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Arcanjo GS, Souza MB, Domingos IF, Pereira-Martins DA, Falcão DA, Batista JV, Hatzlhofer BL, Diniz MV, Silva AP, Guaraná WL, Hazin MF, Araujo AS, Cunha AF, Saad SO, Costa FF, Lucena-Araujo AR, Bezerra MAC. BMP6 and VDR gene polymorphisms are associated with osteonecrosis in a sickle cell anaemia cohort. Br J Haematol 2024; 204:1507-1514. [PMID: 38323352 DOI: 10.1111/bjh.19329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
The occurrence and severity of osteonecrosis in sickle cell anaemia (SCA) vary due to risk factors, including genetic modifiers. Bone morphogenetic proteins (BMPs), particularly BMP6, and the vitamin D receptor (VDR) play key roles in cartilage and bone metabolism, making them potential contributors to orthopaedic outcomes in SCA. Here, we evaluated the association of polymorphisms in BMP6 (rs3812163, rs270393 and rs449853) and VDR (FokI rs2228570 and Cdx2 rs11568820) genes with osteonecrosis risk in a Brazilian SCA cohort. A total of 177 unrelated SCA patients were selected. The AA genotype of BMP6 rs3812163 was independently associated with a lower osteonecrosis risk (p = 0.015; odds ratio (OR): 0.38; 95% confidence interval (CI): 0.18-0.83) and with the long-term cumulative incidence of osteonecrosis (p = 0.029; hazard ratio: 0.56, 95% CI: 0.34-0.94). The VDR rs2228570 TT genotype was independently associated with a lower osteonecrosis risk (p = 0.039; OR: 0.14; 95% CI: 0.02-0.90). In summary, our results provide evidence that BMP6 rs3812163 and the VDR rs2228570 might be implicated in osteonecrosis pathophysiology in SCA and might help identify individuals at high risk.
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Affiliation(s)
- Gabriela S Arcanjo
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Mariana B Souza
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Igor F Domingos
- Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Diego A Pereira-Martins
- Department of Hematology, Cancer Research Centre Groningen, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego A Falcão
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Jessica V Batista
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Betania L Hatzlhofer
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Madi V Diniz
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Alexsandro P Silva
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Werbson L Guaraná
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Manuela F Hazin
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Pernambuco, Brazil
| | - Aderson S Araujo
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Pernambuco, Brazil
| | - Anderson F Cunha
- Department of Genetics and Evolution, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Sara O Saad
- Hematology and Hemotherapy Center, State University of Campinas, Campinas, São Paulo, Brazil
| | - Fernando F Costa
- Hematology and Hemotherapy Center, State University of Campinas, Campinas, São Paulo, Brazil
| | | | - Marcos André C Bezerra
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Jäger M, Busch A, Sowislok A. Bioactivation of scaffolds in osteonecrosis. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:808-814. [PMID: 36074165 DOI: 10.1007/s00132-022-04303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Avascular osteonecrosis (AVN) due to local ischemia leads to an inhomogeneous osseous defect, which can be treated by resection and with bone substitute materials in a joint-preserving treatment. Due to the underlying risk profile of AVN, the mostly subchondral localization and the size of the local bone defect, bone regeneration is impaired. Therefore, bioactivation of the applied bone substitute materials prior to application is highly desirable. Apart from the use of growth factors and other soluble substances, the autologous application of location-typical cells and tissue is a useful alternative to support the bone healing properties of scaffolds. This article presents various methods to activate scaffolds for bone stimulation and discusses these techniques with respect to recent data from the literature.
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Affiliation(s)
- M Jäger
- Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany.
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. Ruhr, Germany.
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Katholisches Klinikum Essen Philippus, Essen, Germany.
| | - A Busch
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Katholisches Klinikum Essen Philippus, Essen, Germany
| | - A Sowislok
- Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
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Tomaru Y, Yoshioka T, Sugaya H, Kumagai H, Aoto K, Wada H, Akaogi H, Yamazaki M, Mishima H. Comparison Between Concentrated Autologous Bone Marrow Aspirate Transplantation as a Hip Preserving Surgery and Natural Course in Idiopathic Osteonecrosis of the Femoral Head. Cureus 2022; 14:e24658. [PMID: 35663701 PMCID: PMC9157266 DOI: 10.7759/cureus.24658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose is to compare the therapeutic efficacy of concentrated autologous bone marrow aspirate transplantation (CABMAT) with that of observation alone for osteonecrosis of the femoral head (ONFH). Methods This single-center study included patients with idiopathic ONFH that were either treated with CABMAT (CABMAT group) or managed through observation alone (observation group) over a >2-year follow-up period. The Japanese Investigation Committee classification was used to diagnose and classify ONFH. The collapse rates for stages 1 and 2 ONFH (i.e., pre-collapse stages) and the THA conversion rates were compared between the CABMAT and observation groups. Results The CABMAT and observation groups comprised 232 (mean follow-up: 8.2 years) and 106 (mean follow-up: 6.0 years) patients, respectively. No significant intergroup differences were noted in the stages, types, and associated factors of ONFH. The collapse rates for pre-collapse stages in the CABMAT and observation groups were 67.1% and 65.3%, respectively. For stage 1, the collapse rates were significantly lower in the observation group than in the CABMAT group (p<0.05). The overall THA conversion rates in the CABMAT and observation groups were 24.3% and 41.5%, respectively (p<0.0001). For ONFH of stages 3A and 3B (collapse stages), the THA conversion rates were significantly lower in the CABMAT group (p<0.05). Conclusion Collapse rates were significantly higher for stage 1 ONFH; for collapse stages, the THA conversion rates were significantly lower in the CABMAT group than in the observation group. Therefore, observation and CABMAT are recommended for ONFH of stage 1 and for ONFH of higher stages, respectively.
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Affiliation(s)
- Yohei Tomaru
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
- Department of Orthopedic Surgery, Chiba Child and Adult Orthopedic Clinic, Chiba, JPN
| | - Tomokazu Yoshioka
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Hisashi Sugaya
- Department of Orthopedic Surgery, Tsukuba University of Technology, Tsukuba, JPN
| | - Hiroshi Kumagai
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Katsuya Aoto
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Hiroshi Wada
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Hiroshi Akaogi
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Hajime Mishima
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
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Leandro MP, Almeida ND, Hocevar LS, Sá CKCD, Souza AJD, Matos MA. Polimorfismos e necrose avascular em pacientes com doença falciforme – Uma revisão sistemática. REVISTA PAULISTA DE PEDIATRIA 2022. [DOI: 10.1590/1984-0462/2022/40/2021013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo Objetivo: Estabelecer, de modo sistemático, se existe associação entre polimorfismos e a necrose avascular em pacientes com doença falciforme. Fontes de dados: A revisão, conduzida segundo as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) e registrada no International Prospective Register of Systematic Reviews (PROSPERO), foi baseada na busca de estudos nas bases de dados PubMed, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Virtual em Saúde (BVS) e na literatura cinza (Google Scholar e Open Gray) até junho de 2020. A análise da qualidade dos artigos foi baseada nos critérios do Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Síntese dos dados: Dez artigos foram selecionados nas bases de dados e dois incluídos por meio da busca manual, totalizando 12 estudos elencados. As amostras resultaram em 2.362 pacientes incluídos. Com base na iniciativa STROBE, sete estudos atenderam total e/ou parcialmente mais de 70% dos itens essenciais e dois atingiram menos que 60% deles, com variação geral de 86,4–54,5%. Os resultados mostram que os polimorfismos nos genes da proteína morfogenética óssea 6 (BMP6), da Klotho (KL) e da Anexina A2 (ANXA2) podem ter associação com osteonecrose no contexto da doença falciforme. Seis artigos estudaram o polimorfismo no gene da enzima MTHFR, mas apenas um obteve associação positiva. Os polimorfismos associados ao receptor DARC, ao gene ITGA4, ao CD36 e aos genes de proteínas trombofílicas não demonstraram associação em nenhum dos estudos. Conclusões: Os polimorfismos nos genes BMP6, KL e ANXA2 estão possivelmente associados com a necrose avascular em indivíduos com doença falciforme. Entretanto, para a confirmação dessas alterações genéticas como fatores de risco, é necessário que mais estudos com maior poder estatístico e com maior rigor metodológico sejam realizados.
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Leandro MP, Almeida ND, Hocevar LS, Sá CKCD, Souza AJD, Matos MA. Polymorphisms and avascular necrosis in patients with sickle cell disease – A systematic review. REVISTA PAULISTA DE PEDIATRIA 2022; 40:e2021013. [PMID: 35584416 PMCID: PMC9113627 DOI: 10.1590/1984-0462/2022/40/2021013in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
Objective: To systematically establish whether there is an association between polymorphisms and avascular necrosis in patients with sickle cell disease. Data source: The review, conducted according to PRISMA guidelines and registered with PROSPERO, was based on research of studies in PubMed, SciELO, LILACS, BVS databases and in the gray literature (Google Scholar and Open Gray) published until June 2020. The STROBE initiative was used to analyze the articles’ quality. Data synthesis: Ten articles were selected from the databases and two were included through manual search, totaling 12 studies. All samples gathered 2,362 patients. According to STROBE, seven studies fully and/or partially covered more than 70% of the essential items and two studies reached less than 60%, with an overall variation of 86.4–54.5%. The results indicate that polymorphisms in the genes of the bone morphogenetic protein 6 (BMP6), Klotho (KL) and Annexin A2 (ANXA2) may be associated with osteonecrosis in the context of sickle cell disease. Six articles addressed the polymorphism in the MTHFR enzyme gene, but only one found a positive association. Polymorphisms associated with the DARC receptor, the ITGA4 gene, CD36 and thrombophilia protein genes were not associated in any of the studies. Conclusions: The results indicate that the polymorphisms in BMP6, Klotho and ANXA2 genes may be associated with avascular necrosis in patients with sickle cell disease. However, in order to confirm these genetic changes as risk factors, further studies with greater statistical power and methodological rigor are needed.
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林 苗, 杨 继, 闫 文, 胡 宁, 刘 子, 张 莉, 李 豫. [Research progress of tissue engineering technology in promoting revascularization of necrotic femoral bone tissue]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1479-1485. [PMID: 34779177 PMCID: PMC8586766 DOI: 10.7507/1002-1892.202105047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/19/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the research progress of tissue engineering technology to promote bone tissue revascularization in osteonecrosis of the femoral head (ONFH). METHODS The relevant domestic and foreign literature in recent years was extensively reviewed. The mechanism of femoral head vascularization and the application progress of tissue engineering technology in the promotion of ONFH bone tissue revascularization were summarized. RESULTS Rebuilding or improving the blood supply of the femoral head is the key to the treatment of ONFH. Tissue engineering is a hot spot in current research. It mainly focuses on the three elements of seed cells, scaffold materials, and angiogenic growth factors, combined with three-dimensional printing technology and drug delivery systems to promote the revascularization of the femoral bone tissue. CONCLUSION The strategy of revascularization of the femoral head can improve the local blood supply and delay or even reverse the progression of ONFH disease.
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Affiliation(s)
- 苗远 林
- 遵义医科大学附属医院(贵州遵义 563000)Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 继滨 杨
- 遵义医科大学附属医院(贵州遵义 563000)Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 文强 闫
- 遵义医科大学附属医院(贵州遵义 563000)Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 宁 胡
- 遵义医科大学附属医院(贵州遵义 563000)Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 子铭 刘
- 遵义医科大学附属医院(贵州遵义 563000)Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 莉 张
- 遵义医科大学附属医院(贵州遵义 563000)Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 豫皖 李
- 遵义医科大学附属医院(贵州遵义 563000)Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
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Dailiana ZH, Stefanou N, Khaldi L, Dimakopoulos G, Bowers JR, Fink C, Urbaniak JR. Vascular endothelial growth factor for the treatment of femoral head osteonecrosis: An experimental study in canines. World J Orthop 2018; 9:120-129. [PMID: 30254968 PMCID: PMC6153136 DOI: 10.5312/wjo.v9.i9.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the treatment of osteonecrosis of the femoral head (ONFH) with the use of vascular endothelial growth factor (VEGF).
METHODS In 30 mature beagles (6 groups of 5 beagles) ONFH was induced cryosurgically and one of the following solutions was administered locally in the femoral head (FH) in each group: Single injection of 500 μg VEGF (t-VEGFμ group); single injection of 500 ng VEGF (t-VEGFn group); continuous delivery of 500 μg VEGF through osmotic micropump (t-VEGFpump-μ group); continuous delivery of 500 ng VEGF through osmotic micropump (t-VEGFpump-n group); single injection of 0.9% sodium chloride (t-NS group), while one group that served as control group did not receive any local solution (No-t group). FHs were retrieved 12 wk postoperatively, underwent decalcification and hematoxylin/eosin and toluidine blue staining. In two canines per group, one half of FH was processed without decalcification and stained with modified Masson Trichrome. Histological sections were observed by light microscopy and measured with a semi-automatized bone histomorphometry system and Bone Volume/Total Volume (BV/TV), Marrow Volume/Total Volume (MaV/TV), and Trabecular Thickness (TbTh) were assessed. Standard and robust tests (Welch, Brown Forsythe) of analysis of variance along with multiple comparisons, were carried out among the categories.
RESULTS The untreated (No-t) group had signs of osteonecrosis, whereas the VEGF groups revealed reversal of the osteonecrosis. Statistical analysis of the decalcified specimens revealed a significantly better BV/TV ratio and a higher TbTh between the VEGF treatment groups (except the t-VEGFn group) and the No-t group or the control t-NS group. Single dose 500 μgVEGF group had significantly better BV/TV ratio and higher TbTh when compared to the No-t group (50.45 ± 6.18 vs 29.50 ± 12.27, P = 0.002 and 151.44 ± 19.07 vs 107.77 ± 35.15, P = 0.161 respectively) and the control t-NS group (50.45 ± 6.18 vs 30.9 ± 6.67, P = 0.004 and 151.44 ± 19.07 vs 107.14 ± 35.71, P = 0.151 respectively). Similar differences were found for the prolonged VEGF delivery/pump groups of 500 μg and 500 ng. Analysis of the totality of specimens (decalcified/non-decalcified) enhanced the aforementioned differences and additionally revealed significant differences in the comparison of the TbTh.
CONCLUSION In an experimental model of ONFH in canines it was found that local treatment with VEGF leads to bone tissue remodeling and new bone formation.
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Affiliation(s)
- Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, Larissa 41500, Greece
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, Larissa 41500, Greece
| | - Lubna Khaldi
- Department of Pathology, “Saint Savvas” Anti-Cancer Hospital, Athens 11522, Greece
| | - Georgios Dimakopoulos
- Medical Statistics, Epirus Science and Technology Park Campus of the University of Ioannina, Ioannina 45500, Greece
| | - James R Bowers
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, United States
- Emerge Ortho, Independence Park, Durham, NC 27704, United States
| | - Cristian Fink
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, United States
- Gelenkpunkt, Sports and Joint Surgery, Innsbruck 6020, Austria
- Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Tirol 6060, Austria
| | - James R Urbaniak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, United States
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Evaluation of BMP-2 Enhances the Osteoblast Differentiation of Human Amnion Mesenchymal Stem Cells Seeded on Nano-Hydroxyapatite/Collagen/Poly(l-Lactide). Int J Mol Sci 2018; 19:ijms19082171. [PMID: 30044394 PMCID: PMC6122075 DOI: 10.3390/ijms19082171] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/22/2023] Open
Abstract
Background: The aim of this study is to evaluate the effects of recombinant human bone morphogenetic protein 2 (rhBMP-2), human amnion mesenchymal stem cells (hAMSCs), and nanohydroxyapatite/collagen/poly(l-lactide) (nHAC/PLA) in tissue engineering to provide potential approaches for periodontal bone regeneration. Methods: hAMSCs were isolated from discarded amniotic membrane samples and cultured in vitro. Alkaline phosphatase (ALP) staining and alizarin red staining were performed to evaluate the osteoblast (OB) differentiation ability of hAMSCs. Three groups were divided: the experimental group (cells transfected with pcDNA3.1-rhBMP-2), the blank group (cells without gene transfection), and the control group (cells transfected with empty plasmid). RT-PCR and western blot were used to examine whether rhBMP-2 has been successfully expressed. 3-(4,5)-dimethylthiahiazol(-z-y1)-3,5-di-phenytetrazo-liumromide assay (MTT) was done to detect the effect of rhBMP-2 on hAMSCs seeded on nHAC/PLA. ALP activity, mineral formation assay, calcium, phosphate and osteocalcin (OCN) content, and OCN and RUNX2 expression of hAMSCs were detected to evaluate osteogenic differentiation capability of rhBMP-2 on hAMSCs seeded on nHAC/PLA. Results: hAMSCs exhibited intense ALP staining, obvious calcium deposition, and mineralization nodules, and rhBMP-2 were highly expressed in the experimental group. The proliferation of the hAMSCs with rhBMP-2 on nHAC/PLA was significantly higher than the cells without rhBMP-2, and the cells all increased in a time-dependent manner. rhBMP-2 significantly increased the OCN and phosphate content, mineral formation, ALP activity, osteogenic biomarkers OCN, and Runx2, and decreased calcium content in hAMSCs seeded on the nHAC/PLA scaffold. Conclusions: This finding demonstrated that hAMSCs has an ideal OB differentiation ability. rhBMP-2 facilitates the proliferation and osteogenesis of hAMSCs. The nHAC/PLA could act as a good scaffold for hAMSCs seeding, proliferation, and osteogenic differentiation. The application of rhBMP-2, nHAC/PLA, and hAMSCs in tissue engineering may offer promising possibilities for periodontal bone regeneration.
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Liu LH, Zhang QY, Sun W, Li ZR, Gao FQ. Corticosteroid-induced Osteonecrosis of the Femoral Head: Detection, Diagnosis, and Treatment in Earlier Stages. Chin Med J (Engl) 2018; 130:2601-2607. [PMID: 29067959 PMCID: PMC5678261 DOI: 10.4103/0366-6999.217094] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: This review aimed to provide a current recommendation to multidisciplinary physicians for early detection, diagnosis, and treatment of corticosteroid-induced osteonecrosis of the femoral head (ONFH) based on a comprehensive analysis of the clinical literature. Data Sources: For the purpose of collecting potentially eligible articles, we searched for articles in the PubMed, Cochrane Library, Embase, and CNKI databases up to February 2017, using the following key words: “corticosteroid”, “osteonecrosis of the femoral head”, “risk factors”, “diagnosis”, “prognosis”, and “treatment”. Study Selection: Articles on relationships between corticosteroid and ONFH were selected for this review. Articles on the diagnosis, prognosis, and intervention of earlier-stage ONFH were also reviewed. Results: The incidence of corticosteroid-induced ONFH was associated with high doses of corticosteroids, and underlying diseases in certain predisposed individuals mainly occurred in the first 3 months of corticosteroid prescription. The enhanced awareness and minimized exposure to the established risk factors and earlier definitive diagnosis are essential for the success of joint preservation. When following up patients with ONFH, treatment should be started if necessary. Surgical treatment yielded better results than conservative therapy in earlier-stage ONFH. The ideal purpose of earlier intervention and treatment is permanent preservation of the femoral head without physical restrictions in daily living. Conclusions: Clinicians should enhance their precaution awareness of corticosteroid-induced ONFH. For high-risk patients, regular follow-up is very important in the 1st year after high-dose prescription of corticosteroids. Patients with suspected ONFH should be referred to orthopedists for diagnosis and treatment in its earlier stage to preserve the joint.
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Affiliation(s)
- Li-Hua Liu
- Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Beijing 100029, China
| | - Qing-Yu Zhang
- Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Beijing 100029, China
| | - Wei Sun
- Department of Orthopaedic Surgery, Centre for Osteonecrosis and Joint Preserving and Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zi-Rong Li
- Department of Orthopaedic Surgery, Centre for Osteonecrosis and Joint Preserving and Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fu-Qiang Gao
- Department of Orthopaedic Surgery, Centre for Osteonecrosis and Joint Preserving and Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
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Effects of rhBMP-2 gene transfection to periodontal ligament cells on osteogenesis. Biosci Rep 2017; 37:BSR20160585. [PMID: 28396514 PMCID: PMC5484033 DOI: 10.1042/bsr20160585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 01/09/2023] Open
Abstract
The present study aims to investigate the effect of recombinant human bone
morphogenetic protein-2 (rhBMP-2) on the osteogenesis of periodontal ligament (PDL)
cells. The expression vector of rhBMP-2 (pcDNA3.1-rhBMP-2) was established. PDL cells
were obtained through the enzymatic digestion and tissue explant methods and verified
by immunohistochemistry. Cells were classified into experimental (cells transfected
with pcDNA3.1/rhBMP-2-EGFP), blank (cells with no transfection) and control
group (cells transfected with empty plasmid). rhBMP-2 expression was assessed via
Western blotting analysis. The mineralization ability, alkaline phosphatase (ALP)
activity and level of related osteogenic biomarkers were detected to evaluate the
osteogenic characteristics of PDL cells. The rhBMP-2 expression vector
(pcDNA3.1-rhBMP-2) was successfully established. Primary PDL cells displayed a star
or long, spindle shape. The cultured cells were long, spindle-shaped, had a plump
cell body and homogeneous cytoplasm and the ellipse nucleus contained two or three
nucleoli. Cells displayed a radial, sheaf-like or eddy-like arrangement after
adherence growth. Immunohistochemical staining confirmed that cells originated from
mesenchymal opposed to epithelium. The experimental group exhibited an enhanced
mineralization ability, higher ALP activity and increased expression of rhBMP-2 and
osteogenic biomarkers (Runx2, collagen type I and osteocalcin) than the blank and
control group. The present study demonstrated that rhBMP-2 transfection enhances the
osteogenesis of PDL cells and provides a possibility for the application of rhBMP-2
expression products in dental disease treatment.
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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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Hou X, Jiang Y, Wang N, Shen Y, Wang X, Zhong Y, Xu P, Zhou L. The Combined Effect of Ear Lobe Crease and Conventional Risk Factor in the Diagnosis of Angiographically Diagnosed Coronary Artery Disease and the Short-Term Prognosis in Patients Who Underwent Coronary Stents. Medicine (Baltimore) 2015; 94:e815. [PMID: 26131833 PMCID: PMC4504544 DOI: 10.1097/md.0000000000000815] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The role of diagonal ear lobe crease (DELC) in coronary artery disease (CAD) diagnosis and prognosis remains controversial. In this study, we aimed to assess the combined effect of DELC with other conventional risk factors in the diagnosis and prognosis of CAD in Chinese patients who underwent angiography and coronary stent implantation.The study consisted of 956 consecutive patients who underwent angiography. The DELC was identified as no DELC, unilateral, and bilateral DELC. The conventional risk factors for CAD were recorded.Our dada showed that the overall presence of DELC is associated with CAD risk. Stratification analyses revealed that the diagnostic value of DELC was mostly significant in those with >4 risk factors. Also in patients with >4 risk factors, the presence of bilateral DELC remains to be associated with higher hs-CRP level, higher severity of CAD, and higher possibility of developing major adverse cardiac events after successful percutaneous coronary intervention (PCI).Our study confirmed the relation of DELC with CAD in Chinese patients; more importantly, our data suggest the combination of DELC and CAD risk factors will help to predict the incidence of CAD and may predict the prognosis after successfully PCI.
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Affiliation(s)
- Xuwei Hou
- From the Department of Cardiology, Hangzhou First Municipal Hospital & Hangzhou Hospital, Nanjing Medical University, Hangzhou (XH, NW, YS, XW, YZ, PX, LZ); Department of Cardiology, Second hospital of Nanchang University, Nanchang, Jiangxi, China (YJ)
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Wang J, Kalhor A, Lu S, Crawford R, Ni JD, Xiao Y. iNOS expression and osteocyte apoptosis in idiopathic, non-traumatic osteonecrosis. Acta Orthop 2015; 86:134-41. [PMID: 25191931 PMCID: PMC4366673 DOI: 10.3109/17453674.2014.960997] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 07/07/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Non-traumatic osteonecrosis is a progressive disease with multiple etiologies. It affects younger individuals more and more, often leading to total hip arthroplasty. We investigated whether there is a correlation between inducible nitric oxide synthase (iNOS) expression and osteocyte apoptosis in non-traumatic osteonecrosis. PATIENTS AND METHODS We collected and studied 20 human idiopathic, non-traumatic osteonecrosis femoral heads. Subchondral bone samples in the non-sclerotic region (n = 30), collected from osteoarthritis patients, were used as controls. Spontaneously hypertensive rats were used as a model for osteonecrosis in the study. We used scanning electron microscopy, TUNEL assay, and immunohistochemical staining to study osteocyte changes and apoptosis. RESULTS The morphology of osteocytes in the areas close to the necrotic region changed and the number of apoptotic osteocytes increased in comparison with the same region in control groups. The expression of iNOS and cytochrome C in osteocytes increased while Bax expression was not detectable in osteonecrosis samples. Using spontaneously hypertensive rats, we found a positive correlation between iNOS expression and osteocyte apoptosis in the osteonecrotic region. iNOS inhibitor (aminoguanidine) added to the drinking water for 5 weeks reduced the production of iNOS and osteonecrosis compared to a control group without aminoguanidine. INTERPRETATION Our findings show that increased iNOS expression can lead to osteocyte apopotosis in idiopathic, non-traumatic osteonecrosis and that an iNOS inhibitor may prevent the progression of the disease.
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Affiliation(s)
- Jun Wang
- Department of Orthopedics , the Second Xiangya Hospital, Central South University, Changsha, Hunan Province , China
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Samara S, Dailiana Z, Chassanidis C, Koromila T, Papatheodorou L, Malizos KN, Kollia P. Expression profile of osteoprotegerin, RANK and RANKL genes in the femoral head of patients with avascular necrosis. Exp Mol Pathol 2014; 96:9-14. [DOI: 10.1016/j.yexmp.2013.10.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 08/22/2013] [Accepted: 10/25/2013] [Indexed: 11/26/2022]
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