Effects of shear force on intervertebral disc: an in vivo rabbit study

Changes in nail position and antirotation blade angles on the risk of femoral head varus in PFNA fixed patients: a clinical review and comprehensive biomechanical research

BACKGROUND

Femoral head varus triggers poor clinical prognosis in intertrochanteric fracture patients with proximal femoral nail antirotation (PFNA) fixation. Studies present that changes in nail position and screw insertion angles will affect fixation stability, but the biomechanical significance of these factors on the risk of femoral head varus has yet to be identified in PFNA fixed patients.

METHODS

Clinical data in PFNA fixed intertrochanteric fracture patients have been reviewed, the relative position of intermedullary nail has been judged in the instant postoperative lateral radiography. Regression analyses have been performed to identify the effect of this factor on femoral head varus. Corresponding biomechanical mechanism has been identified by numerical mechanical simulations.

RESULTS

A clinical review revealed that ventral side nail insertion can trigger higher risk of femoral head varus, corresponding numerical mechanical simulations also recorded poor fixation stability in models with ventral side nail insertion, and changes in the trajectory of anti-rotation blade will not obviously affect this tendency.

CONCLUSIONS

Ventral side insertion of intramedullary nail can trigger higher risk of femoral head varus in PFNA fixed patients by deteriorating the instant postoperative biomechanical environment, and changes in blade trajectory cannot change this tendency biomechanically. Therefore, this nail position should be adjusted to optimize patients' prognosis.

Insights into the mechanical microenvironment within the cartilaginous endplate: An emerging role in maintaining disc homeostasis and normal function

Biomechanical factors are strongly linked with the emergence and development of intervertebral disc degeneration (IVDD). The intervertebral disc (IVD), as a unique enclosed biomechanical structure, exhibits distinct mechanical properties within its substructures. Damage to the mechanical performance of any substructure can disrupt the overall mechanical function of the IVD. Endplate degeneration serves as a significant precursor to IVDD. The endplate (EP) structure, especially the cartilaginous endplate (CEP), serves as a conduit for nutrient and metabolite transport in the IVD. It is inevitably influenced by its nutritional environment, mechanical loading, cytokines and extracellular components. Currently, reports on strategies targeting the CEP for the prevention and treatment of IVDD are scarce. This is due to two primary reasons: first, limited knowledge of the biomechanical microenvironment surrounding the degenerated CEP cells; and second, innovative biological treatment strategies, such as implanting active cells (disc or mesenchymal stem cells) or modulating natural cell activity through the addition of therapeutic factors or genes to treat IVDD often overlook a critical aspect-the restoration of the nutrient supply function and mechanical microenvironment of the endplate. Therefore, restoring the healthy structure of the CEP and maintaining a stable mechanical microenvironment within the EP are crucial for the prevention of IVDD and the repair of degenerated IVDs. We present a comprehensive literature review on the mechanical microenvironment characteristics of cartilage endplates and their associated mechanical signaling pathways. Our aim is to provide valuable insights into the development and implementation of strategies to prevent IVDD by delaying or reversing CEP degeneration.

Tension regulates the cartilage phenotypic expression of endplate chondrocytes through the α-catenin/actin skeleton/Hippo pathway

The study aimed to investigate the regulatory mechanism of intracellular tension signaling in endplate chondrocytes and its impact on extracellular matrix synthesis. Human endplate chondrocytes were subjected to tension load using Flexcell FX-5000™, and changes in phenotype, morphology, and the expression of Hippo signaling pathway and α-Catenin were assessed through various techniques. Through the overexpression of YAP and inhibition of α-Catenin, the study clarified the intracellular tension signaling pathway and its regulation of extracellular matrix synthesis in endplate cartilage. In vitro-cultured human endplate chondrocytes significantly suppressed phenotype-related genes and proteins, accompanied by distinct changes in cytoskeleton morphology. Tension activation resulted in the substantial activation of the Hippo pathway, increased phosphorylation of YAP, and reduced nuclear translocation of YAP. YAP overexpression alleviated the inhibitory effect of tension on extracellular matrix synthesis in endplate chondrocytes. Tension also upregulated the expression of α-Catenin in endplate chondrocytes, which was attenuated by inhibiting α-Catenin expression, thereby reducing the impact of tension on cytoskeletal morphology and YAP nuclear translocation. Taken together, the α-Catenin/actin skeleton/Hippo-coupled network is a crucial signaling pathway for tension signaling in endplate chondrocytes, providing potential therapeutic targets for the treatment of endplate cartilage degeneration.

Aberrant mechanical loading induces annulus fibrosus cells apoptosis in intervertebral disc degeneration via mechanosensitive ion channel Piezo1

BACKGROUND

Intervertebral disc degeneration (IVDD) is closely associated with the structural damage in the annulus fibrosus (AF). Aberrant mechanical loading is an important inducement of annulus fibrosus cells (AFCs) apoptosis, which contributes to the AF structural damage and aggravates IVDD, but the underlying mechanism is still unclear. This study aims to investigate the mechanism of a mechanosensitive ion channel protein Piezo1 in aberrant mechanical loading-induced AFCs apoptosis and IVDD.

METHODS

Rats were subjected to lumbar instability surgery to induce the unbalanced dynamic and static forces to establish the lumbar instability model. MRI and histological staining were used to evaluate the IVDD degree. A cyclic mechanical stretch (CMS)-stimulated AFCs apoptosis model was established by a Flexcell system in vitro. Tunel staining, mitochondrial membrane potential (MMP) detection, and flow cytometry were used to evaluate the apoptosis level. The activation of Piezo1 was detected using western blot and calcium fluorescent probes. Chemical activator Yoda1, chemical inhibitor GSMTx4, and a lentiviral shRNA-Piezo1 system (Lv-Piezo1) were utilized to regulate the function of Piezo1. High-throughput RNA sequencing (RNA-seq) was used to explore the mechanism of Piezo1-induced AFCs apoptosis. The Calpain activity and the activation of Calpain2/Bax/Caspase3 axis were evaluated by the Calpain activity kit and western blot with the siRNA-mediated Calapin1 or Calpain2 knockdown. Intradiscal administration of Lv-Piezo1 was utilized to evaluate the therapeutic effect of Piezo1 silencing in IVDD rats.

RESULTS

Lumbar instability surgery promoted the expression of Piezo1 in AFCs and stimulated IVDD in rats 4 weeks after surgery. CMS elicited distinct apoptosis of AFCs, with enhanced Piezo1 activation. Yoda1 further promoted CMS-induced apoptosis of AFCs, while GSMTx4 and Lv-Piezo1 exhibited opposite effects. RNA-seq showed that knocking down Piezo1 inhibited the calcium signaling pathway. CMS enhanced Calpain activity and elevated the expression of BAX and cleaved-Caspase3. Calpain2, but not Calpain1 knockdown, inhibited the expression of BAX and cleaved-Caspase3 and alleviated AFCs apoptosis. Lv-Piezo1 significantly alleviated the progress of IVDD in rats after lumbar instability surgery.

CONCLUSIONS

Aberrant mechanical loading induces AFCs apoptosis to promote IVDD by activating Piezo1 and downstream Calpain2/BAX/Caspase3 pathway. Piezo1 is expected to be a potential therapeutic target in treating IVDD.

Role of non‑coding RNAs in cartilage endplate (Review)

Cartilage endplate (CEP) degeneration is considered one of the major causes of intervertebral disc degeneration (IDD), which causes non-specific neck and lower back pain. In addition, several non-coding RNAs (ncRNAs), including long ncRNAs, microRNAs and circular RNAs have been shown to be involved in the regulation of various diseases. However, the particular role of ncRNAs in CEP remains unclear. Identifying these ncRNAs and their interactions may prove to be is useful for the understanding of CEP health and disease. These RNA molecules regulate signaling pathways and biological processes that are critical for a healthy CEP. When dysregulated, they can contribute to the development disease. Herein, studies related to ncRNAs interactions and regulatory functions in CEP are reviewed. In addition, a summary of the current knowledge regarding the deregulation of ncRNAs in IDD in relation to their actions on CEP cell functions, including cell proliferation, apoptosis and extracellular matrix synthesis/degradation is presented. The present review provides novel insight into the pathogenesis of IDD and may shed light on future therapeutic approaches.

Which typical floor movements of men's artistic gymnastics result in the most extreme lumbar lordosis and ground reaction forces?

Back pain is prevalent among gymnast populations and extreme flexion or extension of the lumbar spine along with high ground reaction forces (GRFs) are known to increase intervertebral stress. The aim of this study was to determine which postures and dynamic conditions among common floor movements provide the greatest risk of injury in men's artistic gymnastics (MAG). For this purpose, lumbar spine curvatures, obtained through a full-body subject-specific kinematic model fed by motion capture data, and GRFs on feet and hands were compared between typical floor movements of MAG (pike jump, round off back handspring, front handspring, forward and backward tucked somersaults) performed by six adolescent gymnasts. The round off back handspring and the pike jump resulted respectively in the largest lumbar extension and flexion, and the forward tucked somersault take-off in the highest GRF. At ground impacts, the largest lumbar flexion was during the backward tucked somersault landing and only the back handspring hands ground contact phase led to lumbar extension. Such identification of high-risk conditions should enable better back pain management in gymnastics through more tailored training adaptations, particularly in case of pathologies or musculoskeletal specificities.

YAP1 controls degeneration of human cartilage chondrocytes in response to mechanical tension

Disc herniation is a kind of disease caused by degenerative discs, which is common in the elderly, bringing substantial financial burden to families and society. Mechanical tension has a vital effect on the maintenance of cartilage function, however, the molecular mechanism by which mechanical tension causes degenerative discs to remain unclear. This study was the first to reveal Yes-associated protein 1(YAP1) is a key regulator in mechanical tension-mediated degenerative discs. Activation of YAP1 may be a valuable strategy to delays the degeneration of human cartilage chondrocytes. We found that YAP1 expression was significantly decreased in degenerative human endplate cartilage and tissue with the strength and time of mechanical stimulation, but the cell cycle distribution was significantly changed under the 10% cyclic mechanical tension(CMT). Besides, the degeneration of endplate cartilage can be delayed by activating the expression level of YAP1 in vitro and it has also been verified in the cartilage endplate tissue in vitro. Furthermore, We found that YAP1 and TEAD1 overexpression increased the activity of the ACAN or COL2A1 promoter to enhance the transcriptional activity of human chondrocyte collagen. The CMT activates the classic Hippo signaling pathway of YAP1, and piezo1 may regulate YAP1 expression through the Hippo signaling pathway. In conclusion, these results suggest the novel mechanism of YAP contributes to delaying the degeneration of endplate cartilage and targeting YAP in combination with Piezo1 is a potential therapeutic approach for the treatment of endplate cartilage degeneration.

Adjacent segments biomechanics following lumbar fusion surgery: a musculoskeletal finite element model study

PURPOSE

This study exploits a novel musculoskeletal finite element (MS-FE) spine model to evaluate the post-fusion (L4-L5) alterations in adjacent segment kinetics.

METHODS

Unlike the existing MS models with idealized representation of spinal joints, this model predicts stress/strain distributions in all passive tissues while organically coupled to a MS model. This generic (in terms of musculature and material properties) model uses population-based in vivo vertebral sagittal rotations, gravity loads, and an optimization algorithm to calculate muscle forces. Simulations represent individuals with an intact L4-L5, a preoperative severely degenerated L4-L5 (by reducing the disc height by ~ 60% and removing the nucleus incompressibility), and a postoperative fused L4-L5 segment with either a fixed or an altered lumbopelvic rhythm with respect to the intact condition (based on clinical observations). Changes in spine kinematics and back muscle cross-sectional areas (due to intraoperative injuries) are considered based on in vivo data while simulating three activities in upright/flexed postures.

RESULTS

Postoperative changes in some adjacent segment kinetics were found considerable (i.e., larger than 25%) that depended on the postoperative lumbopelvic kinematics and preoperative L4-L5 disc condition. Postoperative alterations in adjacent disc shear, facet/ligament forces, and annulus stresses/strains were greater (> 25%) than those found in intradiscal pressure and compression (< 25%). Kinetics of the lower (L5-S1) and upper (L3-L4) adjacent segments were altered to different degrees.

CONCLUSION

Alterations in segmental rotations mainly affected adjacent disc shear forces, facet/ligament forces, and annulus/collagen fibers stresses/strains. An altered lumbopelvic rhythm (increased pelvis rotation) tends to mitigate some of these surgically induced changes.

Intervertebral Disc-on-a-Chip as Advanced In Vitro Model for Mechanobiology Research and Drug Testing: A Review and Perspective

Discogenic back pain is one of the most diffused musculoskeletal pathologies and a hurdle to a good quality of life for millions of people. Existing therapeutic options are exclusively directed at reducing symptoms, not at targeting the underlying, still poorly understood, degenerative processes. Common intervertebral disc (IVD) disease models still do not fully replicate the course of degenerative IVD disease. Advanced disease models that incorporate mechanical loading are needed to investigate pathological causes and processes, as well as to identify therapeutic targets. Organs-on-chip (OoC) are microfluidic-based devices that aim at recapitulating tissue functions in vitro by introducing key features of the tissue microenvironment (e.g., 3D architecture, soluble signals and mechanical conditioning). In this review we analyze and depict existing OoC platforms used to investigate pathological alterations of IVD cells/tissues and discuss their benefits and limitations. Starting from the consideration that mechanobiology plays a pivotal role in both IVD homeostasis and degeneration, we then focus on OoC settings enabling to recapitulate physiological or aberrant mechanical loading, in conjunction with other relevant features (such as inflammation). Finally, we propose our view on design criteria for IVD-on-a-chip systems, offering a future perspective to model IVD mechanobiology.

Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine

Adjacent segment disorders are prevalent in patients following a spinal fusion surgery. Postoperative alterations in the adjacent segment biomechanics play a role in the etiology of these conditions. While experimental approaches fail to directly quantify spinal loads, previous modeling studies have numerous shortcomings when simulating the complex structures of the spine and the pre/postoperative mechanobiology of the patient. The biomechanical effects of the L4–L5 fusion surgery on muscle forces and adjacent segment kinetics (compression, shear, and moment) were investigated using a validated musculoskeletal model. The model was driven by in vivo kinematics for both preoperative (intact or severely degenerated L4–L5) and postoperative conditions while accounting for muscle atrophies. Results indicated marked changes in the kinetics of adjacent L3–L4 and L5–S1 segments (e.g., by up to 115% and 73% in shear loads and passive moments, respectively) that depended on the preoperative L4–L5 disc condition, postoperative lumbopelvic kinematics and, to a lesser extent, postoperative changes in the L4–L5 segmental lordosis and muscle injuries. Upper adjacent segment was more affected post-fusion than the lower one. While these findings identify risk factors for adjacent segment disorders, they indicate that surgical and postoperative rehabilitation interventions should focus on the preservation/restoration of patient’s normal segmental kinematics.

A novel rat model of vertebral inflammation-induced intervertebral disc degeneration mediated by activating cGAS/STING molecular pathway

In this study, we describe a new rat model of vertebral inflammation-induced caudal intervertebral disc degeneration (VI-IVDD), in which IVD structure was not damaged and controllable segment and speed degeneration was achieved. VI-IVDD model was obtained by placing lipopolysaccharide (LPS) in the caudal vertebral bodies of rats. Rat experimental groups were set as follows: normal control group, group with a hole drilled in the middle of vertebral body and not filled with LPS (Blank group), group with a hole drilled in the middle of vertebral body and filled with LPS (Mid group), and group with hole drilled in the vertebral body in proximity of IVD and filled with LPS (NIVD group). Radiological results of VI-IVDD rats showed a significant reduction in the intervertebral space height and decrease in MRI T2 signal intensity. Histological stainings also revealed that the more the nucleus pulposus and endplate degenerated, the more the annulus fibrosus structure appeared disorganized. Immunohistochemistry analysis demonstrated that the expression of Aggrecan and collagen-II decreased, whereas that of MMP-3 increased in Mid and NIVD groups. Abundant local production of pro-inflammatory cytokines was detected together with increased infiltration of M1 macrophages in Mid and NIVD groups. Apoptosis ratio remarkably enhanced in Mid and NIVD groups. Interestingly, we found a strong activation of the cyclic GMP-AMP synthase /stimulator of interferon gene signalling pathway, which is strictly related to inflammatory and degenerative diseases. In this study, we generated a new, reliable and reproducible IVDD rat model, in which controllable segment and speed degeneration was achieved.

Disc measurement and nucleus calibration in a smoothened lumbar model increases the accuracy and efficiency of in-silico study

Backgrounds

Finite element analysis (FEA) is an important tool during the spinal biomechanical study. Irregular surfaces in FEA models directly reconstructed based on imaging data may increase the computational burden and decrease the computational credibility. Definitions of the relative nucleus position and its cross-sectional area ratio do not conform to a uniform standard in FEA.

Methods

To increase the accuracy and efficiency of FEA, nucleus position and cross-sectional area ratio were measured from imaging data. A FEA model with smoothened surfaces was constructed using measured values. Nucleus position was calibrated by estimating the differences in the range of motion (RoM) between the FEA model and that of an in-vitro study. Then, the differences were re-estimated by comparing the RoM, the intradiscal pressure, the facet contact force, and the disc compression to validate the measured and calibrated indicators. The computational time in different models was also recorded to evaluate the efficiency.

Results

Computational results indicated that 99% of accuracy was attained when measured and calibrated indicators were set in the FEA model, with a model validation of greater than 90% attained under almost all of the loading conditions. Computational time decreased by around 70% in the fitted model with smoothened surfaces compared with that of the reconstructed model.

Conclusions

The computational accuracy and efficiency of in-silico study can be improved in the lumbar FEA model constructed using smoothened surfaces with measured and calibrated relative nucleus position and its cross-sectional area ratio.

A Novel Rat Tail Needle Minimally Invasive Puncture Model Using Three-Dimensional Printing for Disk Degeneration and Progressive Osteogenesis Research

Many studies focused on the annulus fibrosus (AF) injury in rodent tail model for the intervertebral disk degeneration (IDD) research. However, previous studies caused tremendous injury of intervertebral disk (IVD) by penetrating whole disk. This study aimed to build a progressive IDD rodent tail model by a novel device for precise and minimally invasive puncture in AF. A precise puncture device was customized by 3D Printing Technique. 40 rodent tail IVDs were randomly grouped as follows: group A, non-puncture; group B, annulus needle puncture (ANP) for 4 week; group C, ANP for 8 week; and group D, ANP for 12 week. Pre- and post-puncture IVD height on radiographs and IVD signal intensity on T2 magnetic resonance imaging (MRI) were measured. Average bone density (ABD) on the end of coccygeal vertebrae between punctured disk was measured on the radiographs. Hematoxylin and eosin, TUNEL staining methods, immunofluorescence for cleaved-caspas3 and immunohistochemistry for aggrecan and collagen II were performed. Progressively and significantly increasing IVD height loss and degenerative grade were observed following the time points. The ABD was respectively, 81.20 ± 4.63 in group A, 83.93±3.18 in group B, 92.65 ± 4.32 in group C, 98.87 ± 6.69 in group D. In both group C and group D, there were significant differences with group A. In histology, increasing number of AF cells was noted in group B. In both group C and D, the fissures in AF were obviously observed, and a marked reduction of AF cells were also observed. In all ANP groups, there were significant decrease in number of NP cells, as well as aggrecan and collagen II contents. TUNEL assay showed cellular apoptosis were stimulated in all puncture group, especially in group D. A progressive IDD rat model could be standardly established by the micro-injury IVD puncture using a novel 3D printing device. This animal model provided a potential application for research of progressive hyperosteogeny following IDD development.

No evidence of a correlation between lumbar spinal subtypes and intervertebral disc degeneration among asymptomatic middle-aged and aged patients

The aim of the present study was to identify whether lumbar spinal subtypes (LSS) were associated with lumbar disc degeneration (LDD) among asymptomatic middle-aged and aged subjects. A cohort of 158 asymptomatic Chinese adults aged >40 years was recruited and 97 volunteers that met the inclusion criteria with complete information available were selected for inclusion. According to spinal morphology, volunteers were divided into four subtypes based on the classification of Roussouly. After baseline information was collected and spinopelvic parameters were measured, the data were compared among the four groups. According to the Pfirrmann classification, the degree of LDD was evaluated at each level on the MRI. For grades I-V, LDD at each level was effectively compared. Each of the four LSS from I to IV according to Roussouly classification from types I to IV were comprised of 25 (25.8%), 19 (19.6%), 38 (39.2%) and 15 (15.5%) of volunteers, respectively. Lumbar lordosis, sacral slope and pelvic incidence were significantly different among the four sub-types (P<0.001 for each), but no difference in pelvic tilt was observed (P=0.21). From types I to IV LSS, the proportion of disc degeneration was found to be 44, 52, 50 and 48%, respectively, which exhibited no statistically significant difference among LSS. No correlation between LSS and intervertebral disc degeneration was obtained among the asymptomatic middle-aged and aged subjects. The present study provides a reference for spinal surgery and indicated that additional risk factors should be assessed in the asymptomatic population of this age group, particularly in terms of differentially expressed genes.

Curcumin prevents tension-induced endplate cartilage degeneration by enhancing autophagy

AIMS

Intermittent cyclic tension stimulation(ICMT) was shown to promote degeneration of endplate chondrocytes and induce autophagy. However, enhancing autophagy can alleviate degeneration partly. Studies have shown that curcumin can induce autophagy and protect chondrocytes, we speculated that regulation of autophagy by curcumin might be an effective method to improve the stress resistance of endplate cartilage. In this study, human cervical endplate cartilage specimens were collected, and expression of autophagy markers was detected and compared.

MAIN METHODS

Human cervical endplate chondrocytes were cultured to establish a tension-induced degeneration model, for which changes of functional metabolism and autophagy levels were detected under different tension loading conditions. Changes in functional metabolism of endplate chondrocytes were observed under high-intensity tension loading in the presence of inhibitors, inducers, and curcumin to regulate the autophagy level of cells. In addition, a rat model of lumbar instability was established to observe the degeneration of lumbar disc after curcumin administration.

KEY FINDINGS

Through a series of experiments, we found that low-intensity tension stimulation can maintain a stable phenotype of endplate chondrocytes, but high-intensity tension stimulation has a negative effect. Moreover, with increasing tension intensity, the degree of degeneration of endplate chondrocytes was gradually aggravated and the level of autophagy increased. Besides, curcumin upregulated autophagy, inhibited apoptosis, and reduced phenotype loss of endplate chondrocytes induced by high-intensity tension loading, thereby relieving intervertebral disc degeneration induced by mechanical imbalance.

SIGNIFICANCE

Curcumin mediated autophagy and enhanced the adaptability of endplate chondrocytes to high-intensity tension load, thereby relieving intervertebral disc degeneration.

Greater Lumbar Extension During Dolphin Kick and Psoas Major Tightness in Swimmers With Low Back Pain

CONTEXT

In competitive swimming, many swimmers experience low back pain (LBP). Lumbar hyperextension may cause LBP, and tight hip-flexor muscle may cause lumbar extension during swimming.

OBJECTIVE

The purpose of this study was to clarify the features of the elastic moduli of the muscles and the lumbar extension when swimmers with LBP perform a dolphin kick (DK).

DESIGN

Cross-sectional study.

SETTING

Single center.

OTHER PARTICIPANTS

Eleven male college swimmers were enrolled as the LBP group (who have LBP when swimming and during a lumbar extension), and 21 male college swimmers were recruited as the control group (no LBP).

INTERVENTIONS

The elastic moduli of the psoas major, iliacus, teres major, latissimus dorsi, pectoralis major, and pectoralis minor were measured through ultrasonic shear wave elastography. The lumbar and hip extension angles during a DK were measured using a video camera. The passive hip extension and shoulder-flexion range of motion (ROM) were measured using a goniometer.

MAIN OUTCOME MEASURES

Muscle elastic moduli and lumbar extension angles during DK.

RESULTS

The characteristics, muscle elastic moduli, DK motion, and ROM were compared between the 2 groups. LBP group demonstrated significantly higher elastic modulus of the psoas major and lower modulus of pectoralis minor compared with the control group. Also, LBP group showed greater lumbar extension during a DK and less hip extension ROM than the control group.

CONCLUSIONS

The higher elastic modulus of the psoas major and greater lumbar extension during a DK may be related to the LBP in swimmers.

The Sirt1/P53 Axis in Diabetic Intervertebral Disc Degeneration Pathogenesis and Therapeutics

Intervertebral disc degeneration (IDD) is one of the major causes of low back pain. Diabetes is a risk factor for IDD and may aggravate IDD in rats; however, the mechanism is poorly understood. Previously, we demonstrated that apoptosis and senescence were increased in diabetic nucleus pulposus (NP) tissues; in the current study, we found that hyperglycaemia may promote the incidence of apoptosis and senescence in NP cells in vitro. Meanwhile, the acetylation of P53, a master transcription factor of apoptosis and senescence, was also found increased in diabetic NP tissues in vivo as well as in hyperglycaemic NP cells in vitro. Sirt1 is an NAD⁺-dependent deacetylase, and we showed that the expression of Sirt1 was decreased in NP tissues, while hyperglycaemia could suppress the expression and activity of Sirt1 in NP cells. Furthermore, we demonstrated that butein may inhibit acetylation of P53 and protect NP cells against hyperglycaemia-induced apoptosis and senescence through Sirt1 activation, as the Sirt1 inhibitor Ex527 may counteract the protective effect of butein in hyperglycaemic NP cells. An in vivo study showed that butein could ameliorate the IDD process in diabetic rats, while Sirt1 was increased and acetyl-p53 was decreased in NP tissues in butein-treated rats. These results indicate that the Sirt1/P53 axis is involved in the pathogenesis of diabetic IDD and may serve as a therapeutic target for diabetic IDD.

circRNA_0058097 promotes tension-induced degeneration of endplate chondrocytes by regulating HDAC4 expression through sponge adsorption of miR-365a-5p

Excessive mechanical tension can lead to the degeneration of endplate chondrocytes. The presence of tension-sensitive circRNA_0058097 molecules has been detected in human endplate chondrocytes, where it was found to be a potential competing endogenous RNA. Indeed, inhibiting the expression of circRNA_0058097 effectively enhanced the stress resistance of endplate chondrocytes, suggesting that it may be an important trigger point for the degeneration of endplate cartilage. Through a series of experiments, we reveal that circRNA_0058097 can upregulate the expression of downstream target gene histone deacetylase 4 by sponge adsorption of miR-365a-5p, which promoted morphological changes of endplate chondrocytes, and increased extracellular matrix degradation and degeneration of endplate cartilage. Therefore, circRNA_0058097 may provide a new way to prevent and treat endplate cartilage degeneration.

Microfluidic Disc-on-a-Chip Device for Mouse Intervertebral Disc-Pitching a Next-Generation Research Platform To Study Disc Degeneration

Low back pain is the most common cause of disability worldwide, and intervertebral disc degeneration is a major cause of low back pain. Unfortunately, discogenic low back pain is often treated with symptomatic relief interventions, as no disease-modifying medications are yet available. Both to-be-deciphered disc biology/pathology and inadequate in vitro research platform are major hurdles limiting drug discovery progress for disc degeneration. Here, we developed a microfluidic disc-on-a-chip device tailored for mouse disc organ as an in vitro research platform. We hypothesize that continuous nutrients empowered by a microfluidic device would improve biological performance of cultured mouse discs compared to those in static condition. This device permitted continuous media flow to mimic in vivo disc microenvironment. Intriguingly, mouse discs cultured on the microfluidic device exhibited much higher cell viability, better preserved structure integrity and anabolic-catabolic metabolism in both nucleus pulposus and annulus fibrosus, for up to 21 days compared to those in static culture. This first "disc-on-a-chip" device lays groundwork for future preclinical studies in a relative long-term organ culture given the chronic nature of intervertebral disc degeneration. In addition, this platform is readily transformable into a streamlined in vitro research platform to recapitulate physiological and pathophysiological microenvironment to accelerate disc research.

Relationship Between Apoptosis of Endplate Microvasculature and Degeneration of the Intervertebral Disk

OBJECTIVE

To explore the relationship between intervertebral disk degeneration and endplate microvasculature, and to determine the role of apoptosis in the pathophysiology underlying end plate microvasculature.

METHODS

Twelve 6-month-old rabbits were randomly divided into group A (control group where animals underwent a sham operation, in which the loading device was implanted but without loading) and group B (degeneration group, where a calibrated spring within the loading device would immediately create static shear force of 50 N to the disk of L4-5). Paraffin-embedded midsagittal sections of the L4-5 disk were obtained 4 weeks after surgery in the both groups. Sections were stained with cluster of differentiation (CD) 31 immunohistochemistry to measure the blood vessel density in the endplate, with CD31 immunofluorescence and terminal dUTP nick-end labeling (TUNEL) to detect the apoptosis of vascular endothelial cells in the endplate.

RESULTS

After 4 weeks, the microvasculature density was 91 ± 8 vessels/mm² in group A and 47 ± 2 vessels/mm² (P < 0.001) in group B, demonstrating that vessels were reduced in the endplate of intervertebral disk degeneration. CD31 immunofluorescence and TUNEL showed that apoptosis of vascular endothelial cells exists in the endplate of intervertebral disk degeneration.

CONCLUSIONS

The results of this study suggest that apoptosis of vascular endothelial cells results in a decrease in endplate microvasculature density, further affecting the pathologic process of intervertebral disk degeneration.

TGF-β/SMAD signaling inhibits intermittent cyclic mechanical tension-induced degeneration of endplate chondrocytes by regulating the miR-455-5p/RUNX2 axis

A mechanical stimulation plays a pivotal role in maintaining normal cartilage function. Our objective was to reveal the mechanism of action of the tension-sensitive molecule miR-455-5p in the degeneration of endplate chondrocytes and to identify whether the transforming growth factor beta (TGF-β)/SMAD signaling pathway has a regulatory effect on it. The expression profiles of members of the TGF-β/SMAD pathway, miR-455-5p, and RUNX2 were determined by microRNA microarray analysis, reverse transcription quantitative polymerase chain reaction, luciferase reporter assay, and Western blot analysis. Intermittent cyclic mechanical tension (ICMT) induced the degeneration of endplate chondrocytes without affecting their viability. The tension-sensitive molecule miR-455-5p specifically bound to RUNX2, a gene involved in the degeneration of endplate chondrocytes. Activation of the TGF-β/SMAD signaling pathway upregulated miR-455-5p expression and thus inhibited RUNX2 levels. Therefore, the TGF-β/SMAD signaling pathway inhibits the ICMT-induced degeneration of endplate chondrocytes by regulating the miR-455-5p/RUNX2 axis.

Sirt6 overexpression suppresses senescence and apoptosis of nucleus pulposus cells by inducing autophagy in a model of intervertebral disc degeneration

Treatment of intervertebral disc degeneration (IDD) seeks to prevent senescence and death of nucleus pulposus (NP) cells. Previous studies have shown that sirt6 exerts potent anti-senescent and anti-apoptotic effects in models of age-related degenerative disease. However, it is not known whether sirt6 protects against IDD. Here, we explored whether sirt6 influenced IDD. The sirt6 level was reduced in senescent human NP cells. Sirt6 overexpression protected against apoptosis and both replicative and stress-induced premature senescence. Sirt6 also activated NP cell autophagy both in vivo and in vitro. 3-methyladenine (3-MA) and chloroquine (CQ)-mediated inhibition of autophagy partially reversed the anti-senescent and anti-apoptotic effects of sirt6, which regulated the expression of degeneration-associated proteins. In vivo, sirt6 overexpression attenuated IDD. Together, the data showed that sirt6 attenuated cell senescence, and reduced apoptosis, by triggering autophagy that ultimately ameliorated IDD. Thus, sirt6 may be a novel therapeutic target for IDD treatment.

Static Compression Induces ECM Remodeling and Integrin α2β1 Expression and Signaling in a Rat Tail Caudal Intervertebral Disc Degeneration Model

STUDY DESIGN

A three-level rat tail caudal intervertebral disc (IVD) degeneration (IVDD) model was established to study effects of static compression on extracellular matrix (ECM) remodeling and integrin signaling in IVDs during IVDD.

OBJECTIVE

The aim of this study was to investigate the effect of compression force on ECM remodeling and integrin signaling in IVDs during IVDD.

SUMMARY OF BACKGROUND DATA

Integrins sense mechanical environment alteration via binding to ECM ligands and trigger intracellular signaling for pathological ECM remodeling during IVDD. However, the role of compression force in ECM remodeling and integrin signaling during IVDD remains elusive.

METHODS

Compared with the classical one-level rat tail IVDD model that exerts axial stress on the 8th to 9th caudal vertebral bodies, a three-level model was established by using an Ilizarov-type apparatus to exert stress on the 7th to 10th caudal vertebral bodies in rat tails for four weeks. To exclude side effects from surgical stab injury on manipulated discs, intact coccygeal (Co) disc Co8-9 was analyzed.

RESULTS

In three-level IVDD model, significant degeneration of the Co8-9 disc was observed. Quantitative real-time polymerase chain reaction (qRT-PCR) showed elevated mRNA expression of collagen types I, III, and V; matrix metalloproteinases (MMPs) 2, 3, 9, 13, 14; and decreased mRNA expression of collagen type II in Co8-9 disc. Compression loading altered the expression of integrin α2β1 (upregulated) and α10β1 (downregulated) in NP cells, and activated integrin downstream signaling. By contrast, one-level model showed more severe disc degeneration and ECM remodeling. Integrin α1, α2, α11, and β1 were upregulated, whereas α10 was downregulated. Similar activation of integrin signaling was observed.

CONCLUSION

Static compression altered collagen and MMP expression, and promoted β1 integrin expression and signaling in IVD. Compared with one-level rat tail IVDD model, three-level model showed milder effects on disc degeneration, ECM remodeling, and integrin expression, suggesting one-level model might involve other causes that induce IVDD via mechanisms independent of compression force.

LEVEL OF EVIDENCE

N/A.

Hyaluronic Acid Microgels Modulate Inflammation and Key Matrix Molecules toward a Regenerative Signature in the Injured Annulus Fibrosus

Low back pain results from disc degeneration, which is a chronic inflammatory disease characterized by an imbalance between anabolic and catabolic factors. Today, regenerative medicine is focused on identifying inflammatory markers to target disc disease. Hyaluronan is used as a scaffold for cell delivery in disc degeneration; however, to date high molecular weight hyaluronan (HMW HA) is evaluated for its anti-inflammatory and matrix modulatory properties in an in vivo disc injury model. Ex vivo bovine organ culture studies demonstrate the anti-inflammatory and matrix modulatory effects of HMW HA on the IFNα2β signaling pathway that provides the motivation for evaluating its efficacy in regenerating the annulus fibrosus in an in vivo disc injury model. It is demonstrated that the HMW HA microgel acts as an anti-inflammatory molecule in the annulus fibrosus, by downregulating the expression of the pro-inflammatory interferon gamma (IFNα) and pro-apoptotic insulin-like growth factor-binding protein 3 (IGFBP3) and the apoptosis marker caspase 3. Mass spectrometry studies demonstrate that the HMW HA microgel modulates the matrix modulatory effect by upregulating hyaluronic acid link protein (HAPLN1) and aggrecan, which are further confirmed by immunostaining. The microgel's regenerative capacity is illustrated by the increase in the disc height index.

Intermittent Cyclic Mechanical Tension Promotes Degeneration of Endplate Cartilage via the Nuclear Factor-κB Signaling Pathway: an in Vivo Study

OBJECTIVE

To establish a rabbit model for investigating the effects of intermittent cyclic mechanical tension (ICMT) on promoting degeneration of endplate cartilage.

METHODS

Forty New Zealand white rabbits were subjected to surgery and randomly divided into three equal groups as follows: control group (no treatment, n = 10), sham group (animals underwent a sham operation but were not subjected to mechanical tensile strain, n = 15) and loaded group (discs were subjected to 1.5 MPa external tensile loading by using an external loading device during the animals' daily activity, n = 15). Mechanical tensile strain was applied for 8 h/d. The animals were examined radiologically after 8 weeks treatment and then killed for removal of endplate cartilage tissue samples from their spines. Histological staining was performed to examine the morphology of endplate cartilage tissue. Multiple strategies were employed to examine degeneration of endplate cartilage and nuclear factor (NF)-κB signaling pathway activation.

RESULTS

After ICMT loading for 56 days, radiology revealed ossification, hyperosteogeny and stenosis in the intervertebral spaces. Examination of hematoxylin and eosin staining of sections of endplate cartilage showed significant damage as the load duration increased in the ICMT loading group. Expression of aggrecan (ACAN), type II collagen (COL-2A), SRY-related high mobility group-box gene 9 (SOX9) was down-regulated (FACAN = 21.515, P < 0.01; FCOL-2A = 6.670, P = 0.05; FSOX9 = 7.888, P < 0.05), whereas that of matrix metallopeptidase 13 (MMP13) was up-regulated (FMMP13 = 14.120, P < 0.01) after ICMT. Western blot and immunofluorescence revealed that expression of protein was consistent with gene expression results. Additionally, ICMT loading can lead to NF-κB signaling pathway activation as well as degeneration of endplate cartilage.

CONCLUSION

These experiments indicate that ICMT contributes to the activation of NF-κB signaling pathway in vivo and that the NF-κB signaling pathway further up-regulates MMP13, leading to degeneration of endplate cartilage.