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Spielman AF, Griffin MF, Titan AL, Guardino N, Cotterell AC, Akras D, Wan DC, Longaker MT. Reduction of Tendon Fibrosis Using Galectin-3 Inhibitors. Plast Reconstr Surg 2024; 154:113-121. [PMID: 37344932 DOI: 10.1097/prs.0000000000010880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Fibrosis is a complication of both tendon injuries and repairs. The authors aimed to develop a mouse model to assess tendon fibrosis and to identify an antifibrotic agent capable of overcoming it. METHODS The Achilles tendon of adult C57Bl/6 mice was exposed via skin incision, followed by 50% tendon injury and abrasion with sandpaper. Sham operations were conducted on contralateral hindlimbs. Histologic analyses and immunofluorescent staining for fibrotic markers (collagen type 1 [ Col1 ], α-smooth muscle actin [ α-SMA ]) were used to confirm that the model induced tendon fibrosis. A second experiment further examined the role of α-SMA in adhesion formation using α-SMA.mTmG mice (6 to 8 weeks old; n = 3) with the same injury model. Lastly, α-SMA.mTmG mice were randomized to either condition 1 (tendon injury [control group]) or condition 2 (tendon injury with galectin-3 inhibitor [Gal3i] treatment at time of injury [treatment group]). RESULTS Histologic analyses confirmed tendon thickening and collagen deposition after tendon injury and abrasion compared with control. Immunofluorescence showed higher levels of Col1 and α-SMA protein expression after injury compared with sham ( P < 0.05). Real-time quantitative polymerase chain reaction also demonstrated increased gene expression of Col1 and α-SMA after injury compared with sham ( P < 0.05). Gal3 protein expression also increased after injury and colocalized with α-SMA+ fibroblasts surrounding the fibrotic tendon. Gal3i treatment decreased collagen deposition and scarring observed in the treatment group ( P < 0.05). CONCLUSIONS The authors' study provides a reproducible and reliable model to investigate tendon fibrosis. Findings suggest the potential of Gal3i to overcome fibrosis resulting from tendon injuries. CLINICAL RELEVANCE STATEMENT Tendon injuries are common presentations to hand surgeons. Complications include adhesion formation, which results in reduced strength and frequent reinjury. Advancements in management require a better understanding of the mechanisms behind tendon fibrosis in order to identify ways to overcome it.
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Affiliation(s)
- Amanda F Spielman
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Michelle F Griffin
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Ashley L Titan
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Nicholas Guardino
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Asha C Cotterell
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Deena Akras
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Derrick C Wan
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Michael T Longaker
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
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Daghan B, Cinar F, Yalcin CE, Aydin SY, Acun O, Celik U, Baghaki S, Turkmen A. Morphological, histological and biomechanical comparison of bone marrow aspirate concentrate, micro-fragmented adipose tissue and platelet-rich plasma in prevention of tendon adhesion. J Plast Reconstr Aesthet Surg 2023; 87:1-9. [PMID: 37802016 DOI: 10.1016/j.bjps.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Flexor tendon repair often leads to peritendinous adhesions, reducing finger motion and hand function. This study compares the effects of stromal cells from different sources and platelet-rich plasma (PRP) on adhesion formation after tendon repair. METHODS Forty rabbits had their flexor digitorum profundus tendons transected and repaired with a modified Kessler suture technique. The control group received an isotonic solution. PRP, bone marrow aspirate concentrate (BMAC), and micro-fragmented adipose tissue (MFAT) were injected in groups 2, 3, and 4, respectively. Rabbits wore casts for 2 weeks. Assessments included morphology, histopathology, range of motion (ROM), and biomechanical testing at the 3rd and 8th weeks. RESULTS At 3 weeks, the BMAC group had the thickest and longest adhesions, the highest Tang Score, and inflammation score. However, at 8 weeks, the BMAC group had the lowest Tang Score and inflammation score. ROM was higher in the PRP group at 3 weeks and BMAC group at 8 weeks. No significant differences were found between BMAC and MFAT groups in adhesion measurements. Biomechanical parameters were higher in BMAC and MFAT groups at 8 weeks compared to control. CONCLUSION BMAC therapy after primary flexor tendon repair improves adhesion formation and maintains ROM. It also enhances the biomechanical properties of the flexor tendon during the later stages of healing.
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Affiliation(s)
- Basak Daghan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Burdur State Hospital, Burdur, Turkey
| | - Fatih Cinar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Can Ege Yalcin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey.
| | - Servet Yekta Aydin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Osman Acun
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ugur Celik
- Department of Plastic, Reconstructive and Aesthetic Surgery, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Semih Baghaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, School of Medicine, Koç University, Istanbul, Turkey
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Chen CH, Chen SH, Chen SH, Chuang ADC, T G D, Chen JP. Hyaluronic acid/platelet rich plasma-infused core-shell nanofiber membrane to prevent postoperative tendon adhesion and promote tendon healing. Int J Biol Macromol 2023; 231:123312. [PMID: 36669628 DOI: 10.1016/j.ijbiomac.2023.123312] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
An anti-adhesive barrier membrane incorporating hyaluronic acid (HA) can reduce fibroblasts attachment and impart lubrication effect for smooth tendon gliding during management of post-surgical tendon adhesion. On the other hand, as numerous growth factors are required during tendon recovery, growth factors released by platelets in platelet-rich plasma (PRP) can provide beneficial therapeutic effects to facilitate tendon recovery post tendon injury. Furthermore, PRP is reported to be associated with anti-inflammatory properties for suppressing postoperative adhesion. Toward this end, we fabricate core-shell nanofiber membranes (NFM) with HA/PRP-infused core and polycaprolactone shell in this study. Different NFM with 100 % (H-P), 75 % (HP31-P), 50 % (HP11-P) and 25 % (H31-P) HA in the core was fabricated through coaxial electrospinning and analyzed through microscopic, pore size, mechanical, as well as HA and growth factor release studies. In vitro study with fibroblasts indicates the NFM can act as a barrier to prevent cell penetration and reduce cell attachment/focal adhesion, in addition to promoting tenocyte migration in tendon healing. In vivo studies in a rabbit flexor tendon rupture model indicates the HP11-P NFM shows improved efficacy over H-P NFM and control in reducing tendon adhesion formation and inflammation, while promoting tendon healing, from functional assays and histological analysis.
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Affiliation(s)
- Chih-Hao Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung 20401, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Kwei-San, Taoyuan 33305, Taiwan
| | - Shih-Hsien Chen
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan
| | - Shih-Heng Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Kwei-San, Taoyuan 33305, Taiwan
| | - Andy Deng-Chi Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung 20401, Taiwan
| | - Darshan T G
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan
| | - Jyh-Ping Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Kwei-San, Taoyuan 33305, Taiwan; Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Kwei-San, Taoyuan 33305, Taiwan; Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33302, Taiwan; Department of Materials Engineering, Ming Chi University of Technology, Tai-Shan, New Taipei City 24301, Taiwan.
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Gökkaya A, Görgü M, Kızılkan J, Karanfil E, Doğan A. The measurement of wound tensile strength and the effect of PRP on wound tensile force: an experimental investigation on rabbits. J Plast Surg Hand Surg 2021; 56:38-46. [PMID: 34106813 DOI: 10.1080/2000656x.2021.1914637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Platelets in PRP are used for their functions in the initiation and regulation of the wound healing process and are used for the repair of injured tissues and the rejuvenation of healthy tissues. In this study, we evaluated the effect of a single dose platelet-rich plasma on skin wound healing and we demonstrated the effect of platelet-rich plasma on skin wound healing by measuring changes in the wound tensile strength.Material and methods: A total of 8 incisions, each 3 cm long, were made on the back skin on both sides of the vertebral column of 12 rabbits. After suturing their backs with staples, platelet rich plasma (PRP) was injected into the edges of the wounds on the left side and saline solution (saline) was injected into the edges of the wounds on the right side. The tensile force that causes wounds to rupture by applying tension was measured on the 7th, 14th, 21st, and 28th days with the help of a special home-designed device.Results: The mean PRP enrichment was 3.19 fold over peripheral blood. The saline to PRP tensile strength ratios on the 7th, 14th, 21st, and 28th days were calculated as 75.7%, 104.0%, 105.3% and 86.5%, respectively. Overall, the difference in the tensile strength for wounds that had received saline or PRP was in-significant.Conclusion: The application of PRP increases the tensile strength of the wound in the early period. It is possible to measure the tensile strength precisely in in vivo studies with economical home-designed devices.
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Affiliation(s)
- Ali Gökkaya
- Department of Plastic, Reconstructive and Aesthetic Surgery, Abant Izzet Baysal University, Bolu, Turkey
| | - Metin Görgü
- Department of Plastic, Reconstructive and Aesthetic Surgery, Abant Izzet Baysal University, Bolu, Turkey
| | - Jehat Kızılkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Abant Izzet Baysal University, Bolu, Turkey
| | - Ertuğrul Karanfil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Abant Izzet Baysal University, Bolu, Turkey
| | - Ali Doğan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Abant Izzet Baysal University, Bolu, Turkey
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Orthobiologics in Hand Surgery. J Hand Surg Am 2021; 46:409-415. [PMID: 33958102 DOI: 10.1016/j.jhsa.2021.01.006] [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: 08/11/2020] [Revised: 11/11/2020] [Accepted: 01/14/2021] [Indexed: 02/02/2023]
Abstract
Orthobiologic agents are used as innovative adjuvant therapy to treat common upper-extremity pathology, including carpal tunnel syndrome, de Quervain tenosynovitis, and distal radius fractures. In this article, we perform a narrative review and evaluate current literature on orthobiologics in the upper extremity. Orthobiologics evaluated include bone morphogenetic proteins, platelet-rich plasma, bone marrow aspirate concentrate, mesenchymal stem cells, and amniotic membrane. Studies selected include randomized control trials, case studies, and animal studies. Although there is some clinical evidence regarding the use of orthobiologic agents in the treatment of shoulder, elbow, and sports injuries, there is a paucity of literature regarding their use to treat pathology of the hand and wrist. Further investigation is necessary to determine their effectiveness and therapeutic value in treatment of upper extremity injuries.
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Trull-Ahuir C, Sala D, Chismol-Abad J, Vila-Caballer M, Lisón JF. Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial. Sci Rep 2020; 10:2085. [PMID: 32034241 PMCID: PMC7005701 DOI: 10.1038/s41598-020-59113-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/24/2020] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study is to evaluate the efficiency of local platelet-rich plasma (PRP) injection as an adjuvant treatment after carpal ligament release. We conducted a prospective randomized, triple-blinded, controlled trial. Fifty participants with mild to extreme carpal tunnel syndrome (CTS) were randomly assigned either to the PRP (n = 25) or the platelet-poor plasma (PPP, n = 25) group. After performing open surgical release of the carpal ligament, the inside of the carpal tunnel was irrigated with 3 mL of PRP or PPP according to each participant’s group allocation. The primary outcome was hand grip strength (HGS). Secondary outcomes were the time taken off work after surgery (in days) and scores on the Wong–Baker Faces Scale, Boston Carpal Tunnel Questionnaire, and Southampton Wound Assessment Scale. We evaluated patients before treatment and at 6-weeks. As expected, the pain levels, symptom severity, and functional status improved in all the patients after surgery. However, intragroup analysis revealed that only the participants in the PRP group had regained their pre-operative HGS levels at 6-weeks follow-up. These findings indicate that PRP is an effective adjuvant treatment in patients with mild to severe CTS who require surgery.
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Affiliation(s)
- Carmen Trull-Ahuir
- Department of Nursing, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Diego Sala
- Department of Orthopedic Surgery and Traumatology, Umivale MATEPSSN.15, Valencia, Spain
| | - Joaquín Chismol-Abad
- Department of Orthopedic Surgery and Traumatology, Umivale MATEPSSN.15, Valencia, Spain
| | - Marian Vila-Caballer
- Department of Biomedical Sciences, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.
| | - Juan Francisco Lisón
- Department of Medicine, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain. .,Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03 Carlos III Health Institute, Valencia, Spain.
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Implications of anticoagulants and gender on cell counts and growth factor concentration in platelet-rich plasma and platelet-rich gel supernatants from rabbits. Vet Comp Orthop Traumatol 2017; 29:115-24. [DOI: 10.3415/vcot-15-01-0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 10/18/2015] [Indexed: 11/17/2022]
Abstract
SummaryObjectives: Our objectives were as follows: 1) to validate a protocol for producing rabbit platelet-rich plasma (PRP); 2) to determine the influence of two anticoagulants, sodium citrate and acid-citrate-dextrose solution A, and gender on cell count in PRP and growth factor concentration in pure platelet-rich gel supernatants; 3) to correlate the variables evaluated.Methods: Whole blood from 18 New Zealand rabbits (9 males and 9 females) was obtained with sodium citrate and acid- citrate-dextrose solution A for processing PRP fractions (A and B), which were evaluated for haematology. The PRP fractions were either activated with calcium gluconate or lysated with a detergent. The concentrations of transforming growth factor beta 1 and platelet-derived growth factor BB were assayed by ELISA.Results: The sodium citrate PRP-B had significantly higher counts of platelets in comparison to PRP-A and whole blood obtained with the same anticoagulant and the homologous acid-citrate-dextrose solution A PRP fraction. The sodium citrate PRP-A had a significantly higher count of leukocytes compared to the homologous acid-citrate-dextrose solution A fraction. All the PRP fractions had a significant leuko-reduction when compared to whole blood. The sodium citrate PRP-A fraction from female rabbits had significantly lower platelet counts and significantly higher leukocyte counts than the same acid-citrate-dextrose solution A fraction. Growth factor concentration was not affected by the type of anticoagulant or gender.Clinical significance: The type of anticoagulant and gender affected the cell counts in PRP, but they did not influence the growth factor concentration. More complete rabbit PRP studies should be performed before evaluating this type of substance in models of disease.
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Abstract
Tendons connect muscles to bones, ensuring joint movement. With advanced age, tendons become more prone to degeneration followed by injuries. Tendon repair often requires lengthy periods of rehabilitation, especially in elderly patients. Existing medical and surgical treatments often fail to regain full tendon function. The development of novel treatment methods has been hampered due to limited understanding of basic tendon biology. Recently, it was discovered that tendons, similar to other mesenchymal tissues, contain tendon stem/progenitor cells (TSPCs) which possess the common stem cell properties. The current strategies for enhancing tendon repair consist mainly of applying stem cells, growth factors, natural and artificial biomaterials alone or in combination. In this review, we summarise the basic biology of tendon tissues and provide an update on the latest repair proposals for tendon tears.
Cite this article: EFORT Open Rev 2017;2:332-342. DOI: 10.1302/2058-5241.2.160075
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Affiliation(s)
- Fan Wu
- Experimental Surgery and Regenerative Medicine, Department of Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Regensburg Medical Center, Regensburg, Germany
| | - Denitsa Docheva
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Center, Regensburg, Germany and Department of Medical Biology, Medical University-Plovdiv, Plovdiv, Bulgaria
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Abstract
Orthobiologics are not used as frequently in the hand and wrist as in other sites. The most frequently reported is the use of bone morphogenetic protein for the treatment of Kienböck disease. Animal studies have described improved tendon healing with the use of platelet-rich plasma (PRP), but no clinical studies have confirmed these results. PRP has been reported to produce improvements in the outcomes of distal radial fractures and osteoarthritis of the trapeziometacarpal in small numbers of patients. The use of orthobiologics in the hand and wrist are promising, but clinical trials are necessary to establish efficacy and safety.
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Abstract
Flexor tendon injury is the most commonly seen hand injury. Tendons are the structures which enable the muscles to adhere to the bones and transmit the movement starting from the muscle to the bones. They have significant role in hand movement. As treatment method, surgical repair: (1) Primary repair, (2) Secondary repair; techniques are used. With the scientific studies conducted, flexor tendon morphology, kinematics, biomechanics, biological properties and tendon improvement became quite understandable, good suturing materials were developed and consequently successful studies regarding primary repair results were published. Flexor tendon surgery has reached its current level with the accumulation of knowledge obtained from the increased clinical and experimental studies. This study addresses flexor tendon injuries and surgical treatment methods. We achieved 76.12% full functioning fingers in the results; we obtained following the physical treatment application that started on the 10th day after primary repair that we performed in 67 patients who applied with acute flexor tendon Zone 1-2 and 3 incision. Flexion restriction and contracture developed in 16 patients (23.88%) at various levels. Scar softening and revision surgery for contracture excision was performed in 8 patients (11.94%) with Zone 2 injury due to contracture. Superficial skin infection developed in 21 patients (31.34%) and was treated. Revision surgery was performed in 6 patients with Zone 1 injury due to rupture occurred during rehabilitation.
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Geary MB, Orner CA, Bawany F, Awad HA, Hammert WC, O’Keefe RJ, Loiselle AE. Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair. PLoS One 2015; 10:e0136351. [PMID: 26312751 PMCID: PMC4552471 DOI: 10.1371/journal.pone.0136351] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/14/2015] [Indexed: 01/09/2023] Open
Abstract
Flexor tendon injuries are a common clinical problem, and repairs are frequently complicated by post-operative adhesions forming between the tendon and surrounding soft tissue. Prostaglandin E2 and the EP4 receptor have been implicated in this process following tendon injury; thus, we hypothesized that inhibiting EP4 after tendon injury would attenuate adhesion formation. A model of flexor tendon laceration and repair was utilized in C57BL/6J female mice to evaluate the effects of EP4 inhibition on adhesion formation and matrix deposition during flexor tendon repair. Systemic EP4 antagonist or vehicle control was given by intraperitoneal injection during the late proliferative phase of healing, and outcomes were analyzed for range of motion, biomechanics, histology, and genetic changes. Repairs treated with an EP4 antagonist demonstrated significant decreases in range of motion with increased resistance to gliding within the first three weeks after injury, suggesting greater adhesion formation. Histologic analysis of the repair site revealed a more robust granulation zone in the EP4 antagonist treated repairs, with early polarization for type III collagen by picrosirius red staining, findings consistent with functional outcomes. RT-PCR analysis demonstrated accelerated peaks in F4/80 and type III collagen (Col3a1) expression in the antagonist group, along with decreases in type I collagen (Col1a1). Mmp9 expression was significantly increased after discontinuing the antagonist, consistent with its role in mediating adhesion formation. Mmp2, which contributes to repair site remodeling, increases steadily between 10 and 28 days post-repair in the EP4 antagonist group, consistent with the increased matrix and granulation zones requiring remodeling in these repairs. These findings suggest that systemic EP4 antagonism leads to increased adhesion formation and matrix deposition during flexor tendon healing. Counter to our hypothesis that EP4 antagonism would improve the healing phenotype, these results highlight the complex role of EP4 signaling during tendon repair.
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Affiliation(s)
- Michael B. Geary
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York, United States of America
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, United States of America
| | - Caitlin A. Orner
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York, United States of America
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, United States of America
| | - Fatima Bawany
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York, United States of America
| | - Hani A. Awad
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York, United States of America
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, United States of America
| | - Warren C. Hammert
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York, United States of America
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, United States of America
| | - Regis J. O’Keefe
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York, United States of America
| | - Alayna E. Loiselle
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York, United States of America
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, United States of America
- * E-mail:
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Andarawis-Puri N, Flatow EL, Soslowsky LJ. Tendon basic science: Development, repair, regeneration, and healing. J Orthop Res 2015; 33:780-4. [PMID: 25764524 PMCID: PMC4427041 DOI: 10.1002/jor.22869] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/16/2015] [Indexed: 02/04/2023]
Abstract
Tendinopathy and tendon rupture are common and disabling musculoskeletal conditions. Despite the prevalence of these injuries, a limited number of investigators are conducting fundamental, basic science studies focused on understanding processes governing tendinopathies and tendon healing. Development of effective therapeutics is hindered by the lack of fundamental guiding data on the biology of tendon development, signal transduction, mechanotransduction, and basic mechanisms underlying tendon pathogenesis and healing. To propel much needed progress, the New Frontiers in Tendon Research Conference, co-sponsored by NIAMS/NIH, the Orthopaedic Research Society, and the Icahn School of Medicine at Mount Sinai, was held to promote exchange of ideas between tendon researchers and basic science experts from outside the tendon field. Discussed research areas that are underdeveloped and represent major hurdles to the progress of the field will be presented in this review. To address some of these outstanding questions, conference discussions and breakout sessions focused on six topic areas (Cell Biology and Mechanics, Functional Extracellular Matrix, Development, Mechano-biology, Scarless Healing, and Mechanisms of Injury and Repair), which are reviewed in this special issue and briefly presented in this review. Review articles in this special issue summarize the progress in the field and identify essential new research directions.
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Affiliation(s)
- Nelly Andarawis-Puri
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, New York 10029
| | - Evan L. Flatow
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, New York 10029
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
BACKGROUND The global time and effort attributed to improving outcomes in the management of flexor tendon injury are large, but the degree of advancement made over the past 50 years is relatively small. This review examines the current perceived wisdom in this field and aims to explore the limitations to the authors' understanding of the tendon healing process, examining how this may be a factor that has contributed to the authors' modest progress in the field. METHODS The authors critically evaluate the sum of laboratory and clinical literature on the topic of zone II flexor tendon management that has guided their practice and provide evidence to support their methods. RESULTS The review highlights some of the key developments over the years and assesses their influence on changing current practice. It also highlights recent innovations, which have the potential to influence flexor tendon outcomes by altering the surgical approach, techniques, and rehabilitation regimens. Future innovations in the field will also be discussed to examine their potential in expanding the development in the management of flexor tendon injury. CONCLUSIONS A better understanding of flexor tendon biology will allow progress in developing new therapies for flexor tendon injuries; however, there are as yet few real breakthroughs that will dramatically change current practice.
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