ossification in the tissues of spinal ligament showing a hyperostotic condition. OPLL is developed mostly in the cervical spine and clinical presentations of OPLL are majorly myelopathy and/or radiculopathy, with serious neurological pathology resulting in paralysis of extremities and disturbances of motility lowering the quality of life. OPLL is known to be an idiopathic and multifactorial disease, which genetic factors and non-genetic factors including diet, obesity, physical strain on the posterior longitudinal ligament, age, and diabetes mellitus, are involved into the pathogenesis. Up to now, surgical management by decompressing the spinal cord is regarded as standard treatment for OPLL, although there might be the risk of development of reprogression of ossification. The molecular pathogenesis and efficient therapeutic strategy, especially pharmacotherapy and/or preventive intervention, of OPLL has not been clearly elucidated and suggested. Therefore, in this review, we tried to give an overview to the present research results on OPLL, in order to shed light on the potential pharmacotherapy based on molecular pathophysiologic aspect of OPLL, especially on the genetic/genomic factors involved into the etiology of OPLL.
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Affiliation(s)
- Dae Cheol Nam
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Hyun Jae Lee
- Smith Liberal Arts College and Department of Addiction Science, Graduate School, Sahmyook University, Seoul 01795, Republic of Korea
| | - Choong Jae Lee
- Department of Pharmacology, School of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
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12
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Chen L, Childs RD, Landis WJ. Correlations between gene expression and mineralization in the avian leg tendon. Bone 2019; 121:42-59. [PMID: 30419319 DOI: 10.1016/j.bone.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
Certain avian tendons have been studied previously as a model system for normal mineralization of vertebrates in general. In this regard, the gastrocnemius tendon in the legs of turkeys mineralizes in a well defined temporal and spatial manner such that changes in the initial and subsequent events of mineral formation can be associated with time and specific locations in the tissue. In the present investigation, these parameters and mineral deposition have been correlated with the expression of several genes and the synthesis and secretion of their related extracellular matrix proteins by the composite tenocytes of the tendon. Quantitative polymerase chain reaction analysis demonstrates that mRNA expression of the non-collagenous genes of bone sialoprotein, osteopontin, and osteocalcin corresponds well with the temporal and spatial onset and progression of mineralization. Immunolocalization separately confirms the synthesis and secretion of these matrix molecules. The expression of other non-collagenous genes such as decorin does not show strong correlation with turkey leg tendon mineralization, and expression of vimentin, a cytoskeletal component which may be regulated by biomechanical factors in the tendon, may lead to inhibition of osteocalcin expression during the development and mineralization of the tissue. The overall results of this work provide insight into direct temporal and spatial relations between the genes and proteins of interest as well as the formation and deposition of mineral in the avian tendon model.
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Affiliation(s)
- Ling Chen
- Department of Polymer Science, University of Akron, Akron, OH, USA
| | | | - William J Landis
- Department of Polymer Science, University of Akron, Akron, OH, USA.
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13
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Stavenschi E, Hoey DA. Pressure-induced mesenchymal stem cell osteogenesis is dependent on intermediate filament remodeling. FASEB J 2018; 33:4178-4187. [PMID: 30550359 DOI: 10.1096/fj.201801474rr] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Macroscale loading of bone generates a complex local mechanical microenvironment that drives osteogenesis and bone mechanoadaptation. One such mechanical stimulus generated is hydrostatic pressure (HP); however, the effect of HP on mesenchymal stem cells (MSCs) and the mechanotransduction mechanisms utilized by these cells to sense this stimulus are yet to be fully elucidated. In this study, we demonstrate that cyclic HP is a potent mediator of cytoskeletal reorganization and increases in osteogenic responses in MSCs. In particular, we demonstrate that the intermediate filament (IF) network undergoes breakdown and reorganization with centripetal translocation of IF bundles toward the perinuclear region. Furthermore, we show for the first time that this IF remodeling is required for loading-induced MSC osteogenesis, revealing a novel mechanism of MSC mechanotransduction. In addition, we demonstrate that chemical disruption of IFs with withaferin A induces a similar mechanism of IF breakdown and remodeling as well as a subsequent increase in osteogenic gene expression in MSCs, exhibiting a potential mechanotherapeutic effect to enhance MSC osteogenesis. This study therefore highlights a novel mechanotransduction mechanism of pressure-induced MSC osteogenesis involving the understudied cytoskeletal structure, the IF, and demonstrates a potential new therapy to enhance bone formation in bone-loss diseases such as osteoporosis.-Stavenschi, E., Hoey, D. A. Pressure-induced mesenchymal stem cell osteogenesis is dependent on intermediate filament remodeling.
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Affiliation(s)
- Elena Stavenschi
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - David A Hoey
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland.,Department of Mechanical, Aeronautical and Biomedical Engineering, University of Limerick, Limerick, Ireland; and.,Advanced Materials and Bioengineering Research Centre, Trinity College Dublin and Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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14
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Yan L, Gao R, Liu Y, He B, Lv S, Hao D. The Pathogenesis of Ossification of the Posterior Longitudinal Ligament. Aging Dis 2017; 8:570-582. [PMID: 28966802 PMCID: PMC5614322 DOI: 10.14336/ad.2017.0201] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a multi-factorial disease involving an ectopic bone formation of spinal ligaments. It affects 0.8-3.0% aging Asian and 0.1-1.7% aging European Caucasian. The ossified ligament compresses nerve roots in the spinal cord and causes serious neurological problems such as myelopathy and radiculopathy. Research in understanding pathogenesis of OPLL over the past several decades have revealed many genetic and non-genetic factors contributing to the development and progress of OPLL. The characterizations of aberrant signaling of bone morphogenetic protein (BMP) and mitogen-activated protein kinases (MAPK), and the pathological phenotypes of OPLL-derived mesenchymal stem cells (MSCs) have provided new insights on the molecular mechanisms underlying OPLL. This paper reviews the recent progress in understanding the pathophysiology of OPLL and proposes future research directions on OPLL.
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Affiliation(s)
- Liang Yan
- 1Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
| | - Rui Gao
- 2Department of Respiration, The Children's Hospital of Xi'an City, Xi'an, 710054, China
| | - Yang Liu
- 1Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
| | - Baorong He
- 1Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
| | - Shemin Lv
- 3Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
| | - Dingjun Hao
- 1Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
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15
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Roth CC, Glickman RD, Martens SL, Echchgadda I, Beier HT, Barnes RA, Ibey BL. Adult human dermal fibroblasts exposed to nanosecond electrical pulses exhibit genetic biomarkers of mechanical stress. Biochem Biophys Rep 2017; 9:302-309. [PMID: 28956017 PMCID: PMC5614618 DOI: 10.1016/j.bbrep.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 11/17/2016] [Accepted: 01/24/2017] [Indexed: 11/29/2022] Open
Abstract
Background Exposure of cells to very short (<1 µs) electric pulses in the megavolt/meter range have been shown to cause a multitude of effects, both physical and molecular in nature. Physically, nanosecond electrical pulses (nsEP) can cause disruption of the plasma membrane, cellular swelling, shrinking and blebbing. Molecularly, nsEP have been shown to activate signaling pathways, produce oxidative stress, stimulate hormone secretion and induce both apoptotic and necrotic death. We hypothesize that studying the genetic response of primary human dermal fibroblasts exposed to nsEP, will gain insight into the molecular mechanism(s) either activated directly by nsEP, or indirectly through electrophysiology interactions. Methods Microarray analysis in conjunction with quantitative real time polymerase chain reaction (qRT-PCR) was used to screen and validate genes selectively upregulated in response to nsEP exposure. Results Expression profiles of 486 genes were found to be significantly changed by nsEP exposure. 50% of the top 20 responding genes coded for proteins located in two distinct cellular locations, the plasma membrane and the nucleus. Further analysis of five of the top 20 upregulated genes indicated that the HDFa cells’ response to nsEP exposure included many elements of a mechanical stress response. Conclusions We found that several genes, some of which are mechanosensitive, were selectively upregulated due to nsEP exposure. This genetic response appears to be a primary response to the stimuli and not a secondary response to cellular swelling. General significance This work provides strong evidence that cells exposed to nsEP interpret the insult as a mechanical stress. Global gene expression analysis was performed on primary cells exposed to nsEP. The bioeffects of nsEP on adult human dermal fibroblasts were investigated. Microarray analysis suggests nsEP imparts a mechanical stress on cells. FOS, NR4A2, ITPKB, KLHL24, and SOD2 were upregulated in response to nsEP.
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Affiliation(s)
- Caleb C Roth
- University of Texas Health Science Center San Antonio, School of Medicine, Dept. of Radiological Sciences, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.,General Dynamics IT, 4141 Petroleum Road, JBSA Fort Sam Houston, TX 78234, USA.,Human Effectiveness Directorate, 711th Human Performance Wing, Air Force Research Laboratory, Radio Frequency Bioeffects Branch, Bioeffects Division, 4141 Petroleum Road, JBSA Fort Sam Houston, TX 78234, USA
| | - Randolph D Glickman
- University of Texas Health Science Center San Antonio, School of Medicine, Dept. of Ophthalmology, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Stacey L Martens
- Human Effectiveness Directorate, 711th Human Performance Wing, Air Force Research Laboratory, Radio Frequency Bioeffects Branch, Bioeffects Division, 4141 Petroleum Road, JBSA Fort Sam Houston, TX 78234, USA
| | - Ibtissam Echchgadda
- Human Effectiveness Directorate, 711th Human Performance Wing, Air Force Research Laboratory, Radio Frequency Bioeffects Branch, Bioeffects Division, 4141 Petroleum Road, JBSA Fort Sam Houston, TX 78234, USA
| | - Hope T Beier
- Human Effectiveness Directorate, 711th Human Performance Wing, Air Force Research Laboratory, Optical Radiation Bioeffects Branch, Bioeffects Division, 4141 Petroleum Road, JBSA Fort Sam Houston, TX 78234, USA
| | - Ronald A Barnes
- Human Effectiveness Directorate, 711th Human Performance Wing, Air Force Research Laboratory, Radio Frequency Bioeffects Branch, Bioeffects Division, 4141 Petroleum Road, JBSA Fort Sam Houston, TX 78234, USA
| | - Bennett L Ibey
- Human Effectiveness Directorate, 711th Human Performance Wing, Air Force Research Laboratory, Radio Frequency Bioeffects Branch, Bioeffects Division, 4141 Petroleum Road, JBSA Fort Sam Houston, TX 78234, USA
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16
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Ning S, Chen Z, Fan D, Sun C, Zhang C, Zeng Y, Li W, Hou X, Qu X, Ma Y, Yu H. Genetic differences in osteogenic differentiation potency in the thoracic ossification of the ligamentum flavum under cyclic mechanical stress. Int J Mol Med 2016; 39:135-143. [PMID: 28004120 PMCID: PMC5179181 DOI: 10.3892/ijmm.2016.2803] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/02/2016] [Indexed: 11/05/2022] Open
Abstract
Mechanical stress and genetic factors play important roles in the occurrence of thoracic ossification of ligament flavum (TOLF), which can occur at one, two, or multiple levels of the spine. It is unclear whether single- and multiple-level TOLF differ in terms of osteogenic differentiation potency and osteogenesis-related gene expression under cyclic mechanical stress. This was addressed in the present study using patients with non‑TOLF and single‑ and multiple‑level TOLF (n=8 per group). Primary ligament cells were cultured and osteogenesis was induced by application of cyclic mechanical stress. Osteogenic differentiation was assessed by evaluating alkaline phosphatase (ALP) activity and the mRNA and protein expression of osteogenesis‑related genes, including ALP, bone morphogenetic protein 2 (BMP2), Runt‑related transcription factor‑2 (Runx‑2), osterix, osteopontin (OPN) and osteocalcin. The application of cyclic mechanical stress resulted in higher ALP activity in the multiple‑level than in the single‑level TOLF group, whereas no changes were observed in the non‑TOLF group. The ALP, BMP2, OPN and osterix mRNA levels were higher in the multiple‑level as compared to the single‑level TOLF group, and the levels of all osteogenesis-related genes, apart from Runx2, were higher in the multiple‑level as compared to the non‑TOLF group. The osterix and ALP protein levels were higher in the multiple‑level TOLF group than in the other 2 groups, and were increased with the longer duration of stress. These results highlight the differences in osteogenic differentiation potency between single‑ and multiple‑level TOLF that may be related to the different pathogenesis and genetic background.
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Affiliation(s)
- Shanglong Ning
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Dongwei Fan
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Chuiguo Sun
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Chi Zhang
- Bone Research Laboratory, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Yan Zeng
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Xiaofei Hou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Xiaochen Qu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Yunlong Ma
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Huilei Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, P.R. China
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17
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González-Chávez SA, Quiñonez-Flores CM, Pacheco-Tena C. Molecular mechanisms of bone formation in spondyloarthritis. Joint Bone Spine 2016; 83:394-400. [DOI: 10.1016/j.jbspin.2015.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/20/2015] [Indexed: 12/17/2022]
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18
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Evaluation of the Genetic Response of U937 and Jurkat Cells to 10-Nanosecond Electrical Pulses (nsEP). PLoS One 2016; 11:e0154555. [PMID: 27135944 PMCID: PMC4852903 DOI: 10.1371/journal.pone.0154555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 03/21/2016] [Indexed: 12/21/2022] Open
Abstract
Nanosecond electrical pulse (nsEP) exposure activates signaling pathways, produces oxidative stress, stimulates hormone secretion, causes cell swelling and induces apoptotic and necrotic death. The underlying biophysical connection(s) between these diverse cellular reactions and nsEP has yet to be elucidated. Using global genetic analysis, we evaluated how two commonly studied cell types, U937 and Jurkat, respond to nsEP exposure. We hypothesized that by studying the genetic response of the cells following exposure, we would gain direct insight into the stresses experienced by the cell and in turn better understand the biophysical interaction taking place during the exposure. Using Ingenuity Systems software, we found genes associated with cell growth, movement and development to be significantly up-regulated in both cell types 4 h post exposure to nsEP. In agreement with our hypothesis, we also found that both cell lines exhibit significant biological changes consistent with mechanical stress induction. These results advance nsEP research by providing strong evidence that the interaction of nsEPs with cells involves mechanical stress.
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19
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Zileli M, Sharif S, Qadeer M. Does Trauma Have a Major Role in Ossified Posterior Longitudinal Ligament and Should We Perform Fusion in Every Case? World Neurosurg 2015; 84:1517-9. [PMID: 26145827 DOI: 10.1016/j.wneu.2015.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 06/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Salman Sharif
- Liaquat National Hospital & Medical College, Karachi, Pakistan.
| | - Mohsin Qadeer
- Liaquat National Hospital & Medical College, Karachi, Pakistan
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