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Gazel U, Ayan G, Hryciw N, Delorme JP, Hepworth E, Sampaio M, Jibri Z, Karsh J, Aydin SZ. Disease-specific definitions of new bone formation on spine radiographs: a systematic literature review. Rheumatol Adv Pract 2024; 8:rkae061. [PMID: 38827363 PMCID: PMC11142627 DOI: 10.1093/rap/rkae061] [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] [Received: 09/07/2023] [Accepted: 03/24/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives We aimed to explore the radiographic definitions of types of New Bone formation (NBF) by focusing on the terminology, description and location of the findings. Methods Three systematic literature reviews were conducted in parallel to identify the radiographic spinal NBF definitions for spondyloarthritis (SpA), Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Osteorathritis (OA). Study characteristics and definitions were extracted independently by two reviewers. Definitions were analysed and collated based on whether they were unique, modified or established from previous research. Results We identified 33 studies that indicated a definition for the NBF in SpA, 10 for DISH and 7 for spinal OA. In SpA, the variations in syndesmophytes included the description as well as the subtypes and locations. The differentiation of syndesmophytes from osteophytes were included in 12 articles, based on the origin and the angle of the NBF and associated findings. The definitions of DISH varied in the number of vertebrae, level and laterality. For OA, five articles indicated that osteophytes arose from the anterior or lateral aspects of the vertebral bodies, and two studies required a size cut-off. Discussion Our ultimate aim is to create formal NBF definitions for SpA, DISH and OA guided by an atlas, through a Delphi exercise with international experts. The improved ability to differentiate these conditions radiographically will not only allow the clinicians to accurately approach patients but also will help the researchers to better classify patient phenotypes and focus on accurate radiographic outcomes.
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Affiliation(s)
- Ummugulsum Gazel
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Gizem Ayan
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nicole Hryciw
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Philippe Delorme
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Elliot Hepworth
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Marcos Sampaio
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Division of Radiology, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Zaid Jibri
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Division of Radiology, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jacob Karsh
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sibel Zehra Aydin
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Sun T, Wang M, Liang W, Gao P, Liu Q, Yan X. Revealing mechanism of Methazolamide for treatment of ankylosing spondylitis based on network pharmacology and GSEA. Sci Rep 2023; 13:15370. [PMID: 37717047 PMCID: PMC10505193 DOI: 10.1038/s41598-023-42721-x] [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: 04/22/2023] [Accepted: 09/14/2023] [Indexed: 09/18/2023] Open
Abstract
Methazolamide is a carbonic anhydrase (CA) inhibitor with satisfactory safety. Our previous studies have demonstrated the elevation of CA1 expression and the therapeutic effect of Methazolamide in Ankylosing spondylitis (AS). In this study, we explored the pathogenic role of CA1 and the pharmacological mechanism of Methazolamide in AS through Gene Set Enrichment Analysis (GSEA) and network pharmacology. Seven out of twelve CA1 related gene sets were enriched in AS group. CA1 was core enriched in above seven gene sets involving zinc ion binding, arylesterase activity and one carbon metabolic process. Functional analysis of the candidate target genes obtained from the intersection of AS associated genes and Methazolamide target genes indicated that Methazolamide exerts therapeutic effects on AS mainly through inflammatory pathways which regulate the production of tumor necrosis factor, IL-6 and nitric oxide. PTGS2, ESR1, GSK3β, JAK2, NOS2 and CA1 were selected as therapeutic targets of Methazolamide in AS. Molecular docking and molecular dynamics simulations were performed successfully. In addition, we innovatively obtained the intersection of Gene Ontology (GO)/Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses and GSEA results, and found that 18 GO terms and 5 KEGG terms were indicated in the pharmacological mechanism of Methazolamide in AS, involving bone mineralization, angiogenesis, inflammation, and chemokine signaling pathways. Nevertheless, validation for these mechanisms is needed in vivo/vitro experiments.
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Affiliation(s)
- Tao Sun
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Lixia District, Jinan City, Shandong Province, China
| | - Manzhi Wang
- Department of Hematology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Weiqiang Liang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Lixia District, Jinan City, Shandong Province, China
| | - Ping Gao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Lixia District, Jinan City, Shandong Province, China
| | - Qiang Liu
- Department of Cardiology, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Xinfeng Yan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Lixia District, Jinan City, Shandong Province, China.
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Han Y, Yang H, Hua Z, Nie S, Xu S, Zhou C, Chen F, Li M, Yu Q, Sun Y, Wei Y, Wang X. Rotating Magnetic Field Mitigates Ankylosing Spondylitis Targeting Osteocytes and Chondrocytes via Ameliorating Immune Dysfunctions. Cells 2023; 12:cells12070972. [PMID: 37048045 PMCID: PMC10093245 DOI: 10.3390/cells12070972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
Ankylosing spondylitis (AS) is clinically characterized by bone fusion that is induced by the pathological formation of extra bone. Unfortunately, the fundamental mechanism and related therapies remain unclear. The loss of SHP-2 (encoded by Ptpn11) in CD4-Cre;Ptpn11f/f mice resulted in the induction of AS-like pathological characteristics, including spontaneous cartilage and bone lesions, kyphosis, and arthritis. Hence, this mouse was utilized as an AS model in this study. As one of the basic physical fields, the magnetic field (MF) has been proven to be an effective treatment method for articular cartilage degeneration. In this study, the effects of a rotating magnetic field (RMF; 0.2 T, 4 Hz) on an AS-like mouse model were investigated. The RMF treatment (2 h/d, 0.2 T, 4 Hz) was performed on AS mice from two months after birth until the day before sampling. The murine specimens were subjected to transcriptomics, immunomics, and metabolomics analyses, combined with molecular and pathological experiments. The results demonstrated that the mitigation of inflammatory deterioration resulted in an increase in functional osteogenesis and a decrease in dysfunctional osteolysis due to the maintenance of bone homeostasis via the RANKL/RANK/OPG signaling pathway. Additionally, by regulating the ratio of CD4+ and CD8+ T-cells, RMF treatment rebalanced the immune microenvironment in skeletal tissue. It has been observed that RMF interventions have the potential to alleviate AS, including by decreasing pathogenicity and preventing disease initiation. Consequently, RMF, as a moderately physical therapeutic strategy, could be considered to alleviate the degradation of cartilage and bone tissue in AS and as a potential option to halt the progression of AS.
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Affiliation(s)
- Yu Han
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Hua Yang
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Zhongke Hua
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Shenglan Nie
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Shuling Xu
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Cai Zhou
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Fengyi Chen
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Mengqing Li
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Qinyao Yu
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Yang Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Biotechnology and Pharmaceutical Sciences, School of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Yunpeng Wei
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Xiaomei Wang
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
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Purine metabolites promote ectopic new bone formation in ankylosing spondylitis. Int Immunopharmacol 2023; 116:109810. [PMID: 36774858 DOI: 10.1016/j.intimp.2023.109810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that mainly affects the axial skeleton, whose typical features are inflammatory back pain, bone structural damage and pathological new bone formation. The pathology of ectopic new bone formation is still little known. In this study, we found increased purine metabolites in plasma of patients with AS. Similarly, metabolome analysis indicated increased purine metabolites in both serum of CD4-Cre; Ptpn11fl/fl and SHP2-deficient chondrocytes. SHP2-deficient chondrocytes promoted the growth of wild type chondrocytes and differentiation of osteoblasts in CD4-Cre; Ptpn11fl/fl mice, which spontaneously developed AS-like bone disease. Purine metabolites, along with PTHrP derived from SHP2-deficient chondrocytes, accelerated the growth of chondrocytes and ectopic new bone formation through PKA/CREB signaling. Moreover, Suramin, a purinergic receptor antagonist, suppressed pathological new bone formation in AS-like bone disease. Overall, these results highlight the potential role of targeting purinergic signaling in retarding ectopic new bone formation in AS.
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Targeting chondrocytes for arresting bony fusion in ankylosing spondylitis. Nat Commun 2021; 12:6540. [PMID: 34764263 PMCID: PMC8585952 DOI: 10.1038/s41467-021-26750-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/21/2021] [Indexed: 12/17/2022] Open
Abstract
Bony fusion caused by pathological new bone formation manifests the clinical feature of ankylosing spondylitis (AS). However, the underlying mechanism remains elusive. Here we discovered spontaneous kyphosis, arthritis and bony fusion in mature CD4-Cre;Ptpn11f/f mice, which present the pathophysiological features of AS. A population of CD4-Cre-expressing proliferating chondrocytes was SHP2 deficient, which could differentiate into pre-hypertrophic and hypertrophic chondrocytes. Functionally, SHP2 deficiency in chondrocytes impeded the fusion of epiphyseal plate and promoted chondrogenesis in joint cavity and enthesis. Mechanistically, aberrant chondrocytes promoted ectopic new bone formation through BMP6/pSmad1/5 signaling. It is worth emphasizing that such pathological thickness of growth plates was evident in adolescent humans with enthesitis-related arthritis, which could progress to AS in adulthood. Targeting dysfunctional chondrogenesis with Smo inhibitor sonidegib significantly alleviated the AS-like bone disease in mice. These findings suggest that blockade of chondrogenesis by sonidegib would be a drug repurposing strategy for AS treatment. Current treatments cannot significantly alleviate the radiographic progression in ankylosing spondylitis (AS), which results in joints stiffness and bony fusion of AS. Smo inhibitor sonidegib retards the pathological new bone formation in AS through targeting dysfunctional chondrogenesis.
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Smart RJ, Ghali G. Dysphagia Caused by Diffuse Idiopathic Skeletal Hyperostosis. J Oral Maxillofac Surg 2016; 74:764-9. [DOI: 10.1016/j.joms.2015.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 12/19/2022]
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Dey D, Goldhamer DJ, Yu PB. Contributions of muscle-resident progenitor cells to homeostasis and disease. CURRENT MOLECULAR BIOLOGY REPORTS 2015; 1:175-188. [PMID: 29075589 PMCID: PMC5654566 DOI: 10.1007/s40610-015-0025-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Adult skeletal muscle maintains a homeostatic state with modest levels of cellular turnover, unlike the skin or blood. However, the muscle is highly sensitive to tissue injury, which unleashes a cascade of regenerative and inflammatory processes. Muscle regeneration involves cross-talk between numerous cytokine signaling axes, and the coordinated activity of multiple muscle-resident and circulating progenitor populations. Satellite cells, closely associated with myofibers, are established as the canonical muscle stem cell, with self-renewal and myofiber-regenerating capacity. However, a heterogeneous group of mesenchymal progenitor cells residing within the muscle interstitium are also highly responsive to muscle injury and exhibit varying degrees of regenerative potential. These cells interact with satellite cells via direct and indirect mechanisms to regulate regeneration or repair. We describe the known phylogenetic and functional relationships of the multiple progenitor populations residing within skeletal muscle, their putative roles in the coordination of injury repair, and their possible contributions to health and disease.
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Affiliation(s)
- Devaveena Dey
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA 02115-6119, USA
| | - David J. Goldhamer
- Department of Molecular and Cell Biology, University of Connecticut Stem Cell Institute, University of Connecticut, Storrs, CT 06269-3125, USA
| | - Paul B. Yu
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA 02115-6119, USA
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Daoussis D, Filippopoulou A, Liossis SN, Sirinian C, Klavdianou K, Bouris P, Karamanos NK, Andonopoulos AP. Anti-TNFα treatment decreases the previously increased serum Indian Hedgehog levels in patients with ankylosing spondylitis and affects the expression of functional Hedgehog pathway target genes. Semin Arthritis Rheum 2015; 44:646-51. [PMID: 25701499 DOI: 10.1016/j.semarthrit.2015.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/31/2014] [Accepted: 01/16/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Indian Hedgehog (Ihh) is the ligand that activates the Hedgehog pathway (HH) in the skeleton-the main controller of endochondral ossification. We aimed at assessing serum levels of Ihh in patients with ankylosing spondylitis (AS) and the effect of serum from patients with AS on HH pathway activation. METHODS Serum Ihh levels were measured in 59 patients with AS, 70 patients with rheumatoid arthritis (RA), and 53 healthy subjects. The effect of serum from patients with AS on HH pathway activation was evaluated using an osteoblast-like cell line model. RESULTS Patients with AS not on anti-TNFα treatment had significantly higher Ihh levels compared to patients with RA not on anti-TNFα treatment (mean ± SEM of OD: 0.370 ± 0.025 vs. 0.279 ± 0.026 for patients with AS and RA, respectively, p = 0.027) and healthy subjects (p = 0.031). Patients with AS on anti-TNFα treatment had significantly lower Ihh levels compared to patients with AS not on such treatment (p = 0.028). Patients with RA on anti-TNF treatment had higher levels of Ihh compared to patients not on such treatment (p = 0.013). PTHrP levels were similar in patients with RA, AS, and healthy subjects and were not affected by anti-TNFα treatment. We next assessed HH pathway activation in Saos2 cells following incubation with serum from AS patients prior to and following anti-TNF treatment. The HH pathway was downregulated following treatment. CONCLUSIONS Ihh levels are increased in patients with AS and decrease following anti-TNFα treatment; this finding may have pathogenic and clinical implications.
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Affiliation(s)
- Dimitrios Daoussis
- Department of Rheumatology, University of Patras Medical School, Patras University Hospital, Rion 26504, Patras, Greece.
| | - Alexandra Filippopoulou
- Department of Rheumatology, University of Patras Medical School, Patras University Hospital, Rion 26504, Patras, Greece
| | - Stamatis-Nick Liossis
- Department of Rheumatology, University of Patras Medical School, Patras University Hospital, Rion 26504, Patras, Greece
| | - Chaido Sirinian
- Clinical and Molecular Oncology Laboratoty, University of Patras Medical School, Patras University Hospital, Rion, Patras, Greece
| | - Kalliopi Klavdianou
- Department of Rheumatology, University of Patras Medical School, Patras University Hospital, Rion 26504, Patras, Greece
| | | | | | - Andrew P Andonopoulos
- Department of Rheumatology, University of Patras Medical School, Patras University Hospital, Rion 26504, Patras, Greece
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Kan L, Peng CY, McGuire TL, Kessler JA. Glast-expressing progenitor cells contribute to heterotopic ossification. Bone 2013; 53:194-203. [PMID: 23262027 PMCID: PMC3793345 DOI: 10.1016/j.bone.2012.12.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/28/2012] [Accepted: 12/09/2012] [Indexed: 01/15/2023]
Abstract
Heterotopic ossification (HO), acquired or hereditary, is the formation of true bone outside the normal skeleton. Although the lineages of cells contributing to bone formation during normal development are well defined, the precise lineages of cells that contribute to HO are not clear. This study utilized Cre-lox based genetic lineage tracing to examine the contribution to HO of cells that expressed either FoxD1 or Glast. Both lineages contributed broadly to different normal tissues, and FoxD1-cre labeled cells contributed to normal bone formation. Despite the similarity in labeling patterns of normal tissues, and the significant contribution of FoxD1-cre labeled cells to normal bone, only Glast-creERT labeled progenitors contributed significantly to HO at all stages, suggesting that the cell populations that normally contribute to physiological bone formation, such as the Foxd1-cre labeled cells, may not participate in pathological HO. Further, identification of Glast-expressing cells as precursors that give rise to HO should help with the molecular targeting of this population both for the prevention and for the treatment of HO.
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Affiliation(s)
- Lixin Kan
- Department of Neurology, Northwestern University Feinberg Medical School, 303 East Chicago Avenue, Chicago, IL 60611, USA.
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Braun T, Zwerina J. Positive regulators of osteoclastogenesis and bone resorption in rheumatoid arthritis. Arthritis Res Ther 2011; 13:235. [PMID: 21861862 PMCID: PMC3239343 DOI: 10.1186/ar3380] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Bone destruction is a frequent and clinically serious event in patients with rheumatoid arthritis (RA). Local joint destruction can cause joint instability and often necessitates reconstructive or replacement surgery. Moreover, inflammation-induced systemic bone loss is associated with an increased fracture risk. Bone resorption is a well-controlled process that is dependent on the differentiation of monocytes to bone-resorbing osteoclasts. Infiltrating as well as resident synovial cells, such as T cells, monocytes and synovial fibroblasts, have been identified as sources of osteoclast differentiation signals in RA patients. Pro-inflammatory cytokines are amongst the most important mechanisms driving this process. In particular, macrophage colony-stimulating factor, RANKL, TNF, IL-1 and IL-17 may play dominant roles in the pathogenesis of arthritis-associated bone loss. These cytokines activate different intracellular pathways to initiate osteoclast differentiation. Thus, over the past years several promising targets for the treatment of arthritic bone destruction have been defined.
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Affiliation(s)
- Tobias Braun
- Department of Medicine 3, University of Erlangen-Nuremberg, Erlangen, 91054 Germany
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Lories RJU, de Vlam K, Luyten FP. Are current available therapies disease-modifying in spondyloarthritis? Best Pract Res Clin Rheumatol 2011; 24:625-35. [PMID: 21035084 DOI: 10.1016/j.berh.2010.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Disease modification in spondyloarthritis should target the improvement of symptoms and preservation of function. Therefore, inhibition of structural damage caused by the disease processes appears essential. In spondyloarthritis, structural damage results mainly in progressive ankylosis of the spine and peripheral joint destruction. Currently available therapies for the treatment of spondyloarthritis appear effective at inhibiting tissue destruction but, with the exception of celecoxib, do not appear to affect new tissue formation leading to ankylosis. In this article, we discuss clinical and pathophysiological concepts of disease modification in spondyloarthritis, challenges in its evaluation, recent clinical data and new concepts that may help explain structural damage as well as the onset and progression of disease.
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Affiliation(s)
- Rik J U Lories
- Laboratory for Skeletal Development and Joint Disorders, Division of Rheumatology, Department of Musculoskeletal Sciences, Katholieke Universiteit Leuven, Belgium.
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Chang X, Han J, Zhao Y, Yan X, Sun S, Cui Y. Increased expression of carbonic anhydrase I in the synovium of patients with ankylosing spondylitis. BMC Musculoskelet Disord 2010; 11:279. [PMID: 21143847 PMCID: PMC3012668 DOI: 10.1186/1471-2474-11-279] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 12/08/2010] [Indexed: 12/02/2022] Open
Abstract
Background One of the most distinctive features of ankylosing spondylitis (AS) is new bone formation and bone resorption at sites of chronic inflammation. Previous studies have indicated that the hyperplasia and inflammation of synovial tissues are significantly related to the pathogenic process of AS. The present study used a proteomic approach to identify novel AS-specific proteins by simultaneously comparing the expression profiles of synovial membranes from patients with AS, rheumatoid arthritis (RA) and osteoarthritis (OA). Methods Synovial tissues were collected from the hip joints of patients with AS and knee joints of patients with RA or OA (n = 10 for each disease) during joint replacement surgery. Proteins extracted from the synovial tissues were separated by 2-D electrophoresis (2-DE), and the proteins with significantly increased expression in the AS samples were subjected to MALDI-TOF/TOF-MS analysis. The results were verified using western blotting and immunohistochemistry. Levels of the candidate proteins in synovial fluids from knee joints (n = 40 for each disease) were measured using ELISA. Results The proteomic approach revealed significantly increased expression of carbonic anhydrase I (CA1) in the synovial membrane of patients with AS as compared with the RA and OA tissue samples. Immunohistochemistry and western blotting analysis confirmed the findings described above. The ELISA detected a higher level of CA1 in synovial fluids from patients with AS than those with OA. The mean value of the CA1 level was also higher in AS patients as compared with RA patients. This study also detected increased expression of alpha-1-antitrypsin in the synovial tissues from AS patients, which is in agreement with other reports. Conclusion In vitro experiments by other groups indicated that CA1 catalyzes the generation of HCO3- through the hydration of CO2, which then combines with Ca2+ to form a CaCO3 precipitate. Calcification is an essential step of bone formation. Substantial evidence indicates that carbonic anhydrase also stimulates bone resorption. Hence, overexpression of CA1 in the synovial tissues of AS patients may promote improper calcification and bone resorption in AS.
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Affiliation(s)
- Xiaotian Chang
- National Laboratory for Bio-Drugs of Ministry of Health, Research Center for Medicinal Biotechnology of Shandong Academy of Medical Sciences, Jingshi road 18877, Jinan, Shandong, 250062, PR China.
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Włodarski K, Włodarski P, Galus R, Brodzikowska A. Effects of time of initial exposure to MSV sarcoma on bone induction by dentine matrix implants and on orthotopic femora. Int J Mol Sci 2010; 11:3277-87. [PMID: 20957093 PMCID: PMC2956094 DOI: 10.3390/ijms11093277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 08/23/2010] [Accepted: 09/06/2010] [Indexed: 11/21/2022] Open
Abstract
HCl-demineralized murine lower incisors were implanted intramuscularly into syngeneic BALB/c mice to induce heterotopic osteogenesis. Implants were exposed at the early, preosteogenic stage (4), or at the later, osteogenic stage (12) to the Moloney sarcoma virus (MSV), which within 3–4 days results in a sarcoma. The yield of bone induction was determined by weight of dry bone mass following NaOH hydrolysis of soft tissues. To verify the effect of this sarcoma on orthotopic local femoral bone, the dry mass of the tumor-exposed femora was measured and compared with the weight of MSV-unexposed contralateral controls. MSV-sarcoma or cells involved with their spontaneous rejection have a stimulatory effect on the periosteal membrane of the tumor-adjacent femoral bones, increasing their dry mass on average by 18%. No stimulatory effect on heterotopic bone induction was observed when the MSV sarcoma grew during the early, preosteogenic stage (4 onward), but when the tooth matrix had been exposed to such tumor at the already bone-forming stage, (12 onward), the yield of bone induction was enhanced. Thus, it is postulated that lesions induced by MSV during the early, preosteogenic stage inhibit recruitment of osteoprogenitor cells or degrade Bone Morphogenetic Proteins (BMPs) released by matrix resorbing inflammatory cells, whereas when acting on already existing bone they have a stimulatory effect.
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Affiliation(s)
- Krzysztof Włodarski
- Chair of Histology and Embryology, Institute of Biostructural Research, Medical University of Warsaw, Chalubinskiego 5 Str., 02-004 Warszawa, Poland; E-Mails: (P.W); (R.G)
- * Author to whom correspondence should be addressed; E-Mail: ; Tel.: +48-226-281-041 ext. 1314; Fax: +48-226-295-282
| | - Paweł Włodarski
- Chair of Histology and Embryology, Institute of Biostructural Research, Medical University of Warsaw, Chalubinskiego 5 Str., 02-004 Warszawa, Poland; E-Mails: (P.W); (R.G)
| | - Ryszard Galus
- Chair of Histology and Embryology, Institute of Biostructural Research, Medical University of Warsaw, Chalubinskiego 5 Str., 02-004 Warszawa, Poland; E-Mails: (P.W); (R.G)
| | - Aniela Brodzikowska
- Department of Conservative Dentistry, Institute of Stomatology, Medical University of Warsaw, Miodowa 18 Str., 00-246 Warszawa, Poland; E-Mail: (A.B)
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Heterotopic Ossification in the Residual Lower Limb in an Adult Nontraumatic Amputee Patient. Am J Phys Med Rehabil 2010; 89:245-8. [DOI: 10.1097/phm.0b013e3181c5657c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Targeted therapies that neutralize tumour necrosis factor are often able to control the signs and symptoms of spondyloarthritis. However, recent animal model data and clinical observations indicate that control of inflammation may not be sufficient to impede disease progression toward ankylosis in these patients. Bone morphogenetic proteins and WNTs (wingless-type like) are likely to play an important role in ankylosis and could be therapeutic targets. The relationship between inflammation and new bone formation is still unclear. This review summarizes progress made in our understanding of ankylosis and offers an alternative view of the relationship between inflammation and ankylosis.
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Włodarski PK, Galus R, Włodarski KH, Brodzikowska A. Heterotopic osteogenesis by murine demineralized incisors at lesions sites induced by concanavalin a in mice. Connect Tissue Res 2009; 50:1-6. [PMID: 19212847 DOI: 10.1080/03008200802690661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to examine the effects of Concanavalin A (Con A) administration on the early (preosteogenic) and late stages of osteogenesis induced by implantation of demineralized murine incisors into syngeneic mice. Local administration of Con A resulted in an increased yield of demineralized incisor-induced bone when injected during the preosteogenic stage of induction. This effect was not observed when Con A was injected after heterotopic osteogenesis had been established. This suggests that Con A recruits osteoprogenitor cells, but does not stimulate differentiated chondroblasts and osteoblasts.
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Affiliation(s)
- Paweł K Włodarski
- Department of Histology and Embryology, Center for Biostructure Research, Medical University of Warsaw, Warsaw, Poland.
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Spondyloarthritis at the crossroads of imaging, pathology, and structural damage in the era of biologics. Curr Rheumatol Rep 2008; 10:356-63. [DOI: 10.1007/s11926-008-0058-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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McGonagle D, Wakefield RJ, Tan AL, D'Agostino MA, Toumi H, Hayashi K, Emery P, Benjamin M. Distinct topography of erosion and new bone formation in achilles tendon enthesitis: Implications for understanding the link between inflammation and bone formation in spondylarthritis. ACTA ACUST UNITED AC 2008; 58:2694-9. [DOI: 10.1002/art.23755] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Osteoarthritis is the major cause of joint failure. The outcome of the disease process is determined by complex interactions between cells and molecules steering homeostasis, destruction, restoration, and remodeling. The articular cartilage has a limited restoration and repair capacity. Genetic studies in humans and the development of mouse models have identified the role of signaling pathways that are important for skeletal development in the postnatal biology and pathology of articular cartilage. These include bone morphogenetic protein, transforming growth factor beta, fibroblast growth factor, wingless-type signaling, and their respective antagonists such as noggin and frizzled related protein. The synovium is prone to inflammation and emerging evidence suggests that innate and adaptive immune responses are important. Bone and cartilage form a biomechanical unit; stiffer bones might impair cartilage homeostasis. The biology of frizzled related protein provides a basis for the hypothesized inverse relationship between osteoarthritis and osteoporosis.
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Sieper J, Appel H, Braun J, Rudwaleit M. Critical appraisal of assessment of structural damage in ankylosing spondylitis: Implications for treatment outcomes. ACTA ACUST UNITED AC 2008; 58:649-56. [DOI: 10.1002/art.23260] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Joint destruction and tissue responses determine the outcome of chronic arthritis. Joint inflammation and damage are often the dominant clinical presentation. However, in some arthritic diseases, in particular the spondyloarthritides, joint remodeling is a prominent feature, with new cartilage and bone formation leading to ankylosis and contributing to loss of function. A role for bone morphogenetic proteins in joint remodeling has been demonstrated in the formation of both enthesophytes and osteophytes. Data from genetic models support a role for bone morphogenetic protein signaling in cartilage homeostasis. Finally, this signaling pathway is likely to play a steering role in the synovium.
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Affiliation(s)
- Rik JU Lories
- Laboratory for Skeletal Development and Joint Disorders, Division of Rheumatology, Department of Musculoskeletal Sciences, Katholieke Universiteit Leuven, Belgium
| | - Frank P Luyten
- Laboratory for Skeletal Development and Joint Disorders, Division of Rheumatology, Department of Musculoskeletal Sciences, Katholieke Universiteit Leuven, Belgium
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Geusens P, Vosse D, van der Linden S. Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 2007; 19:335-9. [PMID: 17551362 DOI: 10.1097/bor.0b013e328133f5b3] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review recent data, in the context of what is already known, about an increased risk of vertebral fractures in ankylosing spondylitis patients. RECENT FINDINGS Osteoporosis and fractures of the vertebral body and its dorsal arch are now well recognized features in patients with ankylosing spondylitis, but their diagnosis is still often a challenge. The risk factors and clinical consequences for fractures in ankylosing spondylitis are increasingly understood in the context of osteoimmunology and of spinal biomechanical changes in material and structural components in the spine that result in bone failure. SUMMARY Diagnosing fractures of the vertebral body and its dorsal arch remains a challenge in studies and in clinical practice. Prospective studies are needed to evaluate to what degree such fractures can be prevented in ankylosing spondylitis.
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Affiliation(s)
- Piet Geusens
- Division of Rheumatology, Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
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