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Lee S, Yoo JI, Kang YJ. Integrative analyses of genes related to femoral head osteonecrosis: an umbrella review of systematic reviews and meta-analyses of observational studies. J Orthop Surg Res 2022; 17:182. [PMID: 35346283 PMCID: PMC8961967 DOI: 10.1186/s13018-022-03079-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Femoral head osteonecrosis (FHON) is a worldwide challenging clinical topic. Steroid use is one of the main etiologies of FHON. There are several genetic variants associated with FHON. Therefore, the purpose of this umbrella review was to provide a comprehensive summary of a meta-analysis and systematic review of genetic variations associated with nonsteroidal and steroid-induced FHON.
Methods
The eligible studies were selected from the PubMed and MEDLINE databases for the collection of diverse systematic meta-analyses and reviews. The genetic main effect score was assigned using the Human Genome Epidemiology Network’s Venice criteria to assess the cumulative evidence on the effects of a single nucleotide polymorphism (SNP) on FHON.
Results
Eight articles reported the meta-analysis of candidate SNP-based studies covering eight genes and 13 genetic variants. In the nonsteroid-induced FHON genetic variants including rs2012390 and rs11225394 in MMP8, rs1800629 and rs361525 in tumor necrosis factor (TNF)-α, VNTR in intron 4, rs1799983 and rs2070744 in endothelial nitric oxide synthase (eNOS), rs2010963 in vascular endothelial growth factor (VEGF), and rs6025 in factor V showed significance in each reference. The steroid-induced FHON genetic variants including rs693 and rs1042031 in apolipoprotein (Apo)B, rs1045642 in ABCB1, and rs1799889 in PAI-1 showed significance in each reference.
Conclusion
Based on the systematic review conducted in this study, we organized the genomes associated with FHON and looked at each contribution. Our results could give an integrative approach for understanding the mechanism of FHON etiology. It is expected that these results could contribute to the strategy of prediagnosis, evaluating the individual risk of nonsteroid-induced and steroid-induced FHON.
Level of Evidence: Level I.
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Association of Specific Genetic Polymorphisms with Atraumatic Osteonecrosis of the Femoral Head: A Narrative Review. Indian J Orthop 2022; 56:771-784. [PMID: 35547337 PMCID: PMC9043172 DOI: 10.1007/s43465-021-00583-3] [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] [Received: 09/20/2021] [Accepted: 11/25/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Atraumatic ONFH is one of the leading cause of hip morbidity in the working-age group. It is a multi-factorial disease whose root cause can be attributed to single-nucleotide polymorphism. Identifying such polymorphisms could pave the way for new modalities of treatment for ONFH. METHODOLOGY Two databases were electronically searched for relevant articles. The articles were screened through titles, abstract and full texts to include the relevant studies. A secondary search was done through the reference list of selected articles. RESULTS A total of 52 studies were included among the 181 hits. All 181 were case-control studies. Summary of these studies identifies multiple SNPs which can cause ONFH. There were 117 SNPs in all 181 studies, of which 92 were associated with the causation of ONFH and 25 were protective against ONFH. CONCLUSION SNPs play an essential role in causing atraumatic ONFH. Identification of SNP that contribute to causing ONFH may help reduce the disease burden by early identification, diagnosis and treatment, including targeted gene therapy.
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Ando W, Sakai T, Fukushima W, Kaneuji A, Ueshima K, Yamasaki T, Yamamoto T, Nishii T, Sugano N. Japanese Orthopaedic Association 2019 Guidelines for osteonecrosis of the femoral head. J Orthop Sci 2021; 26:46-68. [PMID: 33388233 DOI: 10.1016/j.jos.2020.06.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The Clinical Practice Guidelines for Osteonecrosis of the Femoral Head (ONFH) 2019 Edition, written by the working group for ONFH guidelines of the Japanese Investigation Committee (JIC) for ONFH under the auspices of the Japanese Ministry of Health, Labour, and Welfare and endorsed by the Japanese Orthopaedic Association, were published in Japanese in October 2019. The objective of this guideline is to provide a support tool for decision-making between doctors and patients. METHODS Procedures for developing this guideline were based on the Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014, which proposed an appropriate method for preparing clinical guidelines in Japan. RESULTS This clinical practice guideline consists of 7 chapters: epidemiology; pathology; diagnosis; conservative therapy; surgical treatment: bone transplantation/cell therapy; surgical treatment: osteotomy; and surgical treatment: hip replacement. Twelve background questions and 13 clinical questions were determined to define the basic features of the disease and to be addressed when deciding treatment in daily practice, respectively. CONCLUSIONS The clinical practice guidelines for the ONFH 2019 edition will be useful for physicians, investigators, and medical staff in clinical practice, as well as for patients, during the decision-making process when defining how to treat ONFH.
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Affiliation(s)
- Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Keiichiro Ueshima
- Department of Orthopaedic Surgery, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Kyoto, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Fukuoka, Japan
| | - Takashi Nishii
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | | | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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Chang C, Greenspan A, Gershwin ME. The pathogenesis, diagnosis and clinical manifestations of steroid-induced osteonecrosis. J Autoimmun 2020; 110:102460. [PMID: 32307211 DOI: 10.1016/j.jaut.2020.102460] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022]
Abstract
Corticosteroid associated osteonecrosis is bone death resulting from the use of chronic glucocorticoids and most commonly affects the femoral head, although the bones such as around knee joint, wrist joint and ankle joint can be affected. The pathogenesis is likely multifactorial, with genetic and environmental factors playing a role. Epigenetics may be the mechanism by which environment exerts it effects. In spite of recent discoveries, the exact pathogenesis of corticosteroid associated osteonecrosis is unknown. Over the past few years, more miRNA's have been found to be associated with osteonecrosis. The older mechanisms such as a coagulopathy, abnormalities in apoptosis and lipid metabolism dysfunction are still believed to play a role. The role of inflammatory pathways including the PDK1/AKT/mTOR signaling pathway, the PERK and Parkin pathways have been increasingly recognized as playing a mechanistic role. Histological damage to the joint can occur before the presence of symptoms. The most common symptoms are pain and an inability to bear weight. Differential diagnosis includes infection, bone marrow edema syndrome or subchondral fracture. Early detection is important for successful management of the condition. MRI is the best radiologic technique to diagnosis femoral head osteonecrosis. Multiple staging systems for osteonecrosis have been used over the years, including the Ficat and Arlet system and the Steinberg criteria. The later stages of these staging systems are irreversible. Both non-surgical (conservative) and surgical modes of therapy are used in the treatment of osteonecrosis.
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Affiliation(s)
- Christopher Chang
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, 33021, USA; Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, CA, 95616, USA.
| | - Adam Greenspan
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, CA, 95817, USA
| | - M Eric Gershwin
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, 33021, USA.
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Association between genetic polymorphisms and osteonecrosis in steroid treatment populations: a detailed stratified and dose-response meta-analysis. Biosci Rep 2019; 39:BSR20190024. [PMID: 30996113 PMCID: PMC6522878 DOI: 10.1042/bsr20190024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/15/2019] [Accepted: 03/16/2019] [Indexed: 01/03/2023] Open
Abstract
Steroid treatment has become recognized as an important risk factor for avascular osteonecrosis of the femoral head. However, not all patients who receive long-term, high-dose steroids develop osteonecrosis, indicating that there are individual differences in occurrence.We explored the relationship between polymorphisms and steroid-induced osteonecrosis of the femoral head (SONFH) incidence with variables. We used a multilevel mixed-effects logistic regression model, which is an expansion of logistic regression, for each type of steroid, primary disease, drug dose, applied duration, and single-nucleotide polymorphism (SNP). We also conducted a dose-response meta-analysis to analyze the cumulative dosage and SONFH risk in mutation carriers. There were significant correlations between the ABCB1 rs1045642 mutant and SONFH in the prednisone-use and methylprednisolone/prednisone-use populations. The ABCB1 rs2032582 mutant homozygote had a protective effect in the methylprednisolone/prednisolone renal transplant population. For ApoB rs693, mutation increased the incidence of SONFH in prednisone-use and methylprednisolone/prednisolone-use populations and renal transplant patients. For ApoB rs1042031, mutation increased the risk of SONFH in the prednisone-use population. The PAI-1 rs1799768 mutation had a protective effect on the SONFH risk prednisone-use and renal transplant populations. ABCB1 rs1045642 mutations have a protective effect against SONFH, and ApoB rs693 and rs1042031 increase the SONFH risk. Cumulative dosage and treatment duration had little effect on the results. In addition, there was a dose-effect correlation in ABCB1 rs1045642 and rs2032582 mutation carriers.
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Felten R, Perrin P, Caillard S, Moulin B, Javier RM. Avascular osteonecrosis in kidney transplant recipients: Risk factors in a recent cohort study and evaluation of the role of secondary hyperparathyroidism. PLoS One 2019; 14:e0212931. [PMID: 30794689 PMCID: PMC6386392 DOI: 10.1371/journal.pone.0212931] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
Avascular osteonecrosis (AVN) is a bone complication that indicates poor functional prognosis. Modern immunosuppressive and steroid-sparing drugs have significantly lowered the occurrence of AVN after kidney transplantation (KT). However, recent data on its incidence rates and risk factors are lacking. Using a large, recent cohort, we sought to investigate AVN incidence and risk factors, with a special focus on mineral and bone disorders. We conducted a cohort study in 805 patients who underwent KT between 2004 and 2014. AVN was identified in 32 patients (4%): before KT in 15 (1.8%) and after KT in 18 (2.2%) cases, including one patient with both. In the group with post-KT AVN, the median time intervals from KT to 1) first symptoms and 2) AVN diagnosis were 12 months [1–99] and 20 months [4–100], respectively. Being overweight/obese, having pre-transplant diabetes or hyperparathyroidism at transplantation, developing acute rejection, and receiving higher cumulative corticosteroid doses were associated with AVN occurrence. Multivariate analysis revealed that BMI ≥ 26 kg/m2 and higher cumulative corticosteroid doses were predictive of AVN. In conclusion, overweight/obesity is a strong risk factor for AVN. Despite a low maintenance dose, the use of corticosteroids—mostly for treatment of acute rejection—remains an independent risk factor.
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Affiliation(s)
- Renaud Felten
- Department of Rheumatology, University Hospital, Strasbourg, France
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
| | - Peggy Perrin
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
- Department pf Nephrology-Transplantation, University Hospital Strasbourg, France
- * E-mail:
| | - Sophie Caillard
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
- Department pf Nephrology-Transplantation, University Hospital Strasbourg, France
| | - Bruno Moulin
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
- Department pf Nephrology-Transplantation, University Hospital Strasbourg, France
| | - Rose-Marie Javier
- Department of Rheumatology, University Hospital, Strasbourg, France
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
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Chen X, Zhang L, Liang D, Li J, Liu F, Ma H. Lipid Transporter Activity-Related Genetic Polymorphisms Are Associated With Steroid-Induced Osteonecrosis of the Femoral Head: An Updated Meta-Analysis Based on the GRADE Guidelines. Front Physiol 2018; 9:1684. [PMID: 30559675 PMCID: PMC6287043 DOI: 10.3389/fphys.2018.01684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/08/2018] [Indexed: 01/11/2023] Open
Abstract
Aims: The purpose of this study was to assess the relationship between genetic variants and steroid-induced osteonecrosis of the femoral head (SONFH) in steroid use populations. Methods: We searched the public databases up to April 15, 2018. This study analyzed only the single-nucleotide polymorphisms (SNPs) that have appeared in more than three studies and assessed the level of evidence by classifying the outcomes according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: The ABCB1 rs1045642 C>T mutation had a protective effect against SONFH in the allelic model (I 2 = 50.2%; OR: 0.74; 95% CI: 0.55-1.00; p = 0.046). The rs2032582 mutation in the ABCB1 gene showed no relationship to SONFH (allelic model: I 2 = 63.4%; OR: 0.85; 95% CI: 0.58-1.23; p = 0.382). In ApoB rs693, four models showed that mutations can increase SONFH risk, but the allelic model did not. The ApoB rs1042031 mutation increased SONFH risk in the dominant model (I 2 = 50.3%; OR: 2.90; 95% CI: 1.49-5.66; p = 0.002). Conclusion: An allelic model of ABCB1 rs1045642 showed that mutations have a protective effect against SONFH at a very low level of evidence. The mutations in ApoB rs693 and rs1042031 increase the SONFH risk with moderate levels of evidence.
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Affiliation(s)
- Xiantao Chen
- Department of Osteonecrosis of the Femoral Head, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
| | - Leilei Zhang
- Department of Osteonecrosis of the Femoral Head, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
| | - Dawei Liang
- Department of Osteonecrosis of the Femoral Head, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
| | - Jing Li
- Department of Osteoarthritis, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
| | - Fenzhi Liu
- Department of Osteoarthritis, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
| | - Hongxia Ma
- Department of Osteonecrosis of the Femoral Head, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
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Hao Y, Guo H, Xu Z, Qi H, Wang Y, Lu C, Liu J, Yuan P. The relationship between apolipoprotein genes polymorphisms and susceptibility to osteonecrosis of the femoral head: a meta-analysis. Lipids Health Dis 2018; 17:192. [PMID: 30119683 PMCID: PMC6098662 DOI: 10.1186/s12944-018-0827-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/16/2018] [Indexed: 02/08/2023] Open
Abstract
Background The objective of this study was to evaluate whether apolipoprotein gene polymorphisms confer susceptibility to osteonecrosis of the femoral head (ONFH). Methods The relevant literature was screened from databases of Pubmed, Embase, Wanfang, Weipu and China National Knowledge Internet (CNKI) until May, 2017. In addition, odds ratio (OR) and its corresponding 95% confidence interval (CI) were used as a measure of effect size for calculating effect size. Results Totally, six case-control studies were included in this meta-analysis. It revealed that ApoB-C7623T polymorphism frequency was increased in ONFH group than in control group under three genetic models, including allele model (T vs. C, OR = 4.5149, 95% CI: 1.6968–12.0134); additive model (TC vs. CC, OR = 6.2515, 95% CI: 2.0939–18.6640); and dominant model (TT + TC vs. CC, OR = 5.4998, 95% CI: 1.9246–15.7163). In addition, the increased risk of ONFH were related to ApoA1-rs1799837 polymorphism under additive model (AA vs. GG, OR = 1.4175, 95% CI: 1.0522–1.9096) and recessive model (AA vs. GG + AG, OR = 1.7727, 95% CI: 1.3399–2.3452). However, four ApoB rs1042031, rs693, 3’-VNTR and G12619A polymorphisms under the all genetic models were not associated with susceptibility to ONFH. Conclusion The T allele and TC genotype of ApoB-C7623T and AA genotype of ApoA1-rs1799837 may contribute to increase the risk of ONFH.
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Affiliation(s)
- Yangquan Hao
- Department of Osteonecrosis and Joint Reconstruction, Honghui Hospital Xi'an Jiao Tong University Health Science Center, No. 555 Youyi East Road, Shaanxi, 710054, Xi'an, People's Republic of China.
| | - Hao Guo
- Department of Osteonecrosis and Joint Reconstruction, Honghui Hospital Xi'an Jiao Tong University Health Science Center, No. 555 Youyi East Road, Shaanxi, 710054, Xi'an, People's Republic of China
| | - Zhaochen Xu
- Department of Osteonecrosis and Joint Reconstruction, Honghui Hospital Xi'an Jiao Tong University Health Science Center, No. 555 Youyi East Road, Shaanxi, 710054, Xi'an, People's Republic of China
| | - Handeng Qi
- Shaanxi University of Chinese Medicine, Shiji Ave, Xi'an-Xianyang New Ecomic Zone, Shaanxi, 712046, Xi'an, People's Republic of China
| | - Yugui Wang
- Shaanxi University of Chinese Medicine, Shiji Ave, Xi'an-Xianyang New Ecomic Zone, Shaanxi, 712046, Xi'an, People's Republic of China
| | - Chao Lu
- Department of Osteonecrosis and Joint Reconstruction, Honghui Hospital Xi'an Jiao Tong University Health Science Center, No. 555 Youyi East Road, Shaanxi, 710054, Xi'an, People's Republic of China
| | - Jie Liu
- Shaanxi University of Chinese Medicine, Shiji Ave, Xi'an-Xianyang New Ecomic Zone, Shaanxi, 712046, Xi'an, People's Republic of China
| | - Puwei Yuan
- Shaanxi University of Chinese Medicine, Shiji Ave, Xi'an-Xianyang New Ecomic Zone, Shaanxi, 712046, Xi'an, People's Republic of China.
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The relationship between genetic polymorphisms in apolipoprotein E (ApoE) gene and osteonecrosis of the femoral head induced by steroid in Chinese Han population. Genes Genomics 2017; 40:225-231. [PMID: 29892926 DOI: 10.1007/s13258-017-0625-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
Previous studies suggested that apolipoprotein E (ApoE) genetic polymorphisms (SNPs) may result in abnormal lipid metabolism. Therefore, genetic polymorphisms in ApoE may be associated with the occurrence of osteonecrosis of the femoral head (ONFH). A case control study was designed to include 580 patients with steroid-induced ONFH and 560 age- and sex-matched non steroid-induced ONFH control subjects to analyze the association between ApoE polymorphisms and susceptibility of steroid-induced ONFH. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was utilized to differentiate two genotypes SNPs (rs7412 C/T and rs429358 T/C) in ApoE gene. Both rs7412 C/T and rs429358 T/C were found to be associated with the risk of steroid-induced ONFH. However, no significant association was observed between the haplotypes T-T, T-C and C-C in ONFH. Furthermore, T allele of rs7412 and C allele of rs429358 carriers were associated with higher levels of TG in steroid-induced ONFH patients (P < 0.05). The study suggested that ApoE genetic polymorphisms conferred susceptibility to steroid-induced ONFH in Chinese Han population. However, the results need further investigation with large sample size and various populations.
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Wei BF, Feng Z, Wei W, Chen X. Associations of TNF-α -238 A/G and IL-10 -1082 G/A Genetic Polymorphisms With the Risk of NONFH in the Chinese Population. J Cell Biochem 2017; 118:4872-4880. [PMID: 28543357 DOI: 10.1002/jcb.26167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/23/2017] [Indexed: 02/06/2023]
Abstract
The study aims to explore the roles of common polymorphisms of Tumor Necrosis Factor-α (TNF-α) (-238 A/G and -308 A/G) and IL-10 (-819 T/C and -1082 G/A) genes in the risk of non-traumatic osteonecrosis of the femoral head (NONFH). One hundred and forty-seven NONFH patients and 135 healthy individuals were selected as the case and control groups. qRT-PCR and Western blotting techniques detected mRNA as well as protein expressions of TNF-α and IL-10 of each genotype in both the case and control groups. The GA genotype and the A allele of TNF-α -238 A/G were higher in the case group than in the control group. Compared with the control group, AA, GA, and AG + AA genotypes as well as the A allele of IL-10-1082 G/A were all lower in the case group. In the case groups increased levels of TNF-α as well as decreased levels of IL-10 expression when compared with the control group. TNF-α expression of TNF-α-238 GA genotype was significantly higher than that in patients with GG genotype, while the IL-10 expression of GA and AA genotypes of IL-10-1082 was significantly lower than in that of patients with the GG genotype. TNF-α protein expression in the GA genotype was significantly higher than in the GG genotype. In relation to TNF-α -238, TNF-α protein expression of GA and AA genotypes had significantly reduced more so than the GG genotype in IL-10-1082. TNF-α-238 A/G and IL-10-1082 G/A may be involved as risk factors of NONFH. J. Cell. Biochem. 118: 4872-4880, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Biao-Fang Wei
- Department of Femoral Head, Linyi People's Hospital, Linyi, 276000, China
| | - Zhi Feng
- Department of Femoral Head, Linyi People's Hospital, Linyi, 276000, China
| | - Wei Wei
- Department of Orthopaedic, First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Xiao Chen
- Department of Emergency, Women and Children's Health Care Hospital of Linyi, Linyi, 276016, China
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Abstract
Younger patients are affected more often by osteonecrosis than by osteoarthritis, and osteonecrosis has significantly greater long-term morbidity. Corticosteroids are the most common cause of nontraumatic osteonecrosis. The femoral head is the most common site of osteonecrosis. In rare instances, osteonecrosis of the jaw has been associated with bisphosphonate exposure. This phenomenon is more common with repeated intravenous infusions of bisphosphonates. Case reports of osteonecrosis of the jaw in association with other medications, such as denosumab, have been reported. The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone. Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, innate immunity, and oxidative stress may play a role in the pathogenesis of osteonecrosis. Epigenetics may alter the predisposition to develop osteonecrosis. MRI is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis. Nonsurgical treatment of osteonecrosis does not change the natural history of the disease. Although surgical treatment of femoral head osteonecrosis has many variations, most symptomatic patients eventually require total hip arthroplasty. Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis. Because of the lack of successful treatment options, new modes of management focus on the prevention of osteonecrosis.
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Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am 2015; 97:1604-27. [PMID: 26446969 DOI: 10.2106/jbjs.o.00071] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Jeffrey J Cherian
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Rafael J Sierra
- Mayo Clinic, 200 First Street S.W., Gonda 14 South, Rochester, MN 55905
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, JHOC 5245, Baltimore, MD 21287
| | - Jay R Lieberman
- Keck Medical Center of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033
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Liu R, Fan L, Yin L, Wang K, Miao W, Song Q, Dang X, Gao H, Bai C. Comparative study of serum proteomes in Legg-Calve-Perthes disease. BMC Musculoskelet Disord 2015; 16:281. [PMID: 26438379 PMCID: PMC4595068 DOI: 10.1186/s12891-015-0730-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 09/21/2015] [Indexed: 12/12/2022] Open
Abstract
Background Legg-Calve-Perthes Disease (LCPD) is an idiopathic osteonecrosis of the developing femoral head complicated by pain and disability of the hip joint. To date, the pathological mechanisms of LCPD are not well-known. This study screened the changes in serum protein expression in patients with LCPD. Methods Age- and sex-matched serum samples from 10 control subjects and 10 patients with LCPD were compared using the isobaric tags for relative and absolute quantification (iTRAQ) technique. Gene ontology analyses, KEGG pathway and functional network analyses were performed. Proteins of interest with large differences in expression, S100-A8, alpha-1-acid glycoprotein 1, haptoglobin and apolipoprotein E, were compared by western blotting. Results The disease/control ratios showed 26 proteins were significantly differentially expressed (all p < 0.05). Including higher abundances of complement factor H (1.44), complement C4-B (1.45), isocitrate dehydrogenase [NAD] subunit alpha (2.7) alpha-1-acid glycoprotein 1 (1.87), heptoglobin (1.53) and Ig lambda-2 chain C regions (1.46), and lower levels of apolipoprotein E (0.50), apolipoprotein F (0.60), apolipoprotein C-III (0.69), S100-A8 (0.73), S100-A9 (0.75) and prothrombin (0.77) in LCPD than in controls. The alpha-1-acid glycoprotein 1 and haptoglobin increases, and apolipoprotein E and S100-A8 decreases were confirmed by western blot. KEGG pathway analysis revealed these proteins were related to the complement and coagulation cascades, Staphylococcus aureus infection, PPAR signaling, fat digestion and absorption, and vitamin digestion and absorption. Functional network analysis suggested that the proteins were involved in lipid regulation. Conclusions The complement and coagulation cascades, and abnormal lipid metabolism may be involved in the pathogenesis of LCPD.
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Affiliation(s)
- Ruiyu Liu
- Department of Orthopaedic, the Second Hospital Affilicated to Medical College, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, P. R China.
| | - Lihong Fan
- Department of Orthopaedic, the Second Hospital Affilicated to Medical College, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, P. R China.
| | - Longbin Yin
- Department of Orthopaedic, the Second Hospital Affilicated to Medical College, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, P. R China.
| | - Kunzheng Wang
- Department of Orthopaedic, the Second Hospital Affilicated to Medical College, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, P. R China.
| | - Wusheng Miao
- Department of Pediatric Orthopaedic, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Nanshao Men, Beilin District, Xi'an, 710054, P. R China.
| | - Qichun Song
- Department of Orthopaedic, the Second Hospital Affilicated to Medical College, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, P. R China.
| | - Xiaoqian Dang
- Department of Orthopaedic, the Second Hospital Affilicated to Medical College, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, P. R China.
| | - Hang Gao
- Research Center for Proteome Analysis, Shanghai Institutes for Biological5 Sciences, Chinese Academy of Sciences, Shanghai, P. R China.
| | - Chuanyi Bai
- Department of Orthopaedic, the Second Hospital Affilicated to Medical College, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, P. R China.
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Incidence, risk factors, and treatment outcome of symptomatic osteonecrosis in Taiwanese children with acute lymphoblastic leukemia: a retrospective cohort study of 245 patients in a single institution. Int J Hematol 2015; 102:41-7. [PMID: 25840770 DOI: 10.1007/s12185-015-1790-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 03/18/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
Osteonecrosis (ON) is a potentially disabling complication encountered in children who receive chemotherapy for acute lymphoblastic leukemia (ALL). Considering the possible effect of ethnic difference on the clinical features of symptomatic ON in pediatric ALL, we retrospectively evaluated 245 children with ALL who were treated at Chang Gung Memorial Hospital, Linkou, between 2002 and 2011. Six (2.4 %) patients developed symptomatic ON in a total of 17 sites during the follow-up period. Diagnosis of ON was confirmed by X-ray in seven, magnetic resonance imaging in two, and bone scan in three patients. The estimated cumulative incidence of symptomatic ON in newly diagnosed ALL was 3.4 % at 8 years. Four patients received ON-directed surgical interventions, including total hip replacement in three and arthroplasty in one. The incidence of ON was significantly higher among girls (P = 0.03), patients >10 years old (P = 2.2 × 10(-4)), and patients who had received more intensive chemotherapy regimen (P = 0.02). These results indicate that the incidence and risk factors in our institute were similar to those observed in Western countries. Future studies surveying the impact on the quality of life of childhood ALL survivors in Taiwan are warranted.
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Cui Y, Kaisaierjiang A, Cao P, Wu ZY, Lv Q. Association of apolipoprotein A5 genetic polymorphisms with steroid-induced osteonecrosis of femoral head in a Chinese Han population. Diagn Pathol 2014; 9:229. [PMID: 25515090 PMCID: PMC4282735 DOI: 10.1186/s13000-014-0229-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/08/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Previous studies suggested that apolipoprotein A5 (ApoA5) genetic polymorphisms (SNPs) may result in lipid metabolism disorders. Therefore, genetic polymorphisms in ApoA5 may be associated with the occurrence of osteonecrosis of femoral head (ONFH). METHODS We designed a case-control study including 223 patients of osteonecrosis and 201 age- and sex-matched control subjects to analyze the association between ApoA5 polymorphisms and susceptibility of steroid-induced ONFH. We utilized polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to genotype two SNPs (rs662799 and rs3135506) in ApoA5 gene. RESULTS We found both rs662799 and rs3135506 were associated with the risk of ONFH in codominant, dominant, and recessive model, respectively. Haplotype analyses suggested that T-C haplotype was associated with decreased risk of ONFH, whereas the haplotype C-C was significantly associated with an increased risk of ONFH. CONCLUSION Our study suggested that ApoA5 genetic polymorphisms were associated with susceptibility to ONFH in Chinese population. However, our results need further investigation with large sample size and various populations. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_229.
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Affiliation(s)
- Yong Cui
- Department of orthopetics, Fifth Affiliated Hospital of Xinjiang Medical University, No.118, Henan West Street, Urumqi, 830011, China.
| | - Aihemaiti Kaisaierjiang
- Department of orthopetics, Fifth Affiliated Hospital of Xinjiang Medical University, No.118, Henan West Street, Urumqi, 830011, China.
| | - Peng Cao
- Department of orthopetics, Fifth Affiliated Hospital of Xinjiang Medical University, No.118, Henan West Street, Urumqi, 830011, China.
| | - Zhong-Yan Wu
- Department of orthopetics, Fifth Affiliated Hospital of Xinjiang Medical University, No.118, Henan West Street, Urumqi, 830011, China.
| | - Qing Lv
- Department of orthopetics, Fifth Affiliated Hospital of Xinjiang Medical University, No.118, Henan West Street, Urumqi, 830011, China.
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Yin JM, Liu Z, Zhao SC, Guo YJ, Liu ZT. Relationship between the Apolipoprotein AI, B gene polymorphism and the risk of non-traumatic osteonecrosis. Lipids Health Dis 2014; 13:149. [PMID: 25248404 PMCID: PMC4247152 DOI: 10.1186/1476-511x-13-149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 08/30/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies suggested that Apolipoprotein AI (ApoAI) and apolipoprotein B (ApoB) gene polymorphisms may result in lipid metabolism disorders. Genetic polymorphisms in these genes may be associated with the occurrence of osteonecrosis. METHODS We designed a case-control study including 429 patients of osteonecrosis and 368 age- and sex-matched control subjects. Polymerase chain reaction was used to amplify the DNA fragments in promoter -75 G > A of ApoAI gene and EcoR I, Xba I and 3'-VNTR of ApoB gene in osteonecrosis patients and healthy controls. We utilized polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to genotype these four single nucleotide polymorphisms (SNPs). RESULTS For -75 G > A polymorphism of ApoAI, AA genotype frequency (0.501) was significantly higher in patients with osteonecrosis than that in control (0.462) subjects (P <0.001), GA genotype frequency (0.170) was significantly lower than that in the control (0.310) group (P <0.0001). In osteonecrosis patients, the odds ratio (OR) of A allele was 3.932 (95% CI: 3.0847 ~ 5.0123), which suggested that subjects carrying A allele of promoter region -75 G > A of ApoAI gene had higher susceptibility to osteonecrosis than G allele carriers. The genotype and allele frequency distributions showed no significant difference in EcoR I, Xba Iand 3'-VNTR loci of ApoB gene between the osteonecrosis group and control group. CONCLUSION Our study suggested that ApoAI gene -75G > A polymorphism may be associated with susceptibility to osteonecrosis in Chinese population. However, our results need further investigation with large sample size and various populations.
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Affiliation(s)
- Ji-Min Yin
- />Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, No.600 Yishan Road, Shanghai, 200233 China
| | - Zhao Liu
- />Department of hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-Chang Zhao
- />Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, No.600 Yishan Road, Shanghai, 200233 China
| | - Yan-Jie Guo
- />Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, No.600 Yishan Road, Shanghai, 200233 China
| | - Zhong-Tang Liu
- />Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, No.600 Yishan Road, Shanghai, 200233 China
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Xue Y, Zhao ZQ, Hong D, Zhang HJ, Chen HX, Fan SW. MDR1 gene polymorphisms are associated with glucocorticoid-induced avascular necrosis of the femoral head in a Chinese population. Genet Test Mol Biomarkers 2014; 18:196-201. [PMID: 24387690 DOI: 10.1089/gtmb.2013.0374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
P-glycoprotein (P-gp) is present in various tissue cells, required for the pumping of lipophilic drugs (including glucocorticoids) out of cells. We hypothesized that polymorphisms in the P-gp encoding gene (multidrug-resistant transporter-1 [MDR1]) are related to individual differences in glucocorticoid sensitivity and the development of glucocorticoid-induced avascular necrosis of the femoral head (GANFH). In this case-control study, we genotyped three known single-nucleotide polymorphisms (SNPs: C1236T, G2677T/A, and C3435T) within the MDR1 gene in 662 Chinese subjects. Statistically significant differences between GANFH patients and either healthy controls or glucocorticoid-resistant patients (non-GANFH) were found for the T allele or TT genotype of C3435T. The haplotype TTT, composed of these three SNPs, exhibited a significant association with the disease. No associations were identified between C1236T or G2677T/A and GANFH. Our results suggest that the C3435T polymorphism of the MDR1 gene is associated with susceptibility to GANFH in a Chinese population.
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Affiliation(s)
- Yun Xue
- 1 Department of Orthopedics, Sir Run Run Shaw Hospital, Zhejiang University , Hangzhou, China
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18
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Shuai B, Yang Y, Shen L, Wu M. Effect of <i>Qing’e Pill</i> plus <i>Salvia</i> on Non-Traumatic Osteonecrosis of the Femoral Head of Idiopathic Type in Earlier Stage: A Case Report of a Twelve-Month of Period. Chin Med 2014. [DOI: 10.4236/cm.2014.52013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
The aim of this review was to provide information about the variety of thrombophilic and hypofibrinolytic markers that are possible risk factors for the development of osteonecrosis and bone marrow edema syndrome. A total of 48 parameters were identified in 45 studies that included 2163 patients. The most frequently reported laboratory findings included altered serum concentrations of lipoproteins, decreased concentration and function of fibrinolytic agents, increased levels of thrombophilic markers, and several single nucleotide polymorphisms. Despite inhomogeneities in reported parameters, results, patients' collectives, and treatment strategies, these data suggest that coagulation abnormalities may play an important role in the emergence of osteonecrosis and bone marrow edema syndrome.
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Affiliation(s)
- Patrick Orth
- Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Saar, Germany
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20
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Gong LL, Fang LH, Wang HY, Peng JH, Si K, Zhu J, Han FF, Wang YH, Du GH, Pei LX, Liu LH. Genetic risk factors for glucocorticoid-induced osteonecrosis: a meta-analysis. Steroids 2013; 78:401-8. [PMID: 23357434 DOI: 10.1016/j.steroids.2013.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/11/2012] [Accepted: 01/11/2013] [Indexed: 12/17/2022]
Abstract
Glucocorticoid-induced osteonecrosis is a common and severe adverse event. We conducted a meta-analysis to investigate whether polymorphisms in target genes were associated with the risk of corticosteroid-induced osteonecrosis. Published literature from PubMed and EMBASE were searched for eligible publications. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a fixed- or random-effects model. There were 23 articles with 35 genes described the relationship between polymorphisms and glucocorticoid-induced osteonecrosis. Meta-analyses were carried out for those SNPs with three or more eligible studies, which included four SNPs located in three genes (PAI-1, MTHFR, ABCB1). The meta-analysis revealed that the PAI-1 4G allele was associated with an increased risk of osteonecrosis compared with the 5G allele (combined studies: OR=1.932, 95% CI=1.145-3.261). The OR for the 4G/4G vs. 5G/5G genotype of PAI-1 was 3.217 (95% CI 1.667-6.209 with combined studies), The relative risk of osteonecrosis was increased in the 4G allele vs. 5G/5G and 4G/4G genotype vs. 5G allele, with odds ratios of 2.304 (95% CI=1.235-4.299) and 2.307 (95% CI=1.527-3.485) in combined studies, respectively. The ABCB1 C3435T genotype distributions available confirmed that the C allele increased osteonecrosis risk compared with the T allele (OR 1.668, 95% CI=1.214-2.293) and TT genotype (OR 2.946, 95% CI=1.422-6.101). There was no evidence for significant association between MTHFR C677T and ABCB1 G2677T/A polymorphisms and risk of osteonecrosis. Results of this meta-analysis indicate that the PAI-1 4G/5G and ABCB1 C3435T polymorphisms may be risk factors for osteonecrosis.
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Affiliation(s)
- Li-Li Gong
- Beijing Chao-Yang Hospital, Affiliate of Capital Medical University, Beijing 100020, China.
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Abstract
Osteonecrosis affects younger patients more often than osteoarthritis and has significantly greater long-term morbidity. Corticosteroids constitute the most common cause of nontraumatic osteonecrosis. The femoral head is the most common site of osteonecrosis. Bisphosphonate use is associated with osteonecrosis of the jaw. The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone. Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, and oxidative stress may play a role in the pathogenesis of osteonecrosis. Magnetic resonance imaging is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis. Nonsurgical treatment of osteonecrosis does not change the natural history of the disease. Although there are many variations on surgical treatment of femoral head osteonecrosis, most patients eventually require total hip arthroplasty. Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis. Due to the lack of successful treatment options, new modes focus on prevention of osteonecrosis.
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Clinical Pharmacokinetics and Pharmacodynamics of Prednisolone and Prednisone in Solid Organ Transplantation. Clin Pharmacokinet 2012; 51:711-41. [DOI: 10.1007/s40262-012-0007-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Liu B, Cao Y, Wang D, Yao G, Bi Z. Vascular endothelial growth factor -634G/C polymorphism associated with osteonecrosis of the femoral head in a Chinese population. Genet Test Mol Biomarkers 2012; 16:739-43. [PMID: 22612467 DOI: 10.1089/gtmb.2011.0384] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
An impeded blood flow through the femoral head is incriminated in the etiopathogenesis of osteonecrosis of the femoral head (ONFH). Vascular endothelial growth factor (VEGF) is a strong angiogenic protein and also plays a role in the formation of cartilage and bone. The aim of this study was to evaluate the association of VEGF -634G/C polymorphism with ONFH in a Chinese population. A total of 220 unrelated patients with nontraumatic ONFH and 220 unrelated control subjects were consecutively enrolled in a hospital-based case-control study. A polymerase chain reaction-restriction fragment length polymorphism analysis was used to detect the VEGF -634G/C genotype. Patients with ONFH had a significantly higher frequency of the CC genotype (odds ratio=1.64, 95% confidence interval=1.03, 2.60; p=0.04) than controls. There were no significant associations between any genotypes and the cause of ONFH. Our results support the hypothesis that the VEGF -634CC genotype is a risk factor of ONFH in the Chinese population. However, current results should be validated prospectively in larger cohorts.
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Affiliation(s)
- Bin Liu
- Department of Orthopedics, First Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
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Lee YJ, Lee JS, Kang EH, Lee YK, Kim SY, Song YW, Koo KH. Vascular endothelial growth factor polymorphisms in patients with steroid-induced femoral head osteonecrosis. J Orthop Res 2012; 30:21-7. [PMID: 21710604 DOI: 10.1002/jor.21492] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 06/09/2011] [Indexed: 02/04/2023]
Abstract
To investigate an association between steroid-induced femoral head osteonecrosis (FHON) and functional vascular endothelial growth factor (VEGF) gene (-2578A/C, -1154A/G, -634C/G, and +405C/G) polymorphisms polymerase chain reaction-restriction fragment length polymorphism genotyping was performed in 160 patients (86 idiopathic FHON and 74 steroid-induced FHON) and 160 gender- and age-matched controls. The steroid-induced subgroup had a significantly lower prevalence of -1154A allele (7.4% vs. 18.1%, odds ratio (OR) = 0.363) and genotype carrying -1154A (14.9% vs. 32.5%, OR = 0.333 in a recessive model) than controls. In a dominant model, the frequency of genotype carrying +405G (74.3% vs. 84.4%, OR = 0.492) was significantly lower in steroid-induced FHON than in controls. The distribution of haplotypes was significantly different between controls and FHON patients (p = 0.00011). Especially, when haplotypes were classified into high (CGCG and AAGG) or low (CGGC and AGGC) VEGF inducing haplotypes, patients with steroid-induced FHON had a significantly lower prevalence of high inducing haplotypes (7.4% vs. 15.9%, OR = 0.424) and a significantly higher prevalence of low inducing haplotypes (4.7% vs. 0.6%, OR = 7.894) than controls. Low inducing VEGF haplotypes may confer an increased risk and high inducing haplotypes have a protective effect for the development of steroid-induced FHON in Korea.
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Affiliation(s)
- Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
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Hwang JT, Baik SH, Choi JS, Lee KH, Rhee SK. Genetic traits of avascular necrosis of the femoral head analyzed by array comparative genomic hybridization and real-time polymerase chain reaction. Orthopedics 2011; 34:14. [PMID: 21210629 DOI: 10.3928/01477447-20101123-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In an attempt to observe the genetic traits of avascular necrosis of the femoral head, we analyzed the genomic alterations in blood samples of 18 patients with avascular necrosis of the femoral head (9 idiopathic and 9 alcoholic cases) using the array comparative genomic hybridization method and real-time polymerase chain reaction. Several candidate genes were identified that may induce avascular necrosis of the femoral head, and we investigated their role in the pathomechanism of osteonecrosis of bone. The frequency of each candidate gene over all the categories of avascular necrosis of the femoral head was also calculated by real-time polymerase chain reaction. The highest frequency specific genes in each category were FLJ40296, CYP27C1, and CTDP1. FLJ40296 and CYP27C1 had the highest frequency (55.6%) in the idiopathic category. FLJ40296 had a high frequency (44.4%) in the alcoholic category, but CYP27C1 had a relatively low frequency (33.3%) in the alcoholic category. However, CTDP1 showed a significantly high frequency (55.6%) in the alcoholic category and a low frequency (22.2%) in the idiopathic category. Although we statistically analyzed the frequency of each gene with Fisher's exact test, we could not prove statistical significance due to the small number of samples. Further studies are needed with larger sample numbers. If the causal genes of avascular necrosis of the femoral head are found, they may be used for early detection, prognosis prediction, and genomic treatment of avascular necrosis of the femoral head in the future.
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Affiliation(s)
- Jung-Taek Hwang
- Department of Orthopedic Surgery, St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Republic of Korea
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SHUAI BO, SHEN LIN, YANG YANP, XIE JING, SHOU ZHEX, WEI BING. Low Plasma Adiponectin as a Potential Biomarker for Osteonecrosis of the Femoral Head. J Rheumatol 2010; 37:2151-5. [DOI: 10.3899/jrheum.100342] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective.To examine whether plasma adiponectin level is correlated with osteonecrosis of the femoral head (ONFH).Methods.Blood adiponectin level in patients with nontraumatic ONFH (n = 120) was compared with a group of healthy subjects (n = 120). Patients with hip osteoarthritis (OA; n = 30) and traumatic ONFH (n = 45) were included as controls. Potential compounding factors, such as plasma low-density lipoprotein (LDL), high-density lipoprotein (HDL), apolipoprotein A1 (apo A1), apolipoprotein B (apo B), total cholesterol (TC), triglycerides (TG), and C-reactive protein (CRP) were also examined.Results.Patients with nontraumatic ONFH had significantly lower plasma levels of adiponectin than the healthy controls (7.14 ± 3.53 vs 10.93 ± 3.41 μg/ml, respectively; p < 0.001). Adiponectin level was positively correlated with HDL (r = 0.282, p < 0.001) and age (r = 0.145, p = 0.01), yet negatively correlated with body mass index (r = −0.70, p < 0.001), TG (r = −0.55, p<0.001), LDL/HDL ratio (r = −0.173, p = 0.002), and CRP (r = −0.634, p < 0.001). No correlation was seen with LDL (r = −0.017, p = 0.762). A multiple logistic regression analysis revealed that adiponectin level is an independent predictor of the presence of nontraumatic ONFH (p < 0.001, OR 0.676, 95% CI 0.546 to 0.845).Conclusion.Low adiponectin level is significantly associated with the presence of nontraumatic ONFH. This biomarker may be useful in assessing the potential presence of nontraumatic ONFH.
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Investigation of occurrence of osteonecrosis of the femoral head after increasing corticosteroids in patients with recurring systemic lupus erythematosus. Rheumatol Int 2009; 30:1587-93. [PMID: 19809818 DOI: 10.1007/s00296-009-1194-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 09/20/2009] [Indexed: 12/19/2022]
Abstract
Osteonecrosis (ON) of the femoral head is known to occur commonly in cases with systemic lupus erythematosus (SLE) that received corticosteroid (CS) treatment. However, there have been no detailed reports about the onset of ON in cases with recurrence of SLE. Using MRI, we followed up 17 patients who experienced recurrence of SLE for at least 1 year at our hospital and in whom the CS dose was increased from a maintenance dose to middle to high dose to see if ON would occur. We then compared the group that developed ON and the group that did not with respect to patient characteristics, blood test results, changes in serum lipid levels, and CS dose. ON occurred in five subjects (29.4%), revealing that osteonecrosis occurs not only when CS are first administered but also in cases which the CS dose is increased for recurrence of SLE. Especially, serum cholesterol levels and its rate of increase soared rapidly soon after increasing the CS dose in the ON group as compared with the non-ON group (P < 0.05). This suggests that increased serum lipid levels might be a contributing factor to onset of ON. Moreover, SLE disease activity index 2000 (SLEDAI-2K) scores when the CS dose was increased were significantly (P < 0.05) higher in the ON group, suggesting that SLE disease activity itself is a risk factor for onset of ON.
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Girnita DM, Burckart G, Zeevi A. Effect of cytokine and pharmacogenomic genetic polymorphisms in transplantation. Curr Opin Immunol 2008; 20:614-25. [PMID: 18706500 PMCID: PMC2739872 DOI: 10.1016/j.coi.2008.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 08/01/2008] [Accepted: 08/04/2008] [Indexed: 12/13/2022]
Abstract
Consolidating the information that we have on pharmacogenetics and on cytokine genetics to produce patient-oriented individualized drug regimens is an important challenge in transplantation medicine. Using a multi-variant approach based on genetic profile and other relevant clinical factors a score system may be developed to predict the severity of rejection, infection, or other complications associated with transplantation. The ultimate goal of these studies is to improve patient outcome through individualized drug regimens.
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Affiliation(s)
- Diana M Girnita
- Department of Pathology, Thomas E Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA 15213
| | - Gilbert Burckart
- Office of Clinical Pharmacology, Office of Translational Science, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Adriana Zeevi
- Department of Pathology, Thomas E Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA 15213
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Kuribayashi M, Fujioka M, Takahashi KA, Arai Y, Hirata T, Nakajima S, Yoshimura N, Satomi Y, Nishino H, Kondo K, Fukushima W, Hirota Y, Kubo T. Combination analysis of three polymorphisms for predicting the risk for steroid-induced osteonecrosis of the femoral head. J Orthop Sci 2008; 13:297-303. [PMID: 18696186 DOI: 10.1007/s00776-008-1244-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 04/10/2008] [Indexed: 02/09/2023]
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONF) often develops following corticosteroid administration. We previously investigated the genetic background for the development of corticosteroid-induced ONF and found relations between ONF development and genetic polymorphisms in the ATP binding cassette B1 (ABCB1) gene (C3435T), apolipoprotein B (ApoB) gene (C7623T), and cAMP-response element binding protein-binding protein (CBP) gene (rs3751845). In the present study, we examined whether combined information regarding these three single nucleotide polymorphisms (SNPs) in the ABCB1, ApoB, and CBP genes is useful for predicting ONF development. METHODS A case-control study was performed to study the development of corticosteroid-induced ONF. The cases were 34 patients who developed ONF, and the references were 123 patients who did not develop ONF. To evaluate the presence of interactions among the ABCB1, ApoB, and CBP genes, a synergistic index was calculated using an additive model. RESULTS The synergistic index between the ABCB1 and CBP genes was >1.00 (1.99), revealing the presence of an interaction. CONCLUSIONS Through analysis of multiple genes that may affect ONF development, we have shown a possible relation among genes encoding completely different proteins. We believe that analysis of the interactions among these genes can contribute to elucidating the mechanism of ONF development in addition to enabling identification of high-risk patients for ONF development.
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Affiliation(s)
- Masaaki Kuribayashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2008; 15:193-207. [PMID: 18316957 DOI: 10.1097/med.0b013e3282fba8b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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