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Oishi Y, Nakamura E, Murase M, Doi K, Takeuchi Y, Hamawaki JI, Sakai A. Association between ligamentous stenosis at spondylolisthetic segments before fusion surgery and symptomatic adjacent canal stenosis at follow-up in patients with degenerative spondylolisthesis. Asian Spine J 2024; 18:425-434. [PMID: 38917859 PMCID: PMC11222893 DOI: 10.31616/asj.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 06/27/2024] Open
Abstract
STUDY DESIGN A retrospective case-control propensity score-matching study. PURPOSE This study aimed to longitudinally evaluate whether preoperative ligamentous stenosis at the spondylolisthetic segments could affect the incidence of symptomatic adjacent canal stenosis following one-segment fusion surgery. OVERVIEW OF LITERATURE Several risk factors for symptomatic adjacent canal stenosis following fusion surgery have been assessed. Patients with lumbar canal stenosis mainly due to ligamentum flavum (LF) hypertrophy (ligamentous stenosis) also have LF hypertrophy in other segments. METHODS In total, 76 patients participated in this case-control study (neurologically symptomatic adjacent canal stenosis, n=33; neurologically asymptomatic cases at follow-up, n=43). Their risk factors during surgery and magnetic resonance (MR) images before the surgery and at follow-up were evaluated. Data from the two groups (n=25 each) were matched using propensity scores for age, sex, time to MR imaging at follow-up, surgical procedure, and LF hypertrophy in adjacent segments before the surgery and analyzed. RESULTS Compared with the asymptomatic group, the symptomatic adjacent canal stenosis group had a significantly larger LF area/spinal canal area in the spondylolisthetic segments before the surgery. During the follow-up periods (in months), they had a larger LF area/ spinal canal area in the adjacent segments: the two values were significantly correlated. The sensitivity, specificity, and positive and negative predictive values for determining symptomatic adjacent canal stenosis were high compared with on the cutoff value for the LF area/spinal canal area at the spondylolisthetic segments before the surgery. These results were the same after matching. CONCLUSIONS Symptomatic adjacent canal stenosis is mainly caused by LF hypertrophy. Ligamentous stenosis at the spondylolisthetic segments before fusion surgery might be strongly associated with symptomatic adjacent canal stenosis at follow-up.
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Affiliation(s)
- Yosuke Oishi
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Eiichiro Nakamura
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu,
Japan
| | - Masaaki Murase
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Katsumi Doi
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Yoshinori Takeuchi
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Jun-ichi Hamawaki
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu,
Japan
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Yabe Y, Takemura T, Hattori S, Ishikawa K, Aizawa T. Comparative Gene-Expression Analysis of the Ligamentum Flavum of Patients with Lumbar Spinal Canal Stenosis: Comparison between the Dural and Dorsal Sides of the Thickened Ligamentum Flavum. TOHOKU J EXP MED 2024; 263:43-50. [PMID: 38355112 DOI: 10.1620/tjem.2024.j015] [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] [Indexed: 02/16/2024]
Abstract
Thickening of the ligamentum flavum is the main factor in the development of lumbar spinal canal stenosis (LSCS). Although previous studies have reported factors related to ligamentum flavum thickening, its etiology has not been clarified. Furthermore, it is often difficult to set proper controls to investigate the pathologies of thickening due to differences in patient characteristics, such as age, sex, obesity, and comorbidities. This study aimed to elucidate the pathologies of ligamentum flavum thickening by comparing the dural and dorsal sides of the thickened ligamentum flavum in patients with LSCS. Ligamentum flavum samples were collected from 19 patients with LSCS. The samples were divided into the dural and dorsal sides. The dural side was used as a control to assess the pathologies occurring on the dorsal side. Elastic Masson staining was used to assess the elastic fibres. Gene expression levels were comprehensively assessed using quantitative reverse transcription polymerase chain reaction and DNA microarray analyses. Gene ontology analysis was used to identify biological processes associated with differentially expressed genes. The elastic fibres were significantly decreased on the dorsal side of the thickened ligamentum flavum. Genes related to fibrosis, inflammation, tissue repair, remodeling, and chondrometaplasia, such as COL1A2, COL3A1, COL5A1, TGFB1, VEGFA, TNFA, MMP2, COL10A1, and ADAMTS4, were highly expressed on the dorsal side of the thickened ligamentum flavum. The biological processes occurring on the dorsal side of the thickened ligamentum flavum were extracellular matrix organization, cell adhesion, extracellular matrix disassembly, and proteolysis.These are considered important pathologies of ligamentum flavum thickening.
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Affiliation(s)
- Yutaka Yabe
- Department of Orthopaedic Surgery, National Hospital Organization Sendai Nishitaga Hospital
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | - Taro Takemura
- Nanotechnology Innovation Station, National Institute for Materials Science
| | - Shinya Hattori
- Nanotechnology Innovation Station, National Institute for Materials Science
| | - Keisuke Ishikawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
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Lee CY, Wu MH, Huang TJ, Wang PY, Wu ATH. Hypertrophic Ligamentum Flavum in Lumbar Spine Stenosis Is Associated With the Increased Expression of Secreted Protein Acidic and Rich in Cysteine. Global Spine J 2024; 14:1248-1256. [PMID: 36355427 PMCID: PMC11289542 DOI: 10.1177/21925682221138766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY DESIGN Basic research. OBJECTIVES Secreted protein acidic and rich in cysteine (SPARC) is a critical pro-fibrotic mediator. This study aims to characterize the role of SPARC in hypertrophic ligamentum flavum (LF) and fibrosis. METHODS Hypertrophic LF samples were obtained from 8 patients with L4/5 lumbar spinal stenosis (LSS) during the decompressive laminectomy. Non-hypertrophic LF from age- and sex-matched 8 patients with L4/5 lumbar disc herniation was selected as control. An in vitro model of fibrosis in human LF cells was established by interleukin 6 (IL-6) to assess SPARC expression. RESULTS Hypertrophic LF samples had higher fibrosis scores than control samples by Masson's trichrome staining (3.6 vs. 1.3, P < .001). Hypertrophic LF samples had significantly more positive staining for collagen and SPARC. Collagen III (Col3), α smooth muscle actin (α-SMA), and SPARC mRNA expression levels were significantly higher in hypertrophic LF samples than in control samples by qPCR. SPARC expression and fibrotic and inflammatory makers (collagen I, Col3, IL-6, interleukin 1β) were significantly upregulated in IL-6 stimulation of normal LF in vitro. CONCLUSION SPARC was detected in human LF and significantly upregulated in the clinical samples of hypertrophic LF compared to their normal counterparts. We also demonstrated an increased level of SPARC in an in vitro fibrosis model of LF. Thus, SPARC could be a crucial biomarker for the pathogenesis of hypertrophic LF and a therapeutic target for LSS.
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Affiliation(s)
- Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Yao Wang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
| | - Alexander T. H Wu
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan
- The PhD Program of Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Clinical Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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4
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Zhang H, Hong Z, Jiang Z, Hu W, Hu J, Zhu R. miR-29b-3p Affects the Hypertrophy of Ligamentum Flavum in Lumbar Spinal Stenosis and its Mechanism. Biochem Genet 2024:10.1007/s10528-024-10811-8. [PMID: 38625592 DOI: 10.1007/s10528-024-10811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
To explore the effect of miR-29b-3p on fibrosis and hypertrophy of ligamentum flavum (LF) in lumbar spinal stenosis (LSS) and its underlying mechanism. Patients with LSS and lumbar disc herniation (LDH) (control) undergoing posterior lumbar laminectomy were included in this study. Human LF samples were obtained for LF cell isolation, RNA, and protein extraction. Histomorphological analysis of LF was performed using hematoxylin-eosin (HE) staining. After isolation, culture, and transfection of primary LF cells, different transfection groups were constructed: NC-mimic, miR-29b-3p-mimic, NC-inhibitor, and miR-29b-3p-inhibitor. Quantitative real time polymerase chain reaction (qRT-PCR) was performed to detect the expression of miR-29b-3p in LF and LF cells. Western blot analysis detected the protein expressions of P16 and CyclinD1. ELISA detected the protein expressions of TGF-β1, Smad2, Smad3, TLR4, Type I collagen, and Type III collagen. Finally, LF cell viability was detected using the Cell Counting Kit-8 (CCK8) assay. The thickness of LF was significantly thicker in the LSS group compared to the LDH group (p < 0.05), accompanied by a higher calcification degree, more fibroblasts, and a larger area of collagen fiber proliferation. miR-29b-3p expression was significantly lower in LSS-derived LF tissues and cells than in LDH-derived tissues and cells (both p < 0.05). Compared to the NC-mimic group, the miR-29b-3p-mimic group exhibited significantly higher miR-29b-3p expression, decreased protein expressions of Type I collagen, Type III collagen, TGF-β1, Smad2, Smad3, TLR4, P16, and CyclinD1, and inhibited LF cell proliferation (all p < 0.05). As expected, the miR-29b-3p-inhibitor group displayed contrasting expression patterns (all p < 0.05). Compared to the phosphate buffer saline (PBS) group, the Trimethylamine-N-Oxide (TMAO) group showed significantly increased expressions of TGF-β1, Smad2, Smad3, TLR4, Type I collagen, Type III collagen, P16, and CyclinD1, as well as enhanced LF cell proliferation (all p < 0.05). However, there was no significant difference between the TMAO group and the Ang II group (all p > 0.05). Upregulation of miR-29b-3p expression may play a role in improving LF fibrosis and hypertrophy in LSS by inhibiting P16 expression and suppressing the activation of the TGF-β/Smad signaling pathway. This finding offers new insights into future gene modification therapy for this patient population.
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Affiliation(s)
- Hongjie Zhang
- Department of Orthopedics, Dehong People's Hospital, Kunming Medical University Affiliated Dehong Hospital, Dehong, No.13 Yonghan Road, Mangshi District, 678400, China
- College of Integrative Chinese and Western Medicine, Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, Jinghai District, Tianjin, 301617, China
| | - Zhixiong Hong
- Department of Orthopedics, Dehong People's Hospital, Kunming Medical University Affiliated Dehong Hospital, Dehong, No.13 Yonghan Road, Mangshi District, 678400, China
| | - Zehua Jiang
- Department of Spine Surgery, Tianjin Union Medical Center, No.190 Jieyuan Road, Hongqiao District, Tianjin, 300122, China
| | - Wei Hu
- Department of Spine Surgery, Tianjin Union Medical Center, No.190 Jieyuan Road, Hongqiao District, Tianjin, 300122, China
| | - Jiashao Hu
- Department of Orthopedics, Dehong People's Hospital, Kunming Medical University Affiliated Dehong Hospital, Dehong, No.13 Yonghan Road, Mangshi District, 678400, China
| | - Rusen Zhu
- Department of Spine Surgery, Tianjin Union Medical Center, No.190 Jieyuan Road, Hongqiao District, Tianjin, 300122, China.
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Guevara-Villazón F, Pacheco-Tena C, Anchondo-López A, Ordoñez-Solorio LA, Contreras Martínez B, Muñoz-Cobos A, Luévano-González A, González-Chávez SA. Transcriptomic alterations in hypertrophy of the ligamentum flavum: interactions of Rho GTPases, RTK, PIK3, and FGF. 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 2023; 32:1901-1910. [PMID: 37115284 DOI: 10.1007/s00586-023-07721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To analyze the differential transcriptome expression in hypertrophic ligaments flavum (HLF) compared to normal ligaments. METHODS A case-control study was conducted that included 15 patients with hypertrophy of LF and 15 controls. Samples of LF were obtained through a lumbar laminectomy and analyzed by DNA microarrays and histology. The dysregulated biological processes, signaling pathways, and pathological markers in the HLF were identified using bioinformatics tools. RESULTS The HLF had notable histological alterations, including hyalinosis, leukocyte infiltration, and disarrangement of collagen fibers. Transcriptomic analysis showed that up-regulated genes were associated with the signaling pathways of Rho GTPases, receptor tyrosine kinases (RTK), fibroblast growth factors (FGF), WNT, vascular endothelial growth factor, phosphoinositide 3-kinase (PIK3), mitogen-activated protein kinases, and immune system. The genes PIK3R1, RHOA, RPS27A, CDC42, VAV1, and FGF5, 9, 18, and 19 were highlighted as crucial markers in HLF. The down-expressed genes in the HLF had associations with the metabolism of RNA and proteins. CONCLUSION Our results suggest that abnormal processes in hypertrophied LF are mediated by the interaction of the Rho GTPase, RTK, and PI3K pathways, which have not been previously described in the HLF, but for which there are currently therapeutic proposals. More studies are required to confirm the therapeutic potential of the pathways and mediators described in our results.
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Affiliation(s)
- Fernando Guevara-Villazón
- Laboratorio PABIOM, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario Campus II, 31125, Chihuahua, Chihuahua, México
- Neuroteam CUU, Hospital Ángeles Chihuahua, Chihuahua, México
| | - César Pacheco-Tena
- Laboratorio PABIOM, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario Campus II, 31125, Chihuahua, Chihuahua, México.
| | - Antonio Anchondo-López
- Laboratorio PABIOM, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario Campus II, 31125, Chihuahua, Chihuahua, México
| | | | | | | | - Arturo Luévano-González
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Susana Aideé González-Chávez
- Laboratorio PABIOM, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario Campus II, 31125, Chihuahua, Chihuahua, México.
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6
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Yabu A, Suzuki A, Hayashi K, Hori Y, Terai H, Orita K, Habibi H, Salimi H, Kono H, Toyoda H, Maeno T, Takahashi S, Tamai K, Ozaki T, Iwamae M, Ohyama S, Imai Y, Nakamura H. Periostin increased by mechanical stress upregulates interleukin-6 expression in the ligamentum flavum. FASEB J 2023; 37:e22726. [PMID: 36583686 DOI: 10.1096/fj.202200917rr] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/13/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
Ligamentum flavum (LF) hypertrophy is a major cause of lumbar spinal canal stenosis. Although mechanical stress is thought to be a major factor involved in LF hypertrophy, the exact mechanism by which it causes hypertrophy has not yet been fully elucidated. Here, changes in gene expression due to long-term mechanical stress were analyzed using RNA-seq in a rabbit LF hypertrophy model. In combination with previously reported analysis results, periostin was identified as a molecule whose expression fluctuates due to mechanical stress. The expression and function of periostin were further investigated using human LF tissues and primary LF cell cultures. Periostin was abundantly expressed in human hypertrophied LF tissues, and periostin gene expression was significantly correlated with LF thickness. In vitro, mechanical stress increased gene expressions of periostin, transforming growth factor-β1, α-smooth muscle actin, collagen type 1 alpha 1, and interleukin-6 (IL-6) in LF cells. Periostin blockade suppressed the mechanical stress-induced gene expression of IL-6 while periostin treatment increased IL-6 gene expression. Our results suggest that periostin is upregulated by mechanical stress and promotes inflammation by upregulating IL-6 expression, which leads to LF degeneration and hypertrophy. Periostin may be a pivotal molecule for LF hypertrophy and a promising therapeutic target for lumbar spinal stenosis.
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Affiliation(s)
- Akito Yabu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Hayashi
- Department of Orthopedic Surgery, Osaka City Juso Hospital, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kumi Orita
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hasibullah Habibi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hamidullah Salimi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kono
- Department of Orthopedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takafumi Maeno
- Department of Orthopedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Tomonori Ozaki
- Department of Orthopedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shoichiro Ohyama
- Department of Orthopedic Surgery, Nishinomiya Watanabe Hospital, Nishinomiya, Japan
| | - Yuuki Imai
- Division of Integrative Pathophysiology, Proteo-Science Center, Ehime University, Toon, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Wang H, Li M, Fei L, Xie C, Ding L, Zhu C, Zeng F, Liu N. Bone Marrow-Derived Mesenchymal Stem Cells Transplantation Attenuates Renal Fibrosis Following Acute Kidney Injury in Rats by Diminishing Pericyte-Myofibroblast Transition and Extracellular Matrix Augment. Transplant Proc 2023; 55:225-234. [PMID: 36604251 DOI: 10.1016/j.transproceed.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Renal fibrosis is a common chronic outcome of acute kidney injury (AKI). Pericyte-myofibroblasts transition and production of abundant extracellular matrix are the important pathologic basis. This study investigated the effect of bone marrow-derived mesenchymal stem cells (BMSCs) transplantation on the AKI kidney fibrosis and the possible mechanisms. METHODS By constructing the animal and cell model of AKI pericyte injury, the therapeutic effect of BMSCs on pericyte-myofibroblasts transition was detected. The production and accumulation of extracellular matrix, including collagen I, collagen III, and fibronectin were also tested. The mechanism was revealed by means of analysis of signal pathway. RESULTS After AKI insult, many myofibroblasts emerged in the renal interstitium together with a large amount of extracellular matrix components. The BMSCs transplantation significantly decreased the number of myofibroblasts trans-differentiated from pericytes in the AKI model. The changes of vascular endothelial growth factor subtypes and Ang-I/AngII secreted by pericytes were also significantly reduced after BMSCs co-culture. At the same time, extracellular matrix components, including collagen I, collagen III, and fibronectin, decreased significantly. Transplantation treatment alleviated the fibrosis score. The transforming growth factor β (TGF-β) concentration decreased as well as the levels of Smad2/3 and p-Smad2/3 with the presence of BMSCs therapy. CONCLUSIONS Bone marrow-derived mesenchymal stem cells transplantation diminished pericyte-myofibroblast transition and extracellular matrix augment after AKI by regulating the TGF-β/Smad2/3 signaling pathway. It may be used as a novel therapeutic method for retarding renal fibrosis, which is worthy of further study.
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Affiliation(s)
- Hao Wang
- Department of Nephrology, Naval Medical Center of PLA, Naval Medical University, Shanghai, China
| | - Maoting Li
- Department of Nephrology, Naval Medical Center of PLA, Naval Medical University, Shanghai, China
| | - Liyan Fei
- Department of Nephrology, Naval Medical Center of PLA, Naval Medical University, Shanghai, China
| | - Chuang Xie
- Department of Nephrology, Naval Medical Center of PLA, Naval Medical University, Shanghai, China
| | - Lingling Ding
- Department of Nephrology, Naval Medical Center of PLA, Naval Medical University, Shanghai, China
| | - Changhao Zhu
- Department of Nephrology, Naval Medical Center of PLA, Naval Medical University, Shanghai, China
| | - Fanzhou Zeng
- Department of Nephrology, Naval Medical Center of PLA, Naval Medical University, Shanghai, China
| | - Nanmei Liu
- Department of Nephrology, Naval Medical Center of PLA, Naval Medical University, Shanghai, China.
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8
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Ma C, Qi X, Wei YF, Li Z, Zhang HL, Li H, Yu FL, Pu YN, Huang YC, Ren YX. Amelioration of ligamentum flavum hypertrophy using umbilical cord mesenchymal stromal cell-derived extracellular vesicles. Bioact Mater 2023; 19:139-154. [PMID: 35475028 PMCID: PMC9014323 DOI: 10.1016/j.bioactmat.2022.03.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/09/2022] Open
Abstract
Ligamentum flavum (LF) hypertrophy (LFH) has been recognised as one of the key contributors to lumbar spinal stenosis. Currently, no effective methods are available to ameliorate this hypertrophy. In this study, human umbilical cord mesenchymal stromal cell-derived extracellular vesicles (hUCMSC-EVs) were introduced for the first time as promising vehicles for drug delivery to treat LFH. The downregulation of miR-146a-5p and miR-221-3p expressions in human LF tissues negatively correlated with increased LF thickness. The hUCMSC-EVs enriched with these two miRNAs significantly suppressed LFH in vivo and notably ameliorated the progression of transforming growth factor β1(TGF-β1)-induced fibrosis in vitro after delivering these two miRNAs to mouse LF cells. The results further demonstrated that miR-146a-5p and miR-221-3p directly bonded to the 3′-UTR regions of SMAD4 mRNA, thereby inhibiting the TGF-β/SMAD4 signalling pathway. Therefore, this translational study determined the effectiveness of a hUCMSC-EVs-based approach for the treatment of LFH and revealed the critical target of miR-146a-5p and miR-221-3p. Our findings provide new insights into promising therapeutics using a hUCMSC-EVs-based delivery system for patients with lumbar spinal stenosis. The downregulation of miR-146a-5p and miR-221-3p expressions were negatively correlated with the development of LFH. MiR-146a-5p and miR-221-3p enriched in hUCMSC-EVs prevent the fibrosis of LF by targeting SMAD4. hUCMSC-EVs are effective as bioactive vehicles to ameliorate the progression of LFH. hUCMSC-EVs-based delivery system is a promising therapy for the patients with lumbar spinal stenosis.
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9
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Yabe Y, Hagiwara Y, Tsuchiya M, Minowa T, Takemura T, Hattori S, Yoshida S, Onoki T, Ishikawa K. Comparative proteome analysis of the ligamentum flavum of patients with lumbar spinal canal stenosis. JOR Spine 2022; 5:e1210. [PMID: 36601375 PMCID: PMC9799084 DOI: 10.1002/jsp2.1210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 01/07/2023] Open
Abstract
Background Thickening of the ligamentum flavum is considered to be the main factor for lumbar spinal canal stenosis (LSCS). Although some mechanisms have been speculated in the thickening of the ligamentum flavum, there are only a few comprehensive approaches to investigate its pathology. The objective of this study was to investigate the pathology of thickened ligamentum flavum in patients with LSCS based on protein expression levels using shotgun proteome analysis. Methods Ligamentum flavum samples were collected from four patients with LSCS (LSCS group) and four patients with lumbar disc herniation (LDH) as controls (LDH group). Protein mixtures were digested and analyzed by liquid chromatography/mass spectrometry analysis. To compare protein expression levels between the LSCS and LDH groups, the mean Mascot score was compared. Biological processes were assessed using Gene Ontology analysis. Results A total of 1151 proteins were identified in some samples of ligamentum flavum. Among these, 145 proteins were detected only in the LSCS group, 315 in the LDH group, and 691 in both groups. The demonstrated biological processes occurring in the LSCS group included: extracellular matrix organization, regulation of peptidase activity, extracellular matrix disassembly, and negative regulation of cell growth. Proteins related to fibrosis, chondrometaplasia, and amyloid deposition were found highly expressed in the LSCS group compared with those in the LDH group. Conclusions Tissue repair via fibrosis, chondrometaplasia, and amyloid deposits may be important pathologies that occur in the thickened ligamentum flavum of patients with LSCS.
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Affiliation(s)
- Yutaka Yabe
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Yoshihiro Hagiwara
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Masahiro Tsuchiya
- Department of Nursing, Faculty of Health ScienceTohoku Fukushi UniversitySendaiJapan
| | - Takashi Minowa
- Nanotechnology Innovation StationNational Institute for Materials ScienceTsukubaJapan
| | - Taro Takemura
- Nanotechnology Innovation StationNational Institute for Materials ScienceTsukubaJapan
| | - Shinya Hattori
- Nanotechnology Innovation StationNational Institute for Materials ScienceTsukubaJapan
| | - Shinichirou Yoshida
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Takahiro Onoki
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Keisuke Ishikawa
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
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Wang AY, Kanter M, Olmos M, McPhail ED, Safain MG, Kryzanski J, Arkun K, Riesenburger RI. Lumbar stenosis due to wild-type transthyretin amyloid-induced thickening of the ligamentum flavum: a separate etiology from degeneration of intervertebral discs? J Neurosurg Spine 2022; 37:687-693. [PMID: 35901753 DOI: 10.3171/2022.5.spine22362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wild-type transthyretin amyloid (ATTRwt) is deposited in the ligamentum flavum (LF) of a subset of patients with spinal stenosis who undergo decompressive surgery, although its role in the pathophysiology of spinal stenosis is unknown. It has been theorized that degeneration of intervertebral discs causes increased mechanical stress and inflammatory/degenerative cascades and ultimately leads to LF fibrosis. If ATTRwt deposits contribute to LF thickening and spinal stenosis through a different pathway, then patients with ATTRwt may have less severe disc degeneration than those without it. In this study, the authors compared the severity of disc degeneration between patients with lumbar stenosis with and without amyloid in their LF to test whether ATTRwt is a unique contributor to LF thickening and spinal stenosis. METHODS Of 324 consecutive patients between 2018 and 2019 who underwent decompression surgery for spinal stenosis and had LF samples sent for pathological analysis, 31 harboring ATTRwt were compared with 88 controls. Patient medical records were retrospectively reviewed for demographic and surgical information. Disc degeneration was assessed on preoperative T2-weighted MR images with the modified Pfirrmann grading system at every lumbar disc level. RESULTS Baseline characteristics were similar between the groups, except for a statistically significant increase in age in the ATTRwt group. The crude unadjusted comparisons between the groups trended toward a less severe disc degeneration in the ATTRwt group, although this difference was not statistically significant. A multivariable linear mixed-effects model was created to adjust for the effects of age and to isolate the influence of ATTRwt, the presence of an operation at the level, and the specific disc level (between L1 and S1). This model revealed that ATTRwt, the presence of an operation, and the specific level each had significant effects on modified Pfirrmann scores. CONCLUSIONS Less severe disc degeneration was noted in patients with degenerative spinal stenosis harboring ATTRwt compared with those without amyloid. This finding suggests that ATTRwt deposition may play a separate role in LF thickening from that played by disc degeneration. Future studies should aim to elucidate this potentially novel pathophysiological pathway, which may uncover an exciting potential for the development of amyloid-targeted therapies that may help slow the development of spinal stenosis.
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Affiliation(s)
- Andy Y Wang
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Matthew Kanter
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Michelle Olmos
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Ellen D McPhail
- 2Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; and
| | - Mina G Safain
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - James Kryzanski
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Knarik Arkun
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
- 3Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Ron I Riesenburger
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
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Administration of N-Acetylcysteine to Regress the Fibrogenic and Proinflammatory Effects of Oxidative Stress in Hypertrophic Ligamentum Flavum Cells. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1380353. [DOI: 10.1155/2022/1380353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/22/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022]
Abstract
Ligamentum flavum hypertrophy (LFH) is a major cause of lumbar spinal stenosis (LSS). In hypertrophic ligamentum flavum (LF) cells, oxidative stress activates intracellular signaling and induces the expression of inflammatory and fibrotic markers. This study explored whether healthy and hypertrophic LF cells respond differently to oxidative stress, via examining the levels of phosphorylated p38 (p-p38), inducible nitric oxide synthase (iNOS), and α-smooth muscle actin (α-SMA). Furthermore, the efficacy of N-acetylcysteine (NAC), an antioxidant, in reversing the fibrogenic and proinflammatory effects of oxidative stress in hypertrophic LF cells was investigated by assessing the expression levels of p-p38, p-p65, iNOS, TGF-β, α-SMA, vimentin, and collagen I under H2O2 treatment with or without NAC. Under oxidative stress, p-p38 increased significantly in both hypertrophic and healthy LF cells, and iNOS was elevated in only the hypertrophic LF cells. This revealed that oxidative stress negatively affected both hypertrophic and healthy LF cells, with the hypertrophic LF cells exhibiting more active inflammation than did the healthy cells. After H2O2 treatment, p-p38, p-p65, iNOS, TGF-β, vimentin, and collagen I increased significantly, and NAC administration reversed the effects of oxidative stress. These results can form the basis of a novel therapeutic treatment for LFH using antioxidants.
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Kwon WK, Ham CH, Choi H, Baek SM, Lee JW, Park YK, Moon HJ, Park WB, Kim JH. Elucidating the effect of mechanical stretch stress on the mechanism of ligamentum flavum hypertrophy: Development of a novel in vitro multi-torsional stretch loading device. PLoS One 2022; 17:e0275239. [PMID: 36269774 PMCID: PMC9586365 DOI: 10.1371/journal.pone.0275239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 09/01/2022] [Indexed: 11/05/2022] Open
Abstract
Objective We developed a novel multi-torsional mechanical stretch stress loading device for ligamentum flavum cells and evaluated its influence on the development of ligamentum flavum hypertrophy, a common cause of lumbar spinal canal stenosis. Materials and methods Stretch strength of the device was optimized by applying 5% and 15% MSS loads for 24, 48, and 72 h. A cytotoxicity assay of human ligamentum flavum cells was performed and the results were compared to control (0% stress). Inflammatory markers (interleukin [IL]-6, IL-8), vascular endothelial growth factor [VEGF], and extracellular matrix (ECM)-regulating cytokines (matrix metalloproteinase [MMP]-1, MMP-3 and MMP-9, and tissue inhibitor of metalloproteinase [TIMP]-1 and TIMP-2) were quantified via enzyme-linked immunosorbent assay. Results Using our multi-torsional mechanical stretch stress loading device, 5% stress for 24 hour was optimal for ligamentum flavum cells. Under this condition, the IL-6 and IL-8 levels, VEGF level, and MMP-1, MMP-3, and TIMP-2 were significantly increased, compared to the control. Conclusion Using the novel multi-torsional mechanical stretch stress loading device we confirmed that, mechanical stress enhances the production of inflammatory cytokines and angiogenic factors, and altered the expression of ECM-regulating enzymes, possibly triggering ligamentum flavum hypertrophy.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea,Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea,Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Choi
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Korea
| | - Seung Min Baek
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Korea
| | - Jae Won Lee
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woong Bae Park
- Department of Neurosurgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea,* E-mail:
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13
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Wang AY, Saini H, Tingen JN, Sharma V, Flores A, Liu D, Olmos M, McPhail ED, Safain MG, Kryzanski J, Arkun K, Riesenburger RI. The Relationship Between Wild-Type Transthyretin Amyloid Load and Ligamentum Flavum Thickness in Lumbar Stenosis Patients. World Neurosurg 2022; 164:e113-e118. [PMID: 35398327 DOI: 10.1016/j.wneu.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND One key contributor to lumbar stenosis is thickening of the ligamentum flavum (LF), a process still poorly understood. Wild-type transthyretin amyloid (ATTRwt) has been found in the LF of patients undergoing decompression surgery, suggesting that amyloid may play a role. However, it is unclear whether within patients harboring ATTRwt, the amount of amyloid is associated with LF thickness. METHODS From an initial cohort of 324 consecutive lumbar stenosis patients whose LF specimens from decompression surgery were sent for analysis (2018-2019), 33 patients met the following criteria: 1) Congo red-positive amyloid in the LF, 2) ATTRwt by mass spectrometry-based proteomics, and 3) an available preoperative magnetic resonance imaging. Histological specimens were digitized, and amyloid load was quantified through Trainable Weka Segmentation machine learning. LF thicknesses were manually measured on axial T2-weighted preoperative magnetic resonance imaging scans at each lumbar level, L1-S1. The sum of thicknesses at every lumbar LF level (L1-S1) equals "lumbar LF burden". RESULTS Patients had a mean age of 72.7 years (range = 59-87), were mostly male (61%) and white (82%), and predominantly had surgery at L4-L5 levels (73%). Amyloid load was positively correlated with LF thickness (R = 0.345, P = 0.0492) at the levels of surgical decompression. Furthermore, amyloid load was positively correlated with lumbar LF burden (R = 0.383, P = 0.0279). CONCLUSIONS Amyloid load is positively correlated with LF thickness and lumbar LF burden across all lumbar levels, in a dose-dependent manner. Further studies are needed to validate these findings, uncover the underlying pathophysiology, and pave the way toward using therapies that slow LF thickening.
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Affiliation(s)
- Andy Y Wang
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Harleen Saini
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Joseph N Tingen
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Vaishnavi Sharma
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Alexandra Flores
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Diang Liu
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michelle Olmos
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ellen D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mina G Safain
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Knarik Arkun
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA.
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Hayashi F, Morimoto M, Higashino K, Goda Y, Sato N, Tezuka F, Yamashita K, Sairyo K. Myofibroblasts are increased in the dorsal layer of the hypertrophic ligamentum flavum in lumbar spinal canal stenosis. Spine J 2022; 22:697-704. [PMID: 34775048 DOI: 10.1016/j.spinee.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/27/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Hypertrophy of the ligamentum flavum (LF) is a major contributor to the development of lumbar spinal canal stenosis (LSS). Although previous studies have identified some factors related to hypertrophy of the LF, the etiology remains unclear. It is well known that myofibroblasts have a key role in the pathology of fibrosis in other tissues, including the skin, liver, kidney, and lung. We hypothesized that myofibroblasts were also important players in the pathology of fibrosis in the LF. PURPOSE To elucidate the distribution and role of myofibroblasts in the hypertrophic LF. STUDY DESIGN A histological, immunohistochemical, and gene expression analysis of the LF in the human lumbar spine. PATIENT SAMPLE Hypertrophic LF tissue samples were collected from patients with LSS. OUTCOME MEASURES Histology, immunohistochemistry, microarray, reverse transcription-quantitative polymerase chain reaction, western blotting, and enzyme-linked immunosorbent assay. METHODS The degree of fibrosis in the dural and dorsal layers of the LF was evaluated by Masson's trichrome tissue staining. Collagen gene expression was evaluated by quantitative reverse transcription polymerase chain reaction. Immunostaining of αSMA was performed to evaluate localization of myofibroblasts in LF tissue. The association between gene expression of alpha-smooth muscle actin (αSMA) and that of several types of collagen was investigated. The signal activated on the dorsal side of LF was examined by gene set enrichment analysis using microarray data. Expression levels of αSMA and several types of collagen in LF fibroblasts were investigated under hypoxic conditions. RESULTS In the histological study using Masson's trichrome staining, the fibrosis score was significantly higher in the dorsal layer than in the dural layer. Gene expression levels for several types of collagen (COL1A1, COL1A2, COL3A1, COL5A1, COL6A1, and COL11A1) and heat shock protein 47 (a collagen-specific chaperone) were significantly higher in the dorsal layer. Furthermore, immunohistochemistry revealed a significantly greater number of αSMA-stained cells in the dorsal layer. There was a strong correlation of αSMA mRNA expression with COL1A-1 in LF fibroblasts. Gene set enrichment analysis showed that the set of fibrosis-related gene signals, including those for epithelial-mesenchymal transition, hypoxia, and inflammation, were significantly upregulated in the dorsal layer compared with the dural layer. Under hypoxic stimulation, expression of αSMA and several types of collagen was increased in LF fibroblasts. CONCLUSIONS This study is the first to reveal that myofibroblast expression levels are higher in the dorsal layer of the LF than in the dural layer. We confirmed that hypertrophy of the LF in LSS is associated with increased expression of myofibroblasts in the dorsal layer. Hypoxia could be a cause of expression of myofibroblasts leading to fibrosis and finally to hypertrophy of the LF. CLINICAL SIGNIFICANCE The results of this study partially elucidate the molecular mechanisms of LF hypertrophy and suggest that myofibroblasts may be involved in age-related degeneration of the LF.
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Affiliation(s)
- Fumio Hayashi
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School. 3-18-15, Kuramoto, Tokushima 770-8503, Japan
| | - Masatoshi Morimoto
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School. 3-18-15, Kuramoto, Tokushima 770-8503, Japan
| | - Kosaku Higashino
- Department of Orthopedics, Shikoku Medical Center for Children and Adults, 2-1-1 Senyu-cho, Zentsuji-shi, Kagawa 765-8507, Japan
| | - Yuichiro Goda
- Department of Orthopedics, National Hospital Organization Kochi Hospital, 1-2-25, Asakuranishimachi, Kochi 780-8077, Japan
| | - Nori Sato
- Department of Rehabilitation, Tokushima University Graduate School. 3-18-15, Kuramoto, Tokushima 770-8503, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School. 3-18-15, Kuramoto, Tokushima 770-8503, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School. 3-18-15, Kuramoto, Tokushima 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School. 3-18-15, Kuramoto, Tokushima 770-8503, Japan.
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15
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Habibi H, Suzuki A, Hayashi K, Salimi H, Hori Y, Orita K, Yabu A, Terai H, Nakamura H. Expression and function of fibroblast growth factor 1 in the hypertrophied ligamentum flavum of lumbar spinal stenosis. J Orthop Sci 2022; 27:299-307. [PMID: 33637374 DOI: 10.1016/j.jos.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/19/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fibrosis is one of the main pathologies caused by hypertrophy of the ligamentum flavum (LF), which leads to lumbar spinal stenosis (LSS). The fibroblast growth factor (FGF) family is a key mediator of fibrosis. However, acidic fibroblast growth factor (FGF-1) expression and function are not well understood in LF. This study sought to evaluate FGF-1 expression in the hypertrophied and non-hypertrophied human LF, and to investigate its function using primary human LF cell cultures. METHODS We obtained hypertrophied lumbar LF from LSS patients and non-hypertrophied lumbar LF from control patients during surgery. Immunohistochemistry and qPCR were performed to evaluate FGF-1 expression in LF tissue. The function of FGF-1 and transforming growth factor beta 1 (TGF-β1) was also investigated using primary LF cell culture. The effects on cell morphology and cell proliferation were examined using a crystal violet staining assay and MTT assay, respectively. Immunocytochemistry, western blotting, and qPCR were performed to evaluate the effect of FGF-1 on TGF-β1-induced myofibroblast differentiation and fibrosis. RESULTS Immunohistochemistry and qPCR showed higher FGF-1 expression in hypertrophied LF compared to control LF. Crystal violet staining and MTT assay revealed that FGF-1 decreases LF cell size and inhibits their proliferation in a dose-dependent manner, whereas TGF-β1 increases cell size and promotes proliferation. Immunocytochemistry and western blotting further demonstrated that TGF-β1 increases, while FGF-1 decreases, α-SMA expression in LF cells. Moreover, FGF-1 also caused downregulation of collagen type 1 and type 3 expression in LF cells. CONCLUSION FGF-1 is highly upregulated in the LF of LSS patients. Meanwhile, in vitro, FGF-1 exhibits antagonistic effects to TGF-β1 by inhibiting cell proliferation and decreasing LF cell size as well as the expression of fibrosis markers. These results suggest that FGF-1 has an anti-fibrotic role in the pathophysiology of LF hypertrophy.
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Affiliation(s)
- Hasibullah Habibi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Kazunori Hayashi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hamidullah Salimi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kumi Orita
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akito Yabu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Mechanical Stress-Induced IGF-1 Facilitates col-I and col-III Synthesis via the IGF-1R/AKT/mTORC1 Signaling Pathway. Stem Cells Int 2021; 2021:5553676. [PMID: 34912459 PMCID: PMC8668368 DOI: 10.1155/2021/5553676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/13/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Mechanical stress promotes human ligamentum flavum cells (LFCs) to synthesize multitype collagens, leading to ligamentum flavum hypertrophy (LFH). However, the mechanism of mechanical stress in the formation of collagen remains unclear. Therefore, we investigated the relationship between mechanical stress and collagen synthesis in the present study. First, LFCs were isolated from 9 patients and cultured with or without mechanical stress exposure for different times. IGF-1, collagen I (col-I), and collagen III (col-III) protein and mRNA levels were then detected via ELISA and qPCR, respectively. Moreover, the activation of pIGF-1R, pAKT, and pS6 was examined by Western blot analysis. To further explore the underlying mechanism, an IGF-1 neutralizing antibody, NVP-AEW541, and rapamycin were used. IGF-1, col-I, and col-III were significantly increased in stressed LFCs compared to nonstressed LFCs. In addition, the activation of pIGF-1R, pAKT, and pS6 was obviously enhanced in stressed LFCs. Interestingly, col-I protein, col-I mRNA, col-III protein, col-III mRNA, and IGF-1 protein, but not IGF-1 mRNA, were inhibited by IGF-1 neutralizing antibody. In addition, col-I and col-III protein and mRNA, but not IGF-1, were inhibited by both NVP-AEW541 and rapamycin. Moreover, the activation of pIGF-1R, pAKT, and pS6 was reduced by the IGF-1 neutralizing antibody and NVP-AEW541, and the activation of pS6 was reduced by rapamycin. In summary, these results suggested that mechanical stress promotes LFCs to produce IGF-1, which facilitates col-I and col-III synthesis via the IGF-1R/AKT/mTORC1 signaling pathway.
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Expression of Estrogen Receptor Alpha and Evaluation of Histological Degeneration Scores in Fibroblasts of Hypertrophied Ligamentum Flavum: A Qualitative Study. Biomolecules 2021; 11:biom11121752. [PMID: 34944396 PMCID: PMC8698276 DOI: 10.3390/biom11121752] [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: 10/05/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
The most common spinal disorder in elderly is lumbar spinal stenosis (LSS), resulting partly from ligamentum flavum (LF) hypertrophy. Its pathophysiology is not completely understood. The present study wants to elucidate the role of estrogen receptor α (ER α) in fibroblasts of hypertrophied LF. LF samples of 38 patients with LSS were obtained during spinal decompression. Twelve LF samples from patients with disk herniation served as controls. Hematoxylin & Eosin (H&E) and Elastica stains and immunohistochemistry for ER α were performed. The proportions of fibrosis, loss and/or degeneration of elastic fibers and proliferation of collagen fibers were assessed according to the scores of Sairyo and Okuda. Group differences in the ER α and Sairyo and Okuda scores between patients and controls, male and female sex and absence and presence of additional orthopedic diagnoses were assessed with the Mann–Whitney U test. There was a tendency towards higher expression of ER α in LF fibroblasts in the hypertrophy group (p = 0.065). The Sairyo and Okuda scores were more severe for the hypertrophy group but, in general, not statistically relevant. There was no statistically relevant correlation between the expression of ER α and sex (p = 0.326). ER α expression was higher in patients with osteochondrosis but not statistically significant (p = 0.113). In patients with scoliosis, ER α expression was significantly lower (p = 0.044). LF hypertrophy may be accompanied by a higher expression of ER α in fibroblasts. No difference in ER α expression was observed regarding sex. Further studies are needed to clarify the biological and clinical significance of these findings.
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Rolipram plays an anti-fibrotic effect in ligamentum flavum fibroblasts by inhibiting the activation of ERK1/2. BMC Musculoskelet Disord 2021; 22:818. [PMID: 34556093 PMCID: PMC8461931 DOI: 10.1186/s12891-021-04712-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Fibrosis is an important factor and process of ligamentum flavum hypertrophy. The expression of phosphodiesterase family (PDE) is related to inflammation and fibrosis. This article studied the expression of PDE in hypertrophic ligamentum flavum fibroblasts and investigated whether inhibition of PDE4 activity can play an anti-fibrotic effect. Methods Samples of clinical hypertrophic ligamentum flavum were collected and patients with lumbar disc herniations as a control group. The collagenase digestion method is used to separate fibroblasts. qPCR is used to detect the expression of PDE subtypes, type I collagen (Col I), type III collagen (Col III), fibronectin (FN1) and transforming growth factor β1 (TGF-β1). Recombinant TGF-β1 was used to stimulate fibroblasts to make a fibrotic cell model and treated with Rolipram. The morphology of the cells treated with drugs was observed by Sirius Red staining. Scratch the cells to observe their migration and proliferation. WB detects the expression of the above-mentioned multiple fibrotic proteins after drug treatment. Finally, combined with a variety of signaling pathway drugs, the signaling mechanism was studied. Results Multiple PDE subtypes were expressed in ligamentum flavum fibroblasts. The expression of PDE4A and 4B was significantly up-regulated in the hypertrophic group. Using Rolipram to inhibit PDE4 activity, the expression of Col I and TGF-β1 in the hypertrophic group was inhibited. Col I recovered to the level of the control group. TGF-β1 was significantly inhibited, which was lower than the control group. Recombinant TGF-β1 stimulated fibroblasts to increase the expression of Col I/III, FN1 and TGF-β1, which was blocked by Rolipram. Rolipram restored the increased expression of p-ERK1/2 stimulated by TGF-β1. Conclusion The expressions of PDE4A and 4B in the hypertrophic ligamentum flavum are increased, suggesting that it is related to the hypertrophy of the ligamentum flavum. Rolipram has a good anti-fibrosis effect after inhibiting the activity of PDE4. This is related to blocking the function of TGF-β1, specifically by restoring normal ERK1/2 signal. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04712-9.
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19
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Takeda H, Nagai S, Ikeda D, Kaneko S, Tsuji T, Fujita N. Collagen profiling of ligamentum flavum in patients with lumbar spinal canal stenosis. J Orthop Sci 2021; 26:560-565. [PMID: 32753253 DOI: 10.1016/j.jos.2020.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/30/2020] [Accepted: 06/24/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although several causes of ligamentum flavum (LF) hypertrophy have been identified, the pathomechanisms underlying LF hypertrophy are not fully understood. Because collagen fibers are essential for the maintenance of LF tissues, characterization of the collagen composition of hypertrophied LF may help to elucidate the pathology of lumbar spinal canal stenosis (LCS). This study aimed to determine the association between the collagen composition and LF hypertrophy. METHODS LF tissues were collected from 23 patients who underwent spinal decompression surgery for lumbar disorders. The cross-sectional area of LF was measured using the axial images of lumbar MRI. The expression of each collagen in human surgical samples was evaluated by real-time RT-PCR and immunohistochemical analysis. To investigate the impact of inflammatory cytokines on the expression of each collagen, we treated primary human LF cells with TNF-α or IL-1β. RESULTS Real-time RT-PCR analysis and immunohistochemistry showed that of the 28 types of collagen, collagen type I, III, V, VI, VIII were highly expressed regardless of LF hypertrophy. In addition, we found the moderate correlation between the cross-sectional area of LF and the mRNA expression level of collagen type I, III, and VI. In vitro analysis showed that the mRNA expression of collagen type I, III, V, VI, and VIII was up-regulated by treatment with TNF-α and with IL-1β. CONCLUSION Our results suggested that collagen type I, III, V, VI, and VIII were the main components of the LF extracellular matrix and that collagen type I, III, and VI may serve as useful markers of LF hypertrophy. These findings may contribute to the future development of diagnostic and treatment modalities for LF hypertrophy and even LCS.
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Affiliation(s)
- Hiroki Takeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan; Department of Spine and Spinal Cord, Fujita Health University, Aichi, Japan
| | - Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord, Fujita Health University, Aichi, Japan
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan.
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20
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Long-term, Time-course Evaluation of Ligamentum Flavum Hypertrophy Induced by Mechanical Stress: An Experimental Animal Study. Spine (Phila Pa 1976) 2021; 46:E520-E527. [PMID: 33273443 DOI: 10.1097/brs.0000000000003832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Experimental animal study. OBJECTIVE The aim of this study was to clarify chronological effects of mechanical stress on ligamentum flavum (LF) using a long-term fusion rabbit model. SUMMARY OF BACKGROUND DATA LF hypertrophy is a major pathology of lumbar spinal stenosis (LSS), but its mechanism remains unclear. We previously demonstrated mechanical-stress-induced LF hypertrophy with a rabbit model. However, we only investigated LFs at a single time point in the short-term; the effects of long-term mechanical stress have not been elucidated. METHODS Eighteen-week-old male New Zealand White rabbits were randomly divided into two groups: the mechanical stress group underwent L2-3 and L4-5 posterolateral fusion and resection of the L3-4 supraspinal muscle, whereas the control group underwent only surgical exposure. Rabbits were sacrificed 16 and 52 weeks after the procedure. Axial specimens of LFs at L3-4 were evaluated histologically. Immunohistochemistry for alpha-smooth muscle actin (α-SMA) was performed to assess the numbers of vessels and myofibroblasts. RESULTS In the mechanical stress group, LFs at the L3-4 level exhibited hypertrophy with elastic fiber disruption and cartilage matrix production at 16 and 52 weeks. A trend test indicated that mechanical stress induced LF hypertrophy, elastic fiber disruption, and cartilage matrix production in a time-dependent manner, with the lowest levels before treatment and the highest at 52 weeks. Immunostaining for α-SMA showed similar numbers of vessels in both groups, whereas the percentage of myofibroblasts was significantly larger at 16 and 52 weeks in the mechanical stress group than in the control group. CONCLUSION We demonstrated that long-term mechanical stress caused LF hypertrophy with progressive elastic fiber disruption and cartilage matrix production accompanied by enhanced myofibroblasts. In addition, the reported rabbit model could be extended to elucidate the mechanism of LF hypertrophy and to develop new therapeutic strategies for LSS by preventing LF hypertrophy.Level of Evidence: SSSSS.
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21
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Kitamura K, Hayashi S, Jin ZW, Yamamoto M, Murakami G, Rodríguez-Vázquez JF, Yamamoto H. Fetal cervical zygapophysial joint with special reference to the associated synovial tissue: a histological study using near-term human fetuses. Anat Cell Biol 2021; 54:65-73. [PMID: 33594011 PMCID: PMC8017452 DOI: 10.5115/acb.20.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/08/2020] [Accepted: 11/18/2020] [Indexed: 01/14/2023] Open
Abstract
Human fetal cervical vertebrae are characterized by the large zygapophysial joint (ZJ) extending posteriorly. During our recent studies on regional differences in the shape, extent, and surrounding tissue of the fetal ZJ, we incidentally found a cervical-specific structure of synovial tissues. This study aimed to provide a detailed evaluation of the synovial structure using sagittal and horizontal sections of 20 near-term fetuses. The cervical ZJ consistently had a large cavity with multiple recesses at the margins and, especially at the anterior end, the recess interdigitated with or were located close to tree-like tributaries of the veins of the external vertebral plexus. In contrast to the flat and thin synovial cell lining of the recess, the venous tributary had cuboidal endothelial cells. No or few elastic fibers were identified around the ZJ. The venous-synovial complex seems to be a transient morphology at and around birth, and it may play a role in the stabilization of the growing cervical ZJ against frequent spontaneous dislocation reported radiologically in infants. The venous-synovial complex in the cervical region should be lost and replaced by elastic fibers in childhood or adolescence. However, the delayed development of the ligament flavum is also likely to occur in the lumbar ZJ in spite of no evidence of a transient venous-synovial structure. The cuboidal venous endothelium may simply represent the high proliferation rate for the growing complex.
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Affiliation(s)
- Kei Kitamura
- Department of Histology and Embryology, Tokyo Dental College, Tokyo, Japan
| | - Shogo Hayashi
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, Kanagawa, Japan
| | - Zhe Wu Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | | | - Gen Murakami
- Division of Internal Medicine, Jikou-kai Clinic of Home Visits, Sapporo, Japan
| | | | - Hitoshi Yamamoto
- Department of Histology and Embryology, Tokyo Dental College, Tokyo, Japan
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22
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Hur JW. Conservative treatment of senile spinal diseases: drug therapy and nerve block. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.3.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
As we get closer to super-aged society, the prevalence of senile spinal diseases is constantly increasing and the burden on individuals and society grows high. Senile spinal disease is basically degenerative in nature. Pain and physical dysfunction occur due to various complex pathologic causes. For the diagnosis and treatment of such complex diseases, it is essential to understand common senile spinal diseases such as intervertebral disc herniation and spinal stenosis. Degenerative changes in intervertebral discs are caused by a combination of aging and excessive physical load, which results in structural damages and molecular biological changes in the intervertebral discs. Spinal stenosis is a disease in which nerves and blood vessels are compressed by hypertrophied ligamentum flavum, bulged disc, and a hypertrophied facet. Ligamentum flavum hypertrophy, which is the most important etiology in spinal stenosis, occurs due to mechanical stress and a cascade of inflammation and fibrosis reactions. Drug therapy targeting these pathologic mechanisms includes non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, and agents that improve blood circulation. Nerve blocks, which prevent these pathophysiologic conditions, are also a good treatment modality. Typical nerve block techniques include medial nerve block and epidural block. It is necessary to understand the pathophysiology of senile spinal diseases and establish an appropriate treatment strategy that suit the patient's condition.
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Abstract
Hypertrophy of the ligamentum flavum (LF) is a major cause of lumbar spinal stenosis (LSS), and the pathology involves disruption of elastic fibers, fibrosis with increased cellularity and collagens, and/or calcification. Previous studies have implicated the increased expression of the proteoglycan family in hypertrophied LF. Furthermore, the gene expression profile in a rabbit experimental model of LF hypertrophy revealed that biglycan (BGN) is upregulated in hypertrophied LF by mechanical stress. However, the expression and function of BGN in human LF has not been well elucidated. To investigate the involvement of BGN in the pathomechanism of human ligamentum hypertrophy, first we confirmed increased expression of BGN by immunohistochemistry in the extracellular matrix of hypertrophied LF of LSS patients compared to LF without hypertrophy. Experiments using primary cell cultures revealed that BGN promoted cell proliferation. Furthermore, BGN induces changes in cell morphology and promotes myofibroblastic differentiation and cell migration. These effects are observed for both cells from hypertrophied and non-hypertrophied LF. The present study revealed hyper-expression of BGN in hypertrophied LF and function of increased proteoglycan in LF cells. BGN may play a crucial role in the pathophysiology of LF hypertrophy through cell proliferation, myofibroblastic differentiation, and cell migration.
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24
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Chuang HC, Tsai KL, Tsai KJ, Tu TY, Shyong YJ, Jou IM, Hsu CC, Shih SS, Liu YF, Lin CL. Oxidative stress mediates age-related hypertrophy of ligamentum flavum by inducing inflammation, fibrosis, and apoptosis through activating Akt and MAPK pathways. Aging (Albany NY) 2020; 12:24168-24183. [PMID: 33223505 PMCID: PMC7762458 DOI: 10.18632/aging.104105] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022]
Abstract
The role of oxidative stress in ligamentum flavum (LF) hypertrophy has not been elucidated. We hypothesize that oxidative stress induces inflammatory responses and the subsequent fibrotic processes in LF, via activation of the Akt and MAPK pathways. Specimens of LFs were collected during surgeries for lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS). Part of the LF specimens underwent analyses for ROS, fibrotic markers, and inflammatory mediators, with the remainder minced for cell cultures. The cell cultures were treated with H2O2, after which the cells were lysed and analyzed via western blotting. The specimens of the LSS patients showed increased infiltration of inflammatory cells and were stained positively for MMP-3, MMP-9, vimentin, and fibronectin. The LF of the LSS patients had increased oxidative stress and inflammation compared to that of the LDH patients. In vitro analyses demonstrated that oxidative stress rapidly activated the Akt and MAPK pathways. Inflammatory mediators, iNOS and NF-κB, and fibrotic markers, including TGF-β, β-catenin, α-SMA and vimentin, were significantly upregulated after induction of oxidative stress. Oxidative stress activated the intrinsic apoptotic pathway. These findings revealed that oxidative stress is one of the etiological factors of LF hypertrophy, which might provide new insights into treatment approaches.
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Affiliation(s)
- Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kun-Ling Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuen-Jer Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Yuan Tu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yan-Jye Shyong
- Department of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Che-Chia Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Shien Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Fu Liu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan, Taiwan
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25
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Zheng Z, Ao X, Li P, Lian Z, Jiang T, Zhang Z, Wang L. CRLF1 Is a Key Regulator in the Ligamentum Flavum Hypertrophy. Front Cell Dev Biol 2020; 8:858. [PMID: 33072735 PMCID: PMC7533558 DOI: 10.3389/fcell.2020.00858] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/10/2020] [Indexed: 12/23/2022] Open
Abstract
Hypertrophy of the ligamentum flavum (HLF) is one of the common causes of lumbar spinal stenosis (LSS). The key molecules and mechanisms responsible for HLF remain unclear. Here, we used an integrated transcriptome and proteomics analysis of human ligamentum flavum (LF), and subsequent immunohistochemistry and real-time PCR assays, to show upregulation of CRLF1 to be the dominant response to HLF. TGF-β1 significantly increased mRNA expression of CRLF1 through SMAD3 pathway. CRLF1 enhanced LF fibrosis via ERK signaling pathway at the post-transcriptional level and was required for the pro-fibrotic effect of TGF-β1. Knockdown of CRLF1 was shown here to reduce fibrosis caused by inflammatory cytokines and mechanical stress. Furthermore, we found that bipedal standing posture can cause HLF and upregulation of CRLF1 expression in mice LF. Overexpression of CRLF1 was indicated to cause HLF in vivo, whereas CRLF1 knockdown impeded the formation of HLF in bipedal standing mice. These results revealed a crucial role of CRLF1 in LF hypertrophy. We propose that inhibition of CRLF1 is a potential therapeutic strategy to treat HLF.
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Affiliation(s)
- Zhenyu Zheng
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Academy of Orthopedics, Guangzhou, China
| | - Xiang Ao
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Academy of Orthopedics, Guangzhou, China
| | - Peng Li
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Academy of Orthopedics, Guangzhou, China
| | - Zhengnan Lian
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Academy of Orthopedics, Guangzhou, China
| | - Tao Jiang
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Academy of Orthopedics, Guangzhou, China
| | - Zhongmin Zhang
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Academy of Orthopedics, Guangzhou, China.,Division of Spine Surgery, Department of Orthopadics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liang Wang
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Academy of Orthopedics, Guangzhou, China
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Jain S, Deer T, Sayed D, Chopra P, Wahezi S, Jassal N, Weisbein J, Jameson J, Malinowski M, Golovac S. Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety. Pain Manag 2020; 10:331-348. [DOI: 10.2217/pmt-2020-0037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Lumbar spinal stenosis is a common degenerative spine condition. In properly selected patients, minimally invasive lumbar decompression ( mild®) may be an option to improve outcomes. This review provides an in-depth description of the mild procedure and a comprehensive examination of safety and efficacy. Two randomized controlled trials, together with 11 other controlled clinical studies, have established the efficacy of mild, which is a minimally invasive procedure that does not involve implants and has demonstrated excellent efficacy and safety. With an established safety profile equivalent to epidural steroid injections, and efficacy that has been shown to be superior to such injections, mild can reasonably be positioned early in the treatment algorithm for these patients. Based on extensive review of the literature, robust safety and efficacy through 2 years, and in accordance with minimally invasive spine treatment guidelines, mild is recommended as the first intervention after failure of conservative measures for lumbar spinal stenosis patients with neurogenic claudication and ligamentum flavum hypertrophy.
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Affiliation(s)
- Sameer Jain
- Pain Treatment Centers of America, Little Rock, AR 72211, USA
| | - Timothy Deer
- The Spine & Nerve Center of The Virginias, Charleston, WV 25301, USA
| | - Dawood Sayed
- University of Kansas Hospital, Kansas City, KS 66160, USA
| | - Pooja Chopra
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sayed Wahezi
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Navdeep Jassal
- Spine & Pain Institute of Florida, Lakeland, FL 33805, USA
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27
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Sun C, Zhang H, Wang X, Liu X. Ligamentum flavum fibrosis and hypertrophy: Molecular pathways, cellular mechanisms, and future directions. FASEB J 2020; 34:9854-9868. [PMID: 32608536 DOI: 10.1096/fj.202000635r] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
Hypertrophy of ligamentum flavum (LF), along with disk protrusion and facet joints degeneration, is associated with the development of lumbar spinal canal stenosis (LSCS). Of note, LF hypertrophy is deemed as an important cause of LSCS. Histologically, fibrosis is proved to be the main pathology of LF hypertrophy. Despite the numerous studies explored the mechanisms of LF fibrosis at the molecular and cellular levels, the exact mechanism remains unknown. It is suggested that pathophysiologic stimuli such as mechanical stress, aging, obesity, and some diseases are the causative factors. Then, many cytokines and growth factors secreted by LF cells and its surrounding tissues play different roles in activating the fibrotic response. Here, we summarize the current status of detailed knowledge available regarding the causative factors, pathology, molecular and cellular mechanisms implicated in LF fibrosis and hypertrophy, also focusing on the possible avenues for anti-fibrotic strategies.
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Affiliation(s)
- Chao Sun
- Department of Spine Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Han Zhang
- Department of Spine Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Wang
- Department of Spine Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xinhui Liu
- Department of Spine Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
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28
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Ultrasound-Guided Percutaneous Release Procedures in the Lumbar Ligamentum Flavum by Acupotomy: A Cadaveric study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2807901. [PMID: 31871474 PMCID: PMC6906825 DOI: 10.1155/2019/2807901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/27/2019] [Accepted: 11/04/2019] [Indexed: 12/04/2022]
Abstract
Objective This study aims to determine the methods of percutaneous release procedures in the lumbar ligamentum flavum (LF) under ultrasound guidance by acupotomy and provide an anatomical basis for intrusive treatment of lumbar disc herniation and lumbar spinal canal stenosis. Methods Twelve cadavers including 4 females and 8 males aged 60 to 90 years (73.42 ± 14.57 years), without formalin fixation, were selected. Guided by an ultrasound transducer, we punctured acupotomy to release lumbar LF in L3/L4, L4/L5, and L5/S1 segments. In the transverse-axis approach, the probe was placed transversely, while in the longitudinal-axis approach, the probe was placed longitudinally. The depth of needle penetration (A), the distance between the puncture point and spinous process (B), and the distance between the puncture point and sacral cornu (C) were measured on cadavers, and the depth of needle penetration (U-A), the distance between the puncture point and spinous process (U-B), and the angle for acupotomy (D) on ultrasound images were also measured. Statistical analyses were carried out using SPSS. Paired sample t-tests and homogeneity of variance tests and one-way analysis of variance (ANOVA) were performed. The Pearson correlation coefficients and linear correlation coefficients were calculated for the data obtained from ultrasound and cadaver measurements. Results No obvious blood vessels and nerves were observed in the puncture path, and the spinal dura was intact. There was no statistical difference between the left and right side measurements obtained from the ultrasound images and the cadavers. The penetration depth in the transverse-axis approach was less than that in the longitudinal-axis approach, and the angle of the needle in the transverse-axis approach was greater than that in the longitudinal-axis approach. The measured data for the transverse-axis approach for L3/L4, L4/L5, and L5/S1 segments showed that there were no differences in the needle angle, the depth of needle penetration, and the distance from the spinous process to the puncture point among the three segments. There was a strong correlation between the depth of needle penetration and the distance from the spinous process to the puncture point on the ultrasonic images and the cadavers on the path of acupotomy. Linear equation A = 2.02 + 0.83 ∗ U-A, R2 = 0.352; B = 1.37 + 0.71 ∗ U-B, R2 = 0.252, where A/B refers to the data measured on the cadavers and U-A/U-B refers to the data measured on the ultrasound images. Conclusion In this study, ultrasound guidance was applied, which better guaranteed the safety and feasibility of acupotomy therapy. Before performing the treatment, the depth of needle penetration in the human body can be determined by measuring the distance between the needle point and the target position on the ultrasound image. Under ultrasound guidance, the transverse-axis approach has a smaller puncture depth and greater puncture angle than the longitudinal-axis approach. Hence, this study believes that the transverse-axis approach is safer for the clinical application of ultrasound-guided LF acupotomy lysis.
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29
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Ye S, Kwon WK, Bae T, Kim S, Lee JB, Cho TH, Park JY, Kim K, Hur JK, Hur JW. CCN5 Reduces Ligamentum Flavum Hypertrophy by Modulating the TGF-β Pathway. J Orthop Res 2019; 37:2634-2644. [PMID: 31334871 PMCID: PMC6899892 DOI: 10.1002/jor.24425] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
Ligamentum flavum hypertrophy (LFH) is the most important component of lumbar spinal canal stenosis. Although the pathophysiology of LFH has been extensively studied, no method has been proposed to prevent or treat it. Since the transforming growth factor-β (TGF-β) pathway is known to be critical in LFH pathology, we investigated whether LFH could be prevented by blocking or modulating the TGF-β mechanism. Human LF cells were used for the experiments. First, we created TGF-β receptor 1 (TGFBR1) knock out (KO) cells with CRISPR (clustered regularly interspaced short palindromic repeats)/Cas9 biotechnology and treated them with TGF-β1 to determine the effects of blocking the TGF-β pathway. Subsequently, we studied the effect of CCN5, which has recently been proposed to modulate the TGF-β pathway. To assess the predisposition toward fibrosis, α-smooth muscle actin (αSMA), fibronectin, collagen-1, collagen-3, and CCN2 were evaluated with quantitative real-time polymerase chain reaction, western blotting, and immunocytochemistry. The TGFBR1 KO LF cells were successfully constructed with high KO efficiency. In wild-type (WT) cells, treatment with TGF-β1 resulted in the overexpression of the messenger RNA (mRNA) of fibrosis-related factors. However, in KO cells, the responses to TGF-β1 stimulation were significantly lower. In addition, CCN5 and TGF-β1 co-treatment caused a notable reduction in mRNA expression levels compared with TGF-β1 stimulation only. The αSMA protein expression increased with TGF-β1 but decreased with CCN5 treatment. TGF-β1 induced LF cell transdifferentiation from fibroblasts to myofibroblasts. However, this cell transition dramatically decreased in the presence of CCN5. In conclusion, CCN5 could prevent LFH by modulating the TGF-β pathway. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2634-2644, 2019.
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Affiliation(s)
| | - Woo-Keun Kwon
- Department of Neurosurgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Taegeun Bae
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Sunghyun Kim
- Department of Molecular and Computational Biology, University of Southern California, Los Angeles, California
| | - Jang-Bo Lee
- Department of Neurosurgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Tai-Hyoung Cho
- Department of Neurosurgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Jung-Yul Park
- Department of Neurosurgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Kyoungmi Kim
- Department of Biomedical Sciences and Department of Physiology, College of Medicine, Korea University, Seoul, Korea
| | - Junho K Hur
- Department of Pathology, College of Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea
- Department of Biomedical Sciences, Graduate School, Kyung Hee University, Seoul, Korea
| | - Junseok W Hur
- Department of Neurosurgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
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Mori T, Sakai Y, Kayano M, Matsuda A, Oboki K, Matsumoto K, Harada A, Niida S, Watanabe K. MicroRNA transcriptome analysis on hypertrophy of ligamentum flavum in patients with lumbar spinal stenosis. Spine Surg Relat Res 2017; 1:211-217. [PMID: 31440636 PMCID: PMC6698563 DOI: 10.22603/ssrr.1.2017-0023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/14/2017] [Indexed: 12/22/2022] Open
Abstract
Introduction Molecular pathways involved in ligamentum flavum (LF) hypertrophy are still unclarified. The purpose of this study was to characterize LF hypertrophy by microRNA (miRNA) profiling according to the classification of lumbar spinal stenosis (LSS). Methods Classification of patients with LSS into ligamentous and non-ligamentous cases was conducted by clinical observation and the morphometric parameter adopting the LF/spinal canal area ratio (LSAR) from measurements of magnetic resonance imaging (MRI) T2 weighed images. LF from patients with ligamentous stenosis (n=10) were considered as the degenerative hypertrophied samples, and those from patients with non-ligamentous LSS (n=7) and lumbar disc herniation (LDH, n=3) were used as non-hypertrophied controls. Profiling of miRNA from all samples was conducted by Agilent microarray. Microarray data analysis was performed with GeneSpring GX, and pathway analysis was performed using Ingenuity Pathway Analysis. Results The mean LSAR in the ligamentous group was significantly higher than that in the control group (0.662±0.154 vs 0.301±0.068, p=0.0000171). Ten significantly differentially expressed miRNA were identified and taken as a signature of LF hypertrophy: nine miRNA showed down-regulated expression, and one showed up-regulated expression in the ligamentous LF. Among those, miR-423-5p (rs=-0.473, p<0.05), miR-4306 (rs=-0.628, p<0.01), miR-516b-5p (rs=-0.629, p<0.01), and miR-497-5p (rs=0.461, p<0.05) were correlated to the LSAR. Pathway analysis predicted aryl hydrocarbon receptor signaling (p<0.01), Wnt/β-catenin signaling (p<0.01), and insulin receptor signaling (p<0.05) as canonical pathways associated with the miRNA signature. Conclusions Classification based on quantification of the MRI axial image is useful for studying hypertrophy of the LF. Aryl hydrocarbon receptor and Wnt/β-catenin signaling may be involved in LF hypertrophy.
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Affiliation(s)
- Taiki Mori
- Medical Genome Center, National Center for Geriatrics and Gerontology (NCGG), Aichi, Japan
| | | | - Mitsunori Kayano
- Medical Genome Center, National Center for Geriatrics and Gerontology (NCGG), Aichi, Japan.,Research Center for Global Agromedicine, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Akio Matsuda
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development (NRICHD), Tokyo, Japan
| | - Keisuke Oboki
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development (NRICHD), Tokyo, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development (NRICHD), Tokyo, Japan
| | | | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology (NCGG), Aichi, Japan
| | - Ken Watanabe
- Department of Bone and Joint Disease, NCGG, Aichi, Japan
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Saito T, Hara M, Kumamaru H, Kobayakawa K, Yokota K, Kijima K, Yoshizaki S, Harimaya K, Matsumoto Y, Kawaguchi K, Hayashida M, Inagaki Y, Shiba K, Nakashima Y, Okada S. Macrophage Infiltration Is a Causative Factor for Ligamentum Flavum Hypertrophy through the Activation of Collagen Production in Fibroblasts. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:2831-2840. [PMID: 28935572 DOI: 10.1016/j.ajpath.2017.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/19/2017] [Accepted: 08/15/2017] [Indexed: 12/22/2022]
Abstract
Ligamentum flavum (LF) hypertrophy causes lumbar spinal canal stenosis, leading to leg pain and disability in activities of daily living in elderly individuals. Although previous studies have been performed on LF hypertrophy, its pathomechanisms have not been fully elucidated. In this study, we demonstrated that infiltrating macrophages were a causative factor for LF hypertrophy. Induction of macrophages into the mouse LF by applying a microinjury resulted in LF hypertrophy along with collagen accumulation and fibroblasts proliferation at the injured site, which were very similar to the characteristics observed in the severely hypertrophied LF of human. However, we found that macrophage depletion by injecting clodronate-containing liposomes counteracted LF hypertrophy even with microinjury. For identification of fibroblasts in the LF, we used collagen type I α2 linked to green fluorescent protein transgenic mice and selectively isolated green fluorescent protein-positive fibroblasts from the microinjured LF using laser microdissection. A quantitative RT-PCR on laser microdissection samples revealed that the gene expression of collagen markedly increased in the fibroblasts at the injured site with infiltrating macrophages compared with the uninjured location. These results suggested that macrophage infiltration was crucial for LF hypertrophy by stimulating collagen production in fibroblasts, providing better understanding of the pathophysiology of LF hypertrophy.
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Affiliation(s)
- Takeyuki Saito
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masamitsu Hara
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiromi Kumamaru
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazu Kobayakawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuya Yokota
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Ken Kijima
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shingo Yoshizaki
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsumasa Hayashida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Inagaki
- Center for Matrix Biology and Medicine, Graduate School of Medicine, Tokai University, Isehara, Japan; Department of Regenerative Medicine, School of Medicine, Tokai University, Isehara, Japan
| | - Keiichiro Shiba
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Seiji Okada
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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