1
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Vishlaghi N, Guo L, Griswold-Wheeler D, Sun Y, Booker C, Crossley JL, Bancroft AC, Juan C, Korlakunta S, Ramesh S, Pagani CA, Xu L, James AW, Tower RJ, Dellinger M, Levi B. Vegfc-expressing cells form heterotopic bone after musculoskeletal injury. Cell Rep 2024; 43:114049. [PMID: 38573853 DOI: 10.1016/j.celrep.2024.114049] [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: 08/30/2023] [Revised: 02/09/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024] Open
Abstract
Heterotopic ossification (HO) is a challenging condition that occurs after musculoskeletal injury and is characterized by the formation of bone in non-skeletal tissues. While the effect of HO on blood vessels is well established, little is known about its impact on lymphatic vessels. Here, we use a mouse model of traumatic HO to investigate the relationship between HO and lymphatic vessels. We show that injury triggers lymphangiogenesis at the injury site, which is associated with elevated vascular endothelial growth factor C (VEGF-C) levels. Through single-cell transcriptomic analyses, we identify mesenchymal progenitor cells and tenocytes as sources of Vegfc. We demonstrate by lineage tracing that Vegfc-expressing cells undergo osteochondral differentiation and contribute to the formation of HO. Last, we show that Vegfc haploinsufficiency results in a nearly 50% reduction in lymphangiogenesis and HO formation. These findings shed light on the complex mechanisms underlying HO formation and its impact on lymphatic vessels.
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Affiliation(s)
- Neda Vishlaghi
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Lei Guo
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, TX, USA
| | | | - Yuxiao Sun
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Cori Booker
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Janna L Crossley
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Alec C Bancroft
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Conan Juan
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Sneha Korlakunta
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Sowmya Ramesh
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Chase A Pagani
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Lin Xu
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, TX, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Robert J Tower
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Michael Dellinger
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
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2
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Kang H, Strong AL, Sun Y, Guo L, Juan C, Bancroft AC, Choi JH, Pagani CA, Fernandes AA, Woodard M, Lee J, Ramesh S, James AW, Hudson D, Dalby KN, Xu L, Tower RJ, Levi B. The HIF-1α/PLOD2 axis integrates extracellular matrix organization and cell metabolism leading to aberrant musculoskeletal repair. Bone Res 2024; 12:17. [PMID: 38472175 PMCID: PMC10933265 DOI: 10.1038/s41413-024-00320-0] [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: 09/05/2023] [Revised: 01/04/2024] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
While hypoxic signaling has been shown to play a role in many cellular processes, its role in metabolism-linked extracellular matrix (ECM) organization and downstream processes of cell fate after musculoskeletal injury remains to be determined. Heterotopic ossification (HO) is a debilitating condition where abnormal bone formation occurs within extra-skeletal tissues. Hypoxia and hypoxia-inducible factor 1α (HIF-1α) activation have been shown to promote HO. However, the underlying molecular mechanisms by which the HIF-1α pathway in mesenchymal progenitor cells (MPCs) contributes to pathologic bone formation remain to be elucidated. Here, we used a proven mouse injury-induced HO model to investigate the role of HIF-1α on aberrant cell fate. Using single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics analyses of the HO site, we found that collagen ECM organization is the most highly up-regulated biological process in MPCs. Zeugopod mesenchymal cell-specific deletion of Hif1α (Hoxa11-CreERT2; Hif1afl/fl) significantly mitigated HO in vivo. ScRNA-seq analysis of these Hoxa11-CreERT2; Hif1afl/fl mice identified the PLOD2/LOX pathway for collagen cross-linking as downstream of the HIF-1α regulation of HO. Importantly, our scRNA-seq data and mechanistic studies further uncovered that glucose metabolism in MPCs is most highly impacted by HIF-1α deletion. From a translational aspect, a pan-LOX inhibitor significantly decreased HO. A newly screened compound revealed that the inhibition of PLOD2 activity in MPCs significantly decreased osteogenic differentiation and glycolytic metabolism. This suggests that the HIF-1α/PLOD2/LOX axis linked to metabolism regulates HO-forming MPC fate. These results suggest that the HIF-1α/PLOD2/LOX pathway represents a promising strategy to mitigate HO formation.
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Affiliation(s)
- Heeseog Kang
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Yuxiao Sun
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Lei Guo
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Conan Juan
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Alec C Bancroft
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Ji Hae Choi
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Chase A Pagani
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Aysel A Fernandes
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Michael Woodard
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Juhoon Lee
- Division of Chemical Biology and Medicinal Chemistry, College of Pharmacy, University of Texas at Austin, Austin, TX, 78712, USA
| | - Sowmya Ramesh
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - David Hudson
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Kevin N Dalby
- Division of Chemical Biology and Medicinal Chemistry, College of Pharmacy, University of Texas at Austin, Austin, TX, 78712, USA
| | - Lin Xu
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Robert J Tower
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Benjamin Levi
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA.
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Brito VGB, Bell-Hensley A, McAlinden A. MicroRNA-138: an emerging regulator of skeletal development, homeostasis, and disease. Am J Physiol Cell Physiol 2023; 325:C1387-C1400. [PMID: 37842749 PMCID: PMC10861148 DOI: 10.1152/ajpcell.00382.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
Noncoding microRNAs are powerful epigenetic regulators of cellular processes by their ability to target and suppress expression of numerous protein-coding mRNAs. This multitargeting function is a unique and complex feature of microRNAs. It is now well-described that microRNAs play important roles in regulating the development and homeostasis of many cell/tissue types, including those that make up the skeletal system. In this review, we focus on microRNA-138 (miR-138) and its effects on regulating bone and cartilage cell differentiation and function. In addition to its reported role as a tumor suppressor, miR-138 appears to function as an inhibitor of osteoblast differentiation. This review provides additional information on studies that have attempted to alter miR-138 expression in vivo as a means to dampen ectopic calcification or alter bone mass. However, a review of the published literature on miR-138 in cartilage reveals a number of contradictory and inconclusive findings with respect to regulating chondrogenesis and chondrocyte catabolism. This highlights the need for more research in understanding the role of miR-138 in cartilage biology and disease. Interestingly, a number of studies in other systems have reported miR-138-mediated effects in dampening inflammation and pain responses. Future studies will reveal if a multifunctional role of miR-138 involving suppression of ectopic bone, inflammation, and pain will be beneficial in skeletal conditions such as osteoarthritis and heterotopic ossification.
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Affiliation(s)
- Victor Gustavo Balera Brito
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Austin Bell-Hensley
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Audrey McAlinden
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Cell Biology & Physiology, Washington University School of Medicine, St. Louis, Missouri, United States
- Shriners Hospital for Children, St. Louis, Missouri, United States
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4
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Wang Z, Yi X, Yi W, Jian C, Qi B, Liu Q, Li Z, Yu A. Early diagnosis of heterotopic ossification with a NIR fluorescent probe by targeting type II collagen. J Mater Chem B 2023; 11:1684-1691. [PMID: 36594255 DOI: 10.1039/d2tb02157a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Heterotopic ossification (HO) is a devastating sequela in which the pathologic extracellular matrix of the cartilage and bone forms abnormally in soft tissues following traumatic injuries or orthopaedic surgeries. Early treatment is essential for inhibiting the progression of HO but is currently limited by the absence of sensitive and specific early diagnosis. Herein, this study exploits the enrichment of type II collagen (Col2a1) in the HO cartilage formation stage towards developing a near-infrared (NIR) probe for early HO diagnosis, namely WL-808 by conjugating a Col2a1-binding peptide (WYRGRL) and a cyanine dye (IR-808). WL-808 exhibits high specificity for targeting the cartilage in vitro and in vivo with no apparent cytotoxicity. The NIR signal of WL-808 can be detected in the HO cartilage lesions as early as 1 week after injury when micro-CT cannot show any ectopic bone formation. Moreover, the probe is rarely distributed in the normal knee articular cartilage in vivo via the intravenous administration method. Taken together, WL-808 demonstrates great potential in early HO diagnosis under NIR imaging, facilitating early HO prophylaxis and treatment in the clinic.
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Affiliation(s)
- Zheng Wang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China. .,Hubei Clinical Medical Research Center of Trauma and Microsurgery, Wuhan, Hubei 430071, China
| | - Xinzeyu Yi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China. .,Hubei Clinical Medical Research Center of Trauma and Microsurgery, Wuhan, Hubei 430071, China
| | - Wanrong Yi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China. .,Hubei Clinical Medical Research Center of Trauma and Microsurgery, Wuhan, Hubei 430071, China
| | - Chao Jian
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China. .,Hubei Clinical Medical Research Center of Trauma and Microsurgery, Wuhan, Hubei 430071, China
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China. .,Hubei Clinical Medical Research Center of Trauma and Microsurgery, Wuhan, Hubei 430071, China
| | - Qiaoyun Liu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
| | - Zonghuan Li
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China. .,Hubei Clinical Medical Research Center of Trauma and Microsurgery, Wuhan, Hubei 430071, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China. .,Hubei Clinical Medical Research Center of Trauma and Microsurgery, Wuhan, Hubei 430071, China
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Pagani CA, Bancroft AC, Tower RJ, Livingston N, Sun Y, Hong JY, Kent RN, Strong AL, Nunez JH, Medrano JMR, Patel N, Nanes BA, Dean KM, Li Z, Ge C, Baker BM, James AW, Weiss SJ, Franceschi RT, Levi B. Discoidin domain receptor 2 regulates aberrant mesenchymal lineage cell fate and matrix organization. SCIENCE ADVANCES 2022; 8:eabq6152. [PMID: 36542719 PMCID: PMC9770942 DOI: 10.1126/sciadv.abq6152] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/05/2022] [Indexed: 06/17/2023]
Abstract
Extracellular matrix (ECM) interactions regulate both the cell transcriptome and proteome, thereby determining cell fate. Traumatic heterotopic ossification (HO) is a disorder characterized by aberrant mesenchymal lineage (MLin) cell differentiation, forming bone within soft tissues of the musculoskeletal system following traumatic injury. Recent work has shown that HO is influenced by ECM-MLin cell receptor signaling, but how ECM binding affects cellular outcomes remains unclear. Using time course transcriptomic and proteomic analyses, we identified discoidin domain receptor 2 (DDR2), a cell surface receptor for fibrillar collagen, as a key MLin cell regulator in HO formation. Inhibition of DDR2 signaling, through either constitutive or conditional Ddr2 deletion or pharmaceutical inhibition, reduced HO formation in mice. Mechanistically, DDR2 perturbation alters focal adhesion orientation and subsequent matrix organization, modulating Focal Adhesion Kinase (FAK) and Yes1 Associated Transcriptional Regulator and WW Domain Containing Transcription Regulator 1 (YAP/TAZ)-mediated MLin cell signaling. Hence, ECM-DDR2 interactions are critical in driving HO and could serve as a previously unknown therapeutic target for treating this disease process.
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Affiliation(s)
- Chase A. Pagani
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Alec C. Bancroft
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Robert J. Tower
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Nicholas Livingston
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Yuxiao Sun
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jonathan Y. Hong
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Robert N. Kent
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Amy L. Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Johanna H. Nunez
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jessica Marie R. Medrano
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Nicole Patel
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin A. Nanes
- Department of Dermatology, University of Texas Southwestern, Dallas, TX, USA
- Lydia Hill Department of Bioinformatics, University of Texas Southwestern, Dallas, TX, USA
| | - Kevin M. Dean
- Lydia Hill Department of Bioinformatics, University of Texas Southwestern, Dallas, TX, USA
- Cecil H. and The Ida Green Center for Systems Biology, University of Texas Southwestern, Dallas, TX, USA
| | - Zhao Li
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Chunxi Ge
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Brendon M. Baker
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Aaron W. James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen J. Weiss
- Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA
| | | | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
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6
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Negri S, Wang Y, Li Z, Qin Q, Lee S, Cherief M, Xu J, Hsu GCY, Tower RJ, Presson B, Levin A, McCarthy E, Levi B, James AW. Acetabular Reaming Is a Reliable Model to Produce and Characterize Periarticular Heterotopic Ossification of the Hip. Stem Cells Transl Med 2022; 11:876-888. [PMID: 35758541 PMCID: PMC9397657 DOI: 10.1093/stcltm/szac042] [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: 11/18/2021] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
Heterotopic ossification (HO) is a pathologic process characterized by the formation of bone tissue in extraskeletal locations. The hip is a common location of HO, especially as a complication of arthroplasty. Here, we devise a first-of-its-kind mouse model of post-surgical hip HO and validate expected cell sources of HO using several HO progenitor cell reporter lines. To induce HO, an anterolateral surgical approach to the hip was used, followed by disclocation and acetabular reaming. Animals were analyzed with high-resolution roentgenograms and micro-computed tomography, conventional histology, immunohistochemistry, and assessments of fluorescent reporter activity. All the treated animals' developed periarticular HO with an anatomical distribution similar to human patients after arthroplasty. Heterotopic bone was found in periosteal, inter/intramuscular, and intracapsular locations. Further, the use of either PDGFRα or scleraxis (Scx) reporter mice demonstrated that both cell types gave rise to periarticular HO in this model. In summary, acetabular reaming reproducibly induces periarticular HO in the mouse reproducing human disease, and with defined mesenchymal cellular contributors similar to other experimental HO models. This protocol may be used in the future for further detailing of the cellular and molecular mediators of post-surgical HO, as well as the screening of new therapies.
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Affiliation(s)
| | | | - Zhao Li
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Qizhi Qin
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Seungyong Lee
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Masnsen Cherief
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Jiajia Xu
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Robert Joel Tower
- Center for Organogenesis Research and Trauma, University of Texas Southwestern, Dallas, TX, USA
| | - Bradley Presson
- Orthopaedic and Trauma Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology of the University of Verona, Verona, Italy
| | - Adam Levin
- Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, USA
| | - Edward McCarthy
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Benjamin Levi
- Center for Organogenesis Research and Trauma, University of Texas Southwestern, Dallas, TX, USA
| | - Aaron W James
- Corresponding author: Aaron W. James, 720 Rutland Avenue, Room 524A, Baltimore, MD 21205, USA. Tel: +1 410 502 4143; Fax: +1 410 955 9777;
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Bohner M, Maazouz Y, Ginebra MP, Habibovic P, Schoenecker JG, Seeherman H, van den Beucken JJ, Witte F. Sustained local ionic homeostatic imbalance caused by calcification modulates inflammation to trigger heterotopic ossification. Acta Biomater 2022; 145:1-24. [PMID: 35398267 DOI: 10.1016/j.actbio.2022.03.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022]
Abstract
Heterotopic ossification (HO) is a condition triggered by an injury leading to the formation of mature lamellar bone in extraskeletal soft tissues. Despite being a frequent complication of orthopedic and trauma surgery, brain and spinal injury, the etiology of HO is poorly understood. The aim of this study is to evaluate the hypothesis that a sustained local ionic homeostatic imbalance (SLIHI) created by mineral formation during tissue calcification modulates inflammation to trigger HO. This evaluation also considers the role SLIHI could play for the design of cell-free, drug-free osteoinductive bone graft substitutes. The evaluation contains five main sections. The first section defines relevant concepts in the context of HO and provides a summary of proposed causes of HO. The second section starts with a detailed analysis of the occurrence and involvement of calcification in HO. It is followed by an explanation of the causes of calcification and its consequences. This allows to speculate on the potential chemical modulators of inflammation and triggers of HO. The end of this second section is devoted to in vitro mineralization tests used to predict the ectopic potential of materials. The third section reviews the biological cascade of events occurring during pathological and material-induced HO, and attempts to propose a quantitative timeline of HO formation. The fourth section looks at potential ways to control HO formation, either acting on SLIHI or on inflammation. Chemical, physical, and drug-based approaches are considered. Finally, the evaluation finishes with a critical assessment of the definition of osteoinduction. STATEMENT OF SIGNIFICANCE: The ability to regenerate bone in a spatially controlled and reproducible manner is an essential prerequisite for the treatment of large bone defects. As such, understanding the mechanism leading to heterotopic ossification (HO), a condition triggered by an injury leading to the formation of mature lamellar bone in extraskeletal soft tissues, would be very useful. Unfortunately, the mechanism(s) behind HO is(are) poorly understood. The present study reviews the literature on HO and based on it, proposes that HO can be caused by a combination of inflammation and calcification. This mechanism helps to better understand current strategies to prevent and treat HO. It also shows new opportunities to improve the treatment of bone defects in orthopedic and dental procedures.
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8
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Sun Y, Lin Y, Chen Z, Breland A, Lineaweaver WC, Zhang F. Heterotopic Ossification in Burn Patients. Ann Plast Surg 2022; 88:S134-S137. [PMID: 34270474 DOI: 10.1097/sap.0000000000002901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Heterotopic ossification (HO) is a known complication of burns. The incidence of this complication is low. The etiology is unclear, but experiment conducted about HO can be significant. Currently, there are still no targeted, effective preventive and therapeutic measures against it. In this study, the relevant literature is summarized to demonstrate the potential pathogenic mechanisms, diagnosis, prophylaxis, and treatment measures of HO in burn patients. Early diagnosis and treatment can be effective in improving the prognosis of patients.
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Affiliation(s)
- Yi Sun
- From the Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University
| | - Yuzhe Lin
- From the Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University
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9
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Fisher C, Harty J, Yee A, Li CL, Komolibus K, Grygoryev K, Lu H, Burke R, Wilson BC, Andersson-Engels S. Perspective on the integration of optical sensing into orthopedic surgical devices. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:010601. [PMID: 34984863 PMCID: PMC8727454 DOI: 10.1117/1.jbo.27.1.010601] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Orthopedic surgery currently comprises over 1.5 million cases annually in the United States alone and is growing rapidly with aging populations. Emerging optical sensing techniques promise fewer side effects with new, more effective approaches aimed at improving patient outcomes following orthopedic surgery. AIM The aim of this perspective paper is to outline potential applications where fiberoptic-based approaches can complement ongoing development of minimally invasive surgical procedures for use in orthopedic applications. APPROACH Several procedures involving orthopedic and spinal surgery, along with the clinical challenge associated with each, are considered. The current and potential applications of optical sensing within these procedures are discussed and future opportunities, challenges, and competing technologies are presented for each surgical application. RESULTS Strong research efforts involving sensor miniaturization and integration of optics into existing surgical devices, including K-wires and cranial perforators, provided the impetus for this perspective analysis. These advances have made it possible to envision a next-generation set of devices that can be rigorously evaluated in controlled clinical trials to become routine tools for orthopedic surgery. CONCLUSIONS Integration of optical devices into surgical drills and burrs to discern bone/tissue interfaces could be used to reduce complication rates across a spectrum of orthopedic surgery procedures or to aid less-experienced surgeons in complex techniques, such as laminoplasty or osteotomy. These developments present both opportunities and challenges for the biomedical optics community.
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Affiliation(s)
- Carl Fisher
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - James Harty
- Cork University Hospital and South Infirmary Victoria University Hospital, Department of Orthopaedic Surgery, Cork, Ireland
| | - Albert Yee
- University of Toronto, Sunnybrook Research Institute, Department of Surgery, Holland Bone and Joint Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences; Orthopaedic Biomechanics Laboratory, Physical Sciences Platform, Toronto, Canada
| | - Celina L. Li
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Katarzyna Komolibus
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Konstantin Grygoryev
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Huihui Lu
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Ray Burke
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Brian C. Wilson
- University of Toronto, Princess Margaret Cancer Centre/University Health Network, Department of Medical Biophysics, Toronto, Canada
| | - Stefan Andersson-Engels
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
- University College Cork, Department of Physics, Cork, Ireland
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10
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Chen H, Lu H, Huang J, Wang Z, Chen Y, Zhang T. Calcitonin Gene-Related Peptide Influences Bone-Tendon Interface Healing Through Osteogenesis: Investigation in a Rabbit Partial Patellectomy Model. Orthop J Sports Med 2021; 9:23259671211003982. [PMID: 34345631 PMCID: PMC8280850 DOI: 10.1177/23259671211003982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Calcitonin gene-related peptide (CGRP), which has been shown to play an
important role in osteogenesis during fracture repair, is also widely
distributed throughout the tendon and ligament. Few studies have focused on
the role of CGRP in repair of the bone-tendon interface (BTI). Purpose: To explore the effect of CGRP expression on BTI healing in a rabbit partial
patellectomy model. Study Design: Controlled laboratory study. Methods: A total of 60 mature rabbits were subjected to a partial patellectomy and
then randomly assigned to CGRP, CGRP-antagonist, and control groups. In the
CGRP-antagonist group, the CGRP receptor antagonist BIBN4096BS was
administered to block CGRP receptors. The patella–patellar tendon complex
was harvested at 8 and 16 weeks postoperatively and subjected to
radiographic, microlaser Raman spectroscopy, histologic, and biomechanical
evaluation. Results: Radiographic data showed that local CGRP expression improved the growth
parameters of newly formed bone, including area and volumetric bone mineral
density (P < .05 for both). Raman spectroscopy revealed
that the relative bone mineral composition increased in the CGRP group
compared with in the control group and the CGRP-antagonist group
(P < .05 for both). Histologic testing revealed that
the CGRP group demonstrated better integration, characterized by
well-developed trabecular bone expansion from the residual patella and
marrow cavity formation, at the 8- and 16-week time points. Mechanical
testing demonstrated that the failure load, ultimate strength, and stiffness
in the CGRP group were significantly higher than those in the control group
(P < .05 for all), whereas these parameters in the
CGRP-antagonist group were significantly lower compared with those in the
control group at 16 weeks after surgery (P < .05 for
all). Conclusion: Increasing the local concentration of CGRP in the early stages of BTI healing
enhanced osteogenesis in a rabbit partial patellectomy model and promoted
healing of the BTI injury, whereas treatment using a CGRP antagonist had the
opposite effect. However, exogenous CGRP expression did not induce novel
bone remolding. Clinical Relevance: CGRP may have potential as a new therapy for BTI injuries or may be added to
postoperative regimens to facilitate healing.
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Affiliation(s)
- Huabin Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Jianjun Huang
- Department of Orthopaedics, Ningde Affiliated Hospital, Fujian Medical University, Ningde, Fujian, People's Republic of China
| | - Zhanwen Wang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Yang Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Tao Zhang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
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11
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Taylor EA, Mileti CJ, Ganesan S, Kim JH, Donnelly E. Measures of Bone Mineral Carbonate Content and Mineral Maturity/Crystallinity for FT-IR and Raman Spectroscopic Imaging Differentially Relate to Physical-Chemical Properties of Carbonate-Substituted Hydroxyapatite. Calcif Tissue Int 2021; 109:77-91. [PMID: 33710382 DOI: 10.1007/s00223-021-00825-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/12/2021] [Indexed: 12/31/2022]
Abstract
Bone mineral carbonate content assessed by vibrational spectroscopy relates to fracture incidence, and mineral maturity/ crystallinity (MMC) relates to tissue age. As FT-IR and Raman spectroscopy become more widely used to characterize the chemical composition of bone in pre-clinical and translational studies, their bone mineral outcomes require improved validation to inform interpretation of spectroscopic data. In this study, our objectives were (1) to relate Raman and FT-IR carbonate:phosphate ratios calculated through direct integration of peaks to gold-standard analytical measures of carbonate content and underlying subband ratios; (2) to relate Raman and FT-IR MMC measures to gold-standard analytical measures of crystal size in chemical standards and native bone powders. Raman and FT-IR direct integration carbonate:phosphate ratios increased with carbonate content (Raman: p < 0.01, R2 = 0.87; FT-IR: p < 0.01, R2 = 0.96) and Raman was more sensitive to carbonate content than the FT-IR (Raman slope + 95% vs FT-IR slope, p < 0.01). MMC increased with crystal size for both Raman and FT-IR (Raman: p < 0.01, R2 = 0.76; FT-IR p < 0.01, R2 = 0.73) and FT-IR was more sensitive to crystal size than Raman (c-axis length: slope FT-IR MMC + 111% vs Raman MMC, p < 0.01). Additionally, FT-IR but not Raman spectroscopy detected differences in the relationship between MMC and crystal size of carbonated hydroxyapatite (CHA) vs poorly crystalline hydroxyapatites (HA) (slope CHA + 87% vs HA, p < 0.01). Combined, these results contribute to the ability of future studies to elucidate the relationships between carbonate content and fracture and provide insight to the strengths and limitations of FT-IR and Raman spectroscopy of native bone mineral.
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Affiliation(s)
- Erik A Taylor
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Cassidy J Mileti
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Sandhya Ganesan
- Department of Materials Science Engineering, Cornell University, 227 Bard Hall, Ithaca, NY, 14853, USA
| | - Joo Ho Kim
- Department of Materials Science Engineering, Cornell University, 227 Bard Hall, Ithaca, NY, 14853, USA
| | - Eve Donnelly
- Department of Materials Science Engineering, Cornell University, 227 Bard Hall, Ithaca, NY, 14853, USA.
- Research Division, Hospital for Special Surgery, New York, NY, 10021, USA.
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12
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Edwards NJ, Hobson E, Dey D, Rhodes A, Overmann A, Hoyt B, Walsh SA, Pagani CA, Strong AL, Hespe GE, Padmanabhan KR, Huber A, Deng C, Davis TA, Levi B. High Frequency Spectral Ultrasound Imaging Detects Early Heterotopic Ossification in Rodents. Stem Cells Dev 2021; 30:473-484. [PMID: 33715398 PMCID: PMC8106252 DOI: 10.1089/scd.2021.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022] Open
Abstract
Heterotopic ossification (HO) is a devastating condition in which ectopic bone forms inappropriately in soft tissues following traumatic injuries and orthopedic surgeries as a result of aberrant mesenchymal progenitor cell (MPC) differentiation. HO leads to chronic pain, decreased range of motion, and an overall decrease in quality of life. While several treatments have shown promise in animal models, all must be given during early stages of formation. Methods for early determination of whether and where endochondral ossification/soft tissue mineralization (HO anlagen) develop are lacking. At-risk patients are not identified sufficiently early in the process of MPC differentiation and soft tissue endochondral ossification for potential treatments to be effective. Hence, a critical need exists to develop technologies capable of detecting HO anlagen soon after trauma, when treatments are most effective. In this study, we investigate high frequency spectral ultrasound imaging (SUSI) as a noninvasive strategy to identify HO anlagen at early time points after injury. We show that by determining quantitative parameters based on tissue organization and structure, SUSI identifies HO anlagen as early as 1-week postinjury in a mouse model of burn/tenotomy and 3 days postinjury in a rat model of blast/amputation. We analyze single cell RNA sequencing profiles of the MPCs responsible for HO formation and show that the early tissue changes detected by SUSI match chondrogenic and osteogenic gene expression in this population. SUSI identifies sites of soft tissue endochondral ossification at early stages of HO formation so that effective intervention can be targeted when and where it is needed following trauma-induced injury. Furthermore, we characterize the chondrogenic to osteogenic transition that occurs in the MPCs during HO formation and correlate gene expression to SUSI detection of the HO anlagen.
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Affiliation(s)
- Nicole J. Edwards
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Hobson
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Devaveena Dey
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Alisha Rhodes
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Archie Overmann
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Benjamin Hoyt
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sarah A. Walsh
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Chase A. Pagani
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy L. Strong
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Geoffrey E. Hespe
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Amanda Huber
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheri Deng
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas A. Davis
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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13
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Kazezian Z, Bull AMJ. A review of the biomarkers and in vivo models for the diagnosis and treatment of heterotopic ossification following blast and trauma-induced injuries. Bone 2021; 143:115765. [PMID: 33285256 DOI: 10.1016/j.bone.2020.115765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022]
Abstract
Heterotopic ossification (HO) is the process of de novo bone formation in non-osseous tissues. HO can occur following trauma and burns and over 60% of military personnel with blast-associated amputations develop HO. This rate is far higher than in other trauma-induced HO development. This suggests that the blast effect itself is a major contributing factor, but the pathway triggering HO following blast injury specifically is not yet fully identified. Also, because of the difficulty of studying the disease using clinical data, the only sources remain the relevant in vivo models. The aim of this paper is first to review the key biomarkers and signalling pathways identified in trauma and blast induced HO in order to summarize the molecular mechanisms underlying HO development, and second to review the blast injury in vivo models developed. The literature derived from trauma-induced HO suggests that inflammatory cytokines play a key role directing different progenitor cells to transform into an osteogenic class contributing to the development of the disease. This highlights the importance of identifying the downstream biomarkers under specific signalling pathways which might trigger similar stimuli in blast to those of trauma induced formation of ectopic bone in the tissues surrounding the site of the injury. The lack of information in the literature regarding the exact biomarkers leading to blast associated HO is hampering the design of specific therapeutics. The majority of existing blast injury in vivo models do not fully replicate the combat scenario in terms of blast, fracture and amputation; these three usually happen in one insult. Hence, this paper highlights the need to replicate the full effect of the blast in preclinical models to better understand the mechanism of blast induced HO development and to enable the design of a specific therapeutic to supress the formation of ectopic bone.
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Affiliation(s)
- Zepur Kazezian
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom.
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom
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14
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Lin H, Shi F, Jiang S, Wang Y, Zou J, Ying Y, Huang D, Luo L, Yan X, Luo Z. Metformin attenuates trauma-induced heterotopic ossification via inhibition of Bone Morphogenetic Protein signalling. J Cell Mol Med 2020; 24:14491-14501. [PMID: 33169942 PMCID: PMC7754007 DOI: 10.1111/jcmm.16076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/04/2020] [Accepted: 10/25/2020] [Indexed: 11/06/2022] Open
Abstract
AMP‐activated protein kinase (AMPK) is an intracellular sensor of energy homoeostasis that is activated under energy stress and suppressed in energy surplus. AMPK activation leads to inhibition of anabolic processes that consume ATP. Osteogenic differentiation is a process that highly demands ATP during which AMPK is inhibited. The bone morphogenetic proteins (BMPs) signalling pathway plays an essential role in osteogenic differentiation. The present study examines the inhibitory effect of metformin on BMP signalling, osteogenic differentiation and trauma‐induced heterotopic ossification. Our results showed that metformin inhibited Smad1/5 phosphorylation induced by BMP6 in osteoblast MC3T3‐E1 cells, concurrent with up‐regulation of Smad6, and this effect was attenuated by knockdown of Smad6. Furthermore, we found that metformin suppressed ALP activity and mineralization of the cells, an event that was attenuated by the dominant negative mutant of AMPK and mimicked by its constitutively active mutant. Finally, administration of metformin prevented the trauma‐induced heterotopic ossification in mice. In conjuncture, AMPK activity and Smad6 and Smurf1 expression were enhanced by metformin treatment in the muscle of injured area, concurrently with the reduction of ALK2. Collectively, our study suggests that metformin prevents heterotopic ossification via activation of AMPK and subsequent up‐regulation of Smad6. Therefore, metformin could be a potential therapeutic drug for heterotopic ossification induced by traumatic injury.
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Affiliation(s)
- Hui Lin
- Jiangxi Province Key Laboratory of Tumor Pathogenesis and Molecular Pathology and Department of Pathophysiology, School of Basic Medical Sciences, Queen Mary School, Nanchang University, Nanchang, China
| | - Fuli Shi
- Jiangxi Province Key Laboratory of Tumor Pathogenesis and Molecular Pathology and Department of Pathophysiology, School of Basic Medical Sciences, Queen Mary School, Nanchang University, Nanchang, China
| | - Shanshan Jiang
- Institute of Hematological Research, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yuanyuan Wang
- Clinical Systems Biology Laboratory, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Junrong Zou
- Jiangxi Province Key Laboratory of Tumor Pathogenesis and Molecular Pathology and Department of Pathophysiology, School of Basic Medical Sciences, Queen Mary School, Nanchang University, Nanchang, China
| | - Ying Ying
- Jiangxi Province Key Laboratory of Tumor Pathogenesis and Molecular Pathology and Department of Pathophysiology, School of Basic Medical Sciences, Queen Mary School, Nanchang University, Nanchang, China
| | - Deqiang Huang
- Research Institute of Digestive Diseases, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Lingyu Luo
- Research Institute of Digestive Diseases, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Xiaohua Yan
- Institute of Basic Biomedical Sciences and Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Nanchang University, Nanchang, China
| | - Zhijun Luo
- Jiangxi Province Key Laboratory of Tumor Pathogenesis and Molecular Pathology and Department of Pathophysiology, School of Basic Medical Sciences, Queen Mary School, Nanchang University, Nanchang, China
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15
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Thorpe CR, Ucer Ozgurel S, Simko LC, Goldstein R, Grant GG, Pagani C, Hwang C, Vasquez K, Sorkin M, Vaishampayan A, Goverman J, Sheridan RL, Friedstat J, Schulz JT, Schneider JC, Levi B, Ryan CM. Investigation into Possible Association of Oxandrolone and Heterotopic Ossification Following Burn Injury. J Burn Care Res 2020; 40:398-405. [PMID: 31053861 DOI: 10.1093/jbcr/irz063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Oxandrolone, a testosterone analog, is used to counteract the catabolic effects of burn injury. Recent animal studies suggest a possible hormonal association with heterotopic ossification (HO) development postburn. This work examines oxandrolone administration and HO development by exploring historical clinical data bridging the introduction of oxandrolone into clinical practice. Additionally, we examine associations between oxandrolone administration and HO in a standardized mouse model of burn/trauma-related HO. Acutely burned adults admitted between 2000 and 2014, survived through discharge, and had a HO risk factor of 7 or higher were selected for analysis from a single burn center. Oxandrolone administration, clinical and demographic data, and elbow HO were recorded and were analyzed with logistic regression. Associations of oxandrolone with HO were examined in a mouse model. Mice were administered oxandrolone or vehicle control following burn/tenotomy to examine any potential effect of oxandrolone on HO and were analyzed by Student's t test. Subjects who received oxandrolone had a higher incidence of elbow HO than those that did not receive oxandrolone. However, when controlling for oxandrolone administration, oxandrolone duration, postburn day oxandrolone initiation, HO risk score category, age, sex, race, burn size, and year of injury, there was no significant difference between rates of elbow HO between the two populations. In agreement with the review, in the mouse model, while there was a trend toward the oxandrolone group developing a greater volume of HO, this did not reach statistical significance.
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Affiliation(s)
- Catherine R Thorpe
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | - Laura C Simko
- Shriners Hospitals for Children-Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | | | - Gabrielle G Grant
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | | | | | | | | | - Jeremy Goverman
- Massachusetts General Hospital, Boston.,Harvard Medical School, Cambridge, Massachusetts
| | - Robert L Sheridan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jonathan Friedstat
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - John T Schulz
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jeffrey C Schneider
- Massachusetts General Hospital, Boston.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Benjamin Levi
- Shriners Hospitals for Children-Boston, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
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16
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Huber AK, Patel N, Pagani CA, Marini S, Padmanabhan KR, Matera DL, Said M, Hwang C, Hsu GCY, Poli AA, Strong AL, Visser ND, Greenstein JA, Nelson R, Li S, Longaker MT, Tang Y, Weiss SJ, Baker BM, James AW, Levi B. Immobilization after injury alters extracellular matrix and stem cell fate. J Clin Invest 2020; 130:5444-5460. [PMID: 32673290 PMCID: PMC7524473 DOI: 10.1172/jci136142] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
Cells sense the extracellular environment and mechanical stimuli and translate these signals into intracellular responses through mechanotransduction, which alters cell maintenance, proliferation, and differentiation. Here we use a mouse model of trauma-induced heterotopic ossification (HO) to examine how cell-extrinsic forces impact mesenchymal progenitor cell (MPC) fate. After injury, single-cell (sc) RNA sequencing of the injury site reveals an early increase in MPC genes associated with pathways of cell adhesion and ECM-receptor interactions, and MPC trajectories to cartilage and bone. Immunostaining uncovers active mechanotransduction after injury with increased focal adhesion kinase signaling and nuclear translocation of transcriptional coactivator TAZ, inhibition of which mitigates HO. Similarly, joint immobilization decreases mechanotransductive signaling, and completely inhibits HO. Joint immobilization decreases collagen alignment and increases adipogenesis. Further, scRNA sequencing of the HO site after injury with or without immobilization identifies gene signatures in mobile MPCs correlating with osteogenesis, and signatures from immobile MPCs with adipogenesis. scATAC-seq in these same MPCs confirm that in mobile MPCs, chromatin regions around osteogenic genes are open, whereas in immobile MPCs, regions around adipogenic genes are open. Together these data suggest that joint immobilization after injury results in decreased ECM alignment, altered MPC mechanotransduction, and changes in genomic architecture favoring adipogenesis over osteogenesis, resulting in decreased formation of HO.
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MESH Headings
- Acyltransferases
- Adipogenesis/genetics
- Animals
- Cell Differentiation
- Cell Lineage
- Disease Models, Animal
- Extracellular Matrix/metabolism
- Extremities/injuries
- Focal Adhesion Kinase 1/deficiency
- Focal Adhesion Kinase 1/genetics
- Focal Adhesion Kinase 1/metabolism
- Humans
- Male
- Mechanotransduction, Cellular/genetics
- Mechanotransduction, Cellular/physiology
- Mesenchymal Stem Cells/pathology
- Mesenchymal Stem Cells/physiology
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Ossification, Heterotopic/etiology
- Ossification, Heterotopic/pathology
- Ossification, Heterotopic/physiopathology
- Osteogenesis/genetics
- Restraint, Physical/adverse effects
- Restraint, Physical/physiology
- Signal Transduction/genetics
- Signal Transduction/physiology
- Transcription Factors/genetics
- Transcription Factors/metabolism
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Affiliation(s)
| | - Nicole Patel
- Section of Plastic Surgery, Department of Surgery
| | | | | | | | - Daniel L Matera
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Mohamed Said
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Andrea A Poli
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery
| | | | | | | | - Shuli Li
- Section of Plastic Surgery, Department of Surgery
| | - Michael T Longaker
- Institute for Stem Cell Biology and Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Yi Tang
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen J Weiss
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Brendon M Baker
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
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17
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Hsu GCY, Marini S, Negri S, Wang Y, Xu J, Pagani C, Hwang C, Stepien D, Meyers CA, Miller S, McCarthy E, Lyons KM, Levi B, James AW. Endogenous CCN family member WISP1 inhibits trauma-induced heterotopic ossification. JCI Insight 2020; 5:135432. [PMID: 32484792 DOI: 10.1172/jci.insight.135432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/21/2020] [Indexed: 12/26/2022] Open
Abstract
Heterotopic ossification (HO) is defined as abnormal differentiation of local stromal cells of mesenchymal origin, resulting in pathologic cartilage and bone matrix deposition. Cyr61, CTGF, Nov (CCN) family members are matricellular proteins that have diverse regulatory functions on cell proliferation and differentiation, including the regulation of chondrogenesis. However, little is known regarding CCN family member expression or function in HO. Here, a combination of bulk and single-cell RNA sequencing defined the dynamic temporospatial pattern of CCN family member induction within a mouse model of trauma-induced HO. Among CCN family proteins, Wisp1 (also known as Ccn4) was most upregulated during the evolution of HO, and Wisp1 expression corresponded with chondrogenic gene profile. Immunohistochemistry confirmed WISP1 expression across traumatic and genetic HO mouse models as well as in human HO samples. Transgenic Wisp1LacZ/LacZ knockin animals showed an increase in endochondral ossification in HO after trauma. Finally, the transcriptome of Wisp1-null tenocytes revealed enrichment in signaling pathways, such as the STAT3 and PCP signaling pathways, that may explain increased HO in the context of Wisp1 deficiency. In sum, CCN family members, and in particular Wisp1, are spatiotemporally associated with and negatively regulate trauma-induced HO formation.
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Affiliation(s)
| | - Simone Marini
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Stefano Negri
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yiyun Wang
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jiajia Xu
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chase Pagani
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles Hwang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - David Stepien
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn A Meyers
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarah Miller
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edward McCarthy
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karen M Lyons
- Orthopaedic Hospital Research Center, University of California, Los Angeles, Los Angeles, California, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.,Orthopaedic Hospital Research Center, University of California, Los Angeles, Los Angeles, California, USA
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18
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Abazari M, Ghaffari A, Rashidzadeh H, Badeleh SM, Maleki Y. A Systematic Review on Classification, Identification, and Healing Process of Burn Wound Healing. INT J LOW EXTR WOUND 2020; 21:18-30. [PMID: 32524874 DOI: 10.1177/1534734620924857] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Because of the intrinsic complexity, the classification of wounds is important for the diagnosis, management, and choosing the correct treatment based on wound type. Generally, burn injuries are classified as a class of wounds in which injury is caused by heat, cold, electricity, chemicals, friction, or radiation. On the other hand, wound healing is a complex process, and understanding the biological trend of this process and differences in the healing process of different wounds could reduce the possible risk in many cases and greatly reduce the future damage to the injured tissue and other organs. The aim of this review is to provide a general perspective for the burn wound location among the other types of injuries and summarizing as well as highlighting the differences of these types of wounds with emphasizing on factors affecting thereof.
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Affiliation(s)
| | | | | | | | - Yaser Maleki
- Institute for Advanced Studies in Basic Sciences. Zanjan, Iran
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19
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Sorkin M, Huber AK, Hwang C, Carson WF, Menon R, Li J, Vasquez K, Pagani C, Patel N, Li S, Visser ND, Niknafs Y, Loder S, Scola M, Nycz D, Gallagher K, McCauley LK, Xu J, James AW, Agarwal S, Kunkel S, Mishina Y, Levi B. Regulation of heterotopic ossification by monocytes in a mouse model of aberrant wound healing. Nat Commun 2020; 11:722. [PMID: 32024825 PMCID: PMC7002453 DOI: 10.1038/s41467-019-14172-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 12/13/2019] [Indexed: 11/08/2022] Open
Abstract
Heterotopic ossification (HO) is an aberrant regenerative process with ectopic bone induction in response to musculoskeletal trauma, in which mesenchymal stem cells (MSC) differentiate into osteochondrogenic cells instead of myocytes or tenocytes. Despite frequent cases of hospitalized musculoskeletal trauma, the inflammatory responses and cell population dynamics that regulate subsequent wound healing and tissue regeneration are still unclear. Here we examine, using a mouse model of trauma-induced HO, the local microenvironment of the initial post-injury inflammatory response. Single cell transcriptome analyses identify distinct monocyte/macrophage populations at the injury site, with their dynamic changes over time elucidated using trajectory analyses. Mechanistically, transforming growth factor beta-1 (TGFβ1)-producing monocytes/macrophages are associated with HO and aberrant chondrogenic progenitor cell differentiation, while CD47-activating peptides that reduce systemic macrophage TGFβ levels and help ameliorate HO. Our data thus implicate CD47 activation as a therapeutic approach for modulating monocyte/macrophage phenotypes, MSC differentiation and HO formation during wound healing.
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Affiliation(s)
- Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Amanda K Huber
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Charles Hwang
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - William F Carson
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Rajasree Menon
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - John Li
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Kaetlin Vasquez
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Chase Pagani
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Nicole Patel
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Shuli Li
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Noelle D Visser
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Yashar Niknafs
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Shawn Loder
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Melissa Scola
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Dylan Nycz
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Katherine Gallagher
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Laurie K McCauley
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jiajia Xu
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Shailesh Agarwal
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Stephen Kunkel
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Yuji Mishina
- Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Benjamin Levi
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA.
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20
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Al-Rifai R, Tournois C, Kheirallah S, Bouland N, Poitevin G, Nguyen P, Beljebbar A. Subcutaneous and transcutaneous monitoring of murine hindlimb ischemia by in vivo Raman spectroscopy. Analyst 2019; 144:4677-4686. [PMID: 31268052 DOI: 10.1039/c8an02449a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We have investigated the development of murine hindlimb ischemia from day 1 to day 55 after femoral artery ligation (FAL) using blood flow analysis, functional tests, histopathological staining, and in vivo Raman spectroscopy. FAL resulted in hindlimb blood deprivation and the loss of functionality as attested by the blood flow analysis and functional tests, respectively. The limbs recovered a normal circulation progressively without recovering complete functionality. Histological analysis showed changes in the morphology of muscle fibers with intense inflammation. From day 22 to day 55 post-ischemia, regeneration of the myofibers was observed. Raman spectroscopic results related to subcutaneous analysis made the identification of modification in the biochemical constituents of hindlimb muscles possible during disease progression. Ischemia was characterized by a quantitative increase in the lipid content and a decrease in the protein content. The lipid to protein ratio can be used as a spectroscopic marker to score the severity of ischemia. Multivariate statistical analysis PC-LDA (Principal Component-Linear Discriminant Analysis) was used to classify all the data measured for the normal and ischemic tissues. This classification illustrated an excellent separation between the control and ischemic tissues at any time during the course of ischemic development. In vivo Raman spectroscopy was then applied to assess the potential of this technique as a screening tool to explore an ischemic disease non-invasively (transcutaneously). For this purpose, the influence of skin on the diagnostic accuracy was evaluated; transcutaneous analysis revealed the accuracy of this technique, indicating its potential in the in situ monitoring of muscle structural changes during ischemia.
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Affiliation(s)
- Rida Al-Rifai
- EA 3801, SFR CAP-Santé, Université de Reims Champagne-Ardenne, France
| | - Claire Tournois
- EA 3801, SFR CAP-Santé, Université de Reims Champagne-Ardenne, France and Laboratoire d'Hématologie, CHU Robert Debré, Reims, France
| | | | - Nicole Bouland
- Laboratoire d'Anatomopathologie, Université de Reims Champagne-Ardenne, France
| | - Gaël Poitevin
- EA 3801, SFR CAP-Santé, Université de Reims Champagne-Ardenne, France
| | - Philippe Nguyen
- EA 3801, SFR CAP-Santé, Université de Reims Champagne-Ardenne, France and Laboratoire d'Hématologie, CHU Robert Debré, Reims, France
| | - Abdelilah Beljebbar
- BioSpectroscopie Translationnelle BioSpecT, EA 7506, Université de Reims Champagne-Ardenne, France.
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21
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Bigelow EM, Patton DM, Ward FS, Ciarelli A, Casden M, Clark A, Goulet RW, Morris MD, Schlecht SH, Mandair GS, Bredbenner TL, Kohn DH, Jepsen KJ. External Bone Size Is a Key Determinant of Strength-Decline Trajectories of Aging Male Radii. J Bone Miner Res 2019; 34:825-837. [PMID: 30715752 PMCID: PMC6536328 DOI: 10.1002/jbmr.3661] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/06/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Given prior work showing associations between remodeling and external bone size, we tested the hypothesis that wide bones would show a greater negative correlation between whole-bone strength and age compared with narrow bones. Cadaveric male radii (n = 37 pairs, 18 to 89 years old) were evaluated biomechanically, and samples were sorted into narrow and wide subgroups using height-adjusted robustness (total area/bone length). Strength was 54% greater (p < 0.0001) in wide compared with narrow radii for young adults (<40 years old). However, the greater strength of young-adult wide radii was not observed for older wide radii, as the wide (R2 = 0.565, p = 0.001), but not narrow (R2 = 0.0004, p = 0.944) subgroup showed a significant negative correlation between strength and age. Significant positive correlations between age and robustness (R2 = 0.269, p = 0.048), cortical area (Ct.Ar; R2 = 0.356, p = 0.019), and the mineral/matrix ratio (MMR; R2 = 0.293, p = 0.037) were observed for narrow, but not wide radii (robustness: R2 = 0.015, p = 0.217; Ct.Ar: R2 = 0.095, p = 0.245; MMR: R2 = 0.086, p = 0.271). Porosity increased with age for the narrow (R2 = 0.556, p = 0.001) and wide (R2 = 0.321, p = 0.022) subgroups. The wide subgroup (p < 0.0001) showed a significantly greater elevation of a new measure called the Cortical Pore Score, which quantifies the cumulative effect of pore size and location, indicating that porosity had a more deleterious effect on strength for wide compared with narrow radii. Thus, the divergent strength-age regressions implied that narrow radii maintained a low strength with aging by increasing external size and mineral content to mechanically offset increases in porosity. In contrast, the significant negative strength-age correlation for wide radii implied that the deleterious effect of greater porosity further from the centroid was not offset by changes in outer bone size or mineral content. Thus, the low strength of elderly male radii arose through different biomechanical mechanisms. Consideration of different strength-age regressions (trajectories) may inform clinical decisions on how best to treat individuals to reduce fracture risk. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Erin Mr Bigelow
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Daniella M Patton
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ferrous S Ward
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Antonio Ciarelli
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Michael Casden
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Clark
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Robert W Goulet
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael D Morris
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | | | - Gurjit S Mandair
- Biological and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Todd L Bredbenner
- Department of Mechanical and Aerospace Engineering, University of Colorado-Colorado Springs, Colorado Springs, CO, USA
| | - David H Kohn
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biological and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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22
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Meyers C, Lisiecki J, Miller S, Levin A, Fayad L, Ding C, Sono T, McCarthy E, Levi B, James AW. Heterotopic Ossification: A Comprehensive Review. JBMR Plus 2019; 3:e10172. [PMID: 31044187 PMCID: PMC6478587 DOI: 10.1002/jbm4.10172] [Citation(s) in RCA: 245] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/31/2018] [Accepted: 01/13/2019] [Indexed: 12/17/2022] Open
Abstract
Heterotopic ossification (HO) is a diverse pathologic process, defined as the formation of extraskeletal bone in muscle and soft tissues. HO can be conceptualized as a tissue repair process gone awry and is a common complication of trauma and surgery. This comprehensive review seeks to synthesize the clinical, pathoetiologic, and basic biologic features of HO, including nongenetic and genetic forms. First, the clinical features, radiographic appearance, histopathologic diagnosis, and current methods of treatment are discussed. Next, current concepts regarding the mechanistic bases for HO are discussed, including the putative cell types responsible for HO formation, the inflammatory milieu and other prerequisite “niche” factors for HO initiation and propagation, and currently available animal models for the study of HO of this common and potentially devastating condition. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Carolyn Meyers
- Department of Pathology Johns Hopkins University Baltimore MD USA
| | | | - Sarah Miller
- Department of Pathology Johns Hopkins University Baltimore MD USA
| | - Adam Levin
- Department of Orthopaedic Surgery Johns Hopkins University Baltimore MD USA
| | - Laura Fayad
- Department of Radiology Johns Hopkins University Baltimore MD USA
| | - Catherine Ding
- UCLA and Orthopaedic Hospital Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center Los Angeles CA USA
| | - Takashi Sono
- Department of Pathology Johns Hopkins University Baltimore MD USA
| | - Edward McCarthy
- Department of Pathology Johns Hopkins University Baltimore MD USA
| | - Benjamin Levi
- Department of Surgery University of Michigan Ann Arbor MI USA
| | - Aaron W James
- Department of Pathology Johns Hopkins University Baltimore MD USA.,UCLA and Orthopaedic Hospital Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center Los Angeles CA USA
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23
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Classification of burn injury using Raman spectroscopy and optical coherence tomography: An ex-vivo study on porcine skin. Burns 2018; 45:659-670. [PMID: 30385061 DOI: 10.1016/j.burns.2018.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/16/2018] [Accepted: 10/04/2018] [Indexed: 11/20/2022]
Abstract
Accurate depth assessment of burn wounds is a critical task to provide the right treatment and care. Currently, laser Doppler imaging is able to provide better accuracy compared to the standard clinical evaluation. However, its clinical applicability is limited by factors like scanning distance, time, and cost. Precise diagnosis of burns requires adequate structural and functional details. In this work, we evaluated the combined potential of two non-invasive optical modalities, optical coherence tomography (OCT) and Raman spectroscopy (RS), to identify degrees of burn wounds (superficial partial-thickness (SPT), deep partial-thickness (DPT), and full-thickness (FT)). OCT provides morphological information, whereas, RS provides biochemical aspects. OCT images and Raman spectra were obtained from burns created on ex-vivo porcine skin. Algorithms were developed to segment skin region and extract textural features from OCT images, and derive spectral wave features from RS. These computed features were fed into machine learning classifiers for categorization of burns. Histological results obtained from trichrome staining were used as ground-truth. The combined performance of RS-OCT reported an overall average accuracy of 85% and ROC-AUC=0.94, in distinguishing the burn wounds. The significant performance on ex vivo skin motivates to assess the feasibility of combined RS-OCT in in vivo models.
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24
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Pahlow S, Weber K, Popp J, Wood BR, Kochan K, Rüther A, Perez-Guaita D, Heraud P, Stone N, Dudgeon A, Gardner B, Reddy R, Mayerich D, Bhargava R. Application of Vibrational Spectroscopy and Imaging to Point-of-Care Medicine: A Review. APPLIED SPECTROSCOPY 2018; 72:52-84. [PMID: 30265133 PMCID: PMC6524782 DOI: 10.1177/0003702818791939] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Susanne Pahlow
- Friedrich Schiller University Jena, Institute of Physical Chemistry and Abbe Center of Photonics, Jena, Germany
- InfectoGnostics Research Campus Jena, Centre for Applied Research, Jena, Germany
| | - Karina Weber
- Friedrich Schiller University Jena, Institute of Physical Chemistry and Abbe Center of Photonics, Jena, Germany
- InfectoGnostics Research Campus Jena, Centre for Applied Research, Jena, Germany
- Leibniz Institute of Photonic Technology-Leibniz Health Technologies, Jena, Germany
| | - Jürgen Popp
- Friedrich Schiller University Jena, Institute of Physical Chemistry and Abbe Center of Photonics, Jena, Germany
- InfectoGnostics Research Campus Jena, Centre for Applied Research, Jena, Germany
- Leibniz Institute of Photonic Technology-Leibniz Health Technologies, Jena, Germany
| | - Bayden R. Wood
- Centre for Biospectroscopy, School of Chemistry, Monash University, Clayton, Victoria, Australia
| | - Kamila Kochan
- Centre for Biospectroscopy, School of Chemistry, Monash University, Clayton, Victoria, Australia
| | - Anja Rüther
- Centre for Biospectroscopy, School of Chemistry, Monash University, Clayton, Victoria, Australia
| | - David Perez-Guaita
- Centre for Biospectroscopy, School of Chemistry, Monash University, Clayton, Victoria, Australia
| | - Philip Heraud
- Centre for Biospectroscopy, School of Chemistry, Monash University, Clayton, Victoria, Australia
| | - Nick Stone
- University of Exeter, School of Physics and Astronomy, Exeter, UK
| | - Alex Dudgeon
- University of Exeter, School of Physics and Astronomy, Exeter, UK
| | - Ben Gardner
- University of Exeter, School of Physics and Astronomy, Exeter, UK
| | - Rohith Reddy
- Department of Electrical Engineering, University of Houston, Houston, USA
| | - David Mayerich
- Department of Electrical Engineering, University of Houston, Houston, USA
| | - Rohit Bhargava
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign, Departments of Mechanical Engineering, Bioengineering, Chemical and Biomolecular Engineering, Electrical and Computer Engineering, and Chemistry, University of Illinois at Urbana-Champaign, Urbana, USA
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25
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Ranganathan K, Hong X, Cholok D, Habbouche J, Priest C, Breuler C, Chung M, Li J, Kaura A, Hsieh HHS, Butts J, Ucer S, Schwartz E, Buchman SR, Stegemann JP, Deng CX, Levi B. High-frequency spectral ultrasound imaging (SUSI) visualizes early post-traumatic heterotopic ossification (HO) in a mouse model. Bone 2018; 109:49-55. [PMID: 29412179 PMCID: PMC5955392 DOI: 10.1016/j.bone.2018.01.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Early treatment of heterotopic ossification (HO) is currently limited by delayed diagnosis due to limited visualization at early time points. In this study, we validate the use of spectral ultrasound imaging (SUSI) in an animal model to detect HO as early as one week after burn tenotomy. METHODS Concurrent SUSI, micro CT, and histology at 1, 2, 4, and 9weeks post-injury were used to follow the progression of HO after an Achilles tenotomy and 30% total body surface area burn (n=3-5 limbs per time point). To compare the use of SUSI in different types of injury models, mice (n=5 per group) underwent either burn/tenotomy or skin incision injury and were imaged using a 55MHz probe on VisualSonics VEVO 770 system at one week post injury to evaluate the ability of SUSI to distinguish between edema and HO. Average acoustic concentration (AAC) and average scatterer diameter (ASD) were calculated for each ultrasound image frame. Micro CT was used to calculate the total volume of HO. Histology was used to confirm bone formation. RESULTS Using SUSI, HO was visualized as early as 1week after injury. HO was visualized earliest by 4weeks after injury by micro CT. The average acoustic concentration of HO was 33% more than that of the control limb (n=5). Spectroscopic foci of HO present at 1week that persisted throughout all time points correlated with the HO present at 9weeks on micro CT imaging. CONCLUSION SUSI visualizes HO as early as one week after injury in an animal model. SUSI represents a new imaging modality with promise for early diagnosis of HO.
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Affiliation(s)
- Kavitha Ranganathan
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Xiaowei Hong
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - David Cholok
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Joe Habbouche
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Caitlin Priest
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael Chung
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - John Li
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Arminder Kaura
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Jonathan Butts
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Serra Ucer
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ean Schwartz
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven R Buchman
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jan P Stegemann
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Cheri X Deng
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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26
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Wheatley BM, Cilwa KE, Dey D, Qureshi AT, Seavey JG, Tomasino AM, Sanders EM, Bova W, Boehm CA, Iwamoto M, Potter BK, Forsberg JA, Muschler GF, Davis TA. Palovarotene inhibits connective tissue progenitor cell proliferation in a rat model of combat-related heterotopic ossification. J Orthop Res 2018; 36:1135-1144. [PMID: 28960501 DOI: 10.1002/jor.23747] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/20/2017] [Indexed: 02/04/2023]
Abstract
Heterotopic ossification (HO) develops in the extremities of wounded service members and is common in the setting of high-energy penetrating injuries and blast-related amputations. No safe and effective prophylaxis modality has been identified for this patient population. Palovarotene has been shown to reduce bone formation in traumatic and genetic models of HO. The purpose of this study was to determine the effects of Palovarotene on inflammation, progenitor cell proliferation, and gene expression following a blast-related amputation in a rodent model (n = 72 animals), as well as the ability of Raman spectroscopy to detect early HO before radiographic changes are present. Treatment with Palovarotene was found to dampen the systemic inflammatory response including the cytokines IL-6 (p = 0.01), TNF-α (p = 0.001), and IFN-γ (p = 0.03) as well as the local inflammatory response via a 76% reduction in the cellular infiltration at post-operative day (POD)-7 (p = 0.03). Palovarotene decreased osteogenic connective tissue progenitor (CTP-O) colonies by as much as 98% both in vitro (p = 0.04) and in vivo (p = 0.01). Palovarotene treated animals exhibited significantly decreased expression of osteo- and chondrogenic genes by POD-7, including BMP4 (p = 0.02). Finally, Raman spectroscopy was able to detect differences between the two groups by POD-1 (p < 0.001). These results indicate that Palovarotene inhibits traumatic HO formation through multiple inter-related mechanisms including anti-inflammatory, anti-proliferative, and gene expression modulation. Further, that Raman spectroscopy is able to detect markers of early HO formation before it becomes radiographically evident, which could facilitate earlier diagnosis and treatment. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1135-1144, 2018.
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Affiliation(s)
- Benjamin M Wheatley
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, Maryland
| | - Katherine E Cilwa
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Devaveena Dey
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Ammar T Qureshi
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Jonathan G Seavey
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, Maryland
| | - Allison M Tomasino
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Erin M Sanders
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Wesley Bova
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Cynthia A Boehm
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Masahiro Iwamoto
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - Benjamin K Potter
- Orthopaedics, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, Maryland
| | - Jonathan A Forsberg
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, Maryland
| | - George F Muschler
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Thomas A Davis
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, Maryland
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27
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Brady RD, Shultz SR, McDonald SJ, O'Brien TJ. Neurological heterotopic ossification: Current understanding and future directions. Bone 2018; 109:35-42. [PMID: 28526267 DOI: 10.1016/j.bone.2017.05.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 12/30/2022]
Abstract
Neurological heterotopic ossification (NHO) involves the formation of bone in soft tissue following a neurological condition, of which the most common are brain and spinal cord injuries. NHO often forms around the hip, knee and shoulder joints, causing severe pain and joint deformation which is associated with significant morbidity and reduced quality of life. The cellular and molecular events that initiate NHO have been the focus of an increasing number of human and animal studies over the past decade, with this work largely driven by the need to unearth potential therapeutic interventions to prevent the formation of NHO. This review provides an overview of the present understanding of NHO pathogenesis and pathobiology, current treatments, novel therapeutic targets, potential biomarkers and future directions.
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Affiliation(s)
- Rhys D Brady
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC, 3010, Australia.
| | - Sandy R Shultz
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC, 3010, Australia
| | - Stuart J McDonald
- Department of Physiology, Anatomy and Microbiology, La Trobe University, VIC, 3086, Australia
| | - Terence J O'Brien
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC, 3010, Australia
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28
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Cholok D, Chung MT, Ranganathan K, Ucer S, Day D, Davis TA, Mishina Y, Levi B. Heterotopic ossification and the elucidation of pathologic differentiation. Bone 2018; 109:12-21. [PMID: 28987285 PMCID: PMC6585944 DOI: 10.1016/j.bone.2017.09.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 01/23/2023]
Abstract
Tissue regeneration following acute or persistent inflammation can manifest a spectrum of phenotypes ranging from the adaptive to the pathologic. Heterotopic Ossification (HO), the endochondral formation of bone within soft-tissue structures following severe injury serves as a prominent example of pathologic differentiation; and remains a persistent clinical issue incurring significant patient morbidity and expense to adequately diagnose and treat. The pathogenesis of HO provides an intriguing opportunity to better characterize the cellular and cell-signaling contributors to aberrant differentiation. Indeed, recent work has continued to resolve the unique cellular lineages, and causative pathways responsible for ectopic bone development yielding promising avenues for the development of novel therapeutic strategies shown to be successful in analogous animal models of HO development. This review details advances in the understanding of HO in the context of inciting inflammation, and explains how these advances inform the current standards of diagnosis and treatment.
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Affiliation(s)
- David Cholok
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael T Chung
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Kavitha Ranganathan
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Serra Ucer
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Devaveena Day
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, USA
| | - Thomas A Davis
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, USA; Department of Surgery, Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Yuji Mishina
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
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Taylor EA, Lloyd AA, Salazar-Lara C, Donnelly E. Raman and Fourier Transform Infrared (FT-IR) Mineral to Matrix Ratios Correlate with Physical Chemical Properties of Model Compounds and Native Bone Tissue. APPLIED SPECTROSCOPY 2017; 71:2404-2410. [PMID: 28485618 DOI: 10.1177/0003702817709286] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Raman and Fourier transform infrared (FT-IR) spectroscopic imaging techniques can be used to characterize bone composition. In this study, our objective was to validate the Raman mineral:matrix ratios (ν1 PO4:amide III, ν1 PO4:amide I, ν1 PO4:Proline + hydroxyproline, ν1 PO4:Phenylalanine, ν1 PO4:δ CH2 peak area ratios) by correlating them to ash fraction and the IR mineral:matrix ratio (ν3 PO4:amide I peak area ratio) in chemical standards and native bone tissue. Chemical standards consisting of varying ratios of synthetic hydroxyapatite (HA) and collagen, as well as bone tissue from humans, sheep, and mice, were characterized with confocal Raman spectroscopy and FT-IR spectroscopy and gravimetric analysis. Raman and IR mineral:matrix ratio values from chemical standards increased reciprocally with ash fraction (Raman ν1 PO4/Amide III: P < 0.01, R2 = 0.966; Raman ν1 PO4/Amide I: P < 0.01, R2 = 0.919; Raman ν1 PO4/Proline + Hydroxyproline: P < 0.01, R2 = 0.976; Raman ν1 PO4/Phenylalanine: P < 0.01, R2 = 0.911; Raman ν1 PO4/δ CH2: P < 0.01, R2 = 0.894; IR P < 0.01, R2 = 0.91). Fourier transform infrared mineral:matrix ratio values from native bone tissue were also similar to theoretical mineral:matrix ratio values for a given ash fraction. Raman and IR mineral:matrix ratio values were strongly correlated ( P < 0.01, R2 = 0.82). These results were confirmed by calculating the mineral:matrix ratio for theoretical IR spectra, developed by applying the Beer-Lambert law to calculate the relative extinction coefficients of HA and collagen over the same range of wavenumbers (800-1800 cm-1). The results confirm that the Raman mineral:matrix bone composition parameter correlates strongly to ash fraction and to its IR counterpart. Finally, the mineral:matrix ratio values of the native bone tissue are similar to those of both chemical standards and theoretical values, confirming the biological relevance of the chemical standards and the characterization techniques.
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Affiliation(s)
- Erik A Taylor
- 1 Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Ashley A Lloyd
- 2 Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Carolina Salazar-Lara
- 2 Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Eve Donnelly
- 2 Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
- 3 Hospital for Special Surgery, New York, NY, USA
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Heterotopic Ossification Encountered During a Complex Ventral Hernia Repair: Case Report and Literature Review. EPLASTY 2017; 17:e29. [PMID: 29062460 PMCID: PMC5638962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: Heterotopic ossification involves the formation of trabecular bone outside of its usual anatomic location. While it is a well-known entity in orthopedic and spinal injury literature, it has also been observed after midline laparotomy and severe burns. Methods/Case Report: We present a case of a 69-year-old man who presented for ventral hernia repair after a prolonged postoperative course following colectomy involving an open abdomen with eventual closure with skin grafting. Results: Two large calcified objects were encountered during the excision of the skin graft from the small intestine and during the component separation. They had grown into the anterior fascia and rectus muscle and interdigitated between loops of the small bowel. After careful resection of the 2 calcified objects, a ventral hernia repair with a component separation was successfully performed. Pathology was consistent with heterotopic ossification. After 18 months, there was no clinical evidence of recurrence. Discussion: Heterotopic ossification is not frequently encountered during ventral hernia repairs, but its presence can complicate repair. Resection is the only option in the context of hernia repair. If recognized preoperatively, waiting up to a year for the bone to mature before excision has been suggested, but there is minimal data to support this. Consultation with a general surgeon is also advised in case the calcified tissue involves the underlying viscera.
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Narayanan A, Khanchandani P, Borkar RM, Ambati CR, Roy A, Han X, Bhoskar RN, Ragampeta S, Gannon F, Mysorekar V, Karanam B, V SM, Sivaramakrishnan V. Avascular Necrosis of Femoral Head: A Metabolomic, Biophysical, Biochemical, Electron Microscopic and Histopathological Characterization. Sci Rep 2017; 7:10721. [PMID: 28878383 PMCID: PMC5587540 DOI: 10.1038/s41598-017-10817-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/14/2017] [Indexed: 12/29/2022] Open
Abstract
Avascular necrosis of the femur head (AVNFH) is a debilitating disease caused due to the use of alcohol, steroids, following trauma or unclear (idiopathic) etiology, affecting mostly the middle aged population. Clinically AVNFH is associated with impaired blood supply to the femoral head resulting in bone necrosis and collapse. Although Homocysteine (HC) has been implicated in AVNFH, levels of homocysteine and its associated pathway metabolites have not been characterized. We demonstrate elevated levels of homocysteine and concomitantly reduced levels of vitamins B6 and B12, in plasma of AVNFH patients. AVNFH patients also had elevated blood levels of sodium and creatinine, and reduced levels of random glucose and haemoglobin. Biophysical and ultrastructural analysis of AVNFH bone revealed increased remodelling and reduced bone mineral density portrayed by increased carbonate to phosphate ratio and decreased Phosphate to amide ratio together with disrupted trabeculae, loss of osteocytes, presence of calcified marrow, and elevated expression of osteocalcin in the osteoblasts localized in necrotic regions. Taken together, our studies for the first time characterize the metabolomic, pathophysiological and morphometric changes associated with AVNFH providing insights for development of new markers and therapeutic strategies for this debilitating disorder.
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Affiliation(s)
- Aswath Narayanan
- Disease Biology Lab, Department of Biosciences, Sri Sathya Sai Institute for Higher Learning, Prasanthi Nilayam, Puttaparthi, Anantapur District, Andhra Pradesh, India
| | - Prakash Khanchandani
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi, Anantapur District, Andhra Pradesh, India.
| | - Roshan M Borkar
- National Centre for Mass Spectrometry, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
| | | | - Arun Roy
- Raman Research Institute, C.V Raman Avenue, Sadashivanagar, Bengaluru, Karnataka, India
| | - Xu Han
- Jan and Dan Duncan Neurological Research Institute, Baylor College of Medicine, One Baylor Plaza, Houston, 77030, United States
| | - Ritesh N Bhoskar
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi, Anantapur District, Andhra Pradesh, India
| | - Srinivas Ragampeta
- National Centre for Mass Spectrometry, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
| | - Francis Gannon
- Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, 77030, United States
- Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, United States
| | - Vijaya Mysorekar
- Department of Pathology, M. S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Balasubramanyam Karanam
- Department of Biology and Cancer Research, 1200, W. Montgomery Rd, Tuskegee University, Tuskegee, AL, 36088, United States
| | - Sai Muthukumar V
- Department of Physics, Sri Sathya Sai Institute for Higher Learning, Prasanthi Nilayam, Puttaparthi, Anantapur District, Andhra Pradesh, India
| | - Venketesh Sivaramakrishnan
- Disease Biology Lab, Department of Biosciences, Sri Sathya Sai Institute for Higher Learning, Prasanthi Nilayam, Puttaparthi, Anantapur District, Andhra Pradesh, India.
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Abstract
OBJECTIVE The purpose of this study is to develop a scoring system that stratifies burn patients at the time of hospital admission according to risk of developing heterotopic ossification (HO). SUMMARY OF BACKGROUND DATA HO in burns is an uncommon but severely debilitating problem with a poorly understood mechanism and no fully effective prophylactic measures. METHODS Data were obtained from the Burn Model System National Database from 1994 to 2010 (n = 3693). The primary outcome is diagnosis of HO at hospital discharge. Logistic regression analysis was used to determine significant demographic and medical predictors of HO. A risk scoring system was created in which point values were assigned to predictive factors and final risk score is correlated with the percent risk of developing HO. The model was internally and externally validated. RESULTS The mean age of the subjects is 42.5 ± 16.0 years, the mean total body surface area (TBSA) burned is 18.5 ± 16.4%, and the population is 74.9% male. TBSA and the need for grafting of the arm, head/neck, and trunk were significant predictors of HO development (P < 0.01). A 13-point risk scoring system was developed using these significant predictors. The model c-statistic is 0.92. The risk scoring system demonstrated evidence of internal and external validity. An online calculator was developed to facilitate translation of knowledge to practice and research. CONCLUSIONS This HO risk scoring system identifies high-risk burn patients suitable for diagnostic testing and interventional HO prophylaxis trials.
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The traumatic bone: trauma-induced heterotopic ossification. Transl Res 2017; 186:95-111. [PMID: 28668522 PMCID: PMC6715128 DOI: 10.1016/j.trsl.2017.06.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 01/08/2023]
Abstract
Heterotopic ossification (HO) is a common occurrence after multiple forms of extensive trauma. These include arthroplasties, traumatic brain and spinal cord injuries, extensive burns in the civilian setting, and combat-related extremity injuries in the battlefield. Irrespective of the form of trauma, heterotopic bone is typically endochondral in structure and is laid down via a cartilaginous matrix. Once formed, the heterotopic bone typically needs to be excised surgically, which may result in wound healing complications, in addition to a risk of recurrence. Refinements of existing diagnostic modalities, like micro- and nano-CT are being adapted toward early intervention. Trauma-induced HO is a consequence of aberrant wound healing, systemic and local immune system activation, infections, extensive vascularization, and innervation. This intricate molecular crosstalk culminates in activation of stem cells that initiate heterotopic endochondral ossification. Development of animal models recapitulating the unique traumatic injuries has greatly facilitated the mechanistic understanding of trauma-induced HO. These same models also serve as powerful tools to test the efficacy of small molecules which specifically target the molecular pathways underlying ectopic ossification. This review summarizes the recent advances in the molecular understanding, diagnostic and treatment modalities in the field of trauma-induced HO.
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Strategic Targeting of Multiple BMP Receptors Prevents Trauma-Induced Heterotopic Ossification. Mol Ther 2017; 25:1974-1987. [PMID: 28716575 DOI: 10.1016/j.ymthe.2017.01.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 01/08/2023] Open
Abstract
Trauma-induced heterotopic ossification (tHO) is a condition of pathologic wound healing, defined by the progressive formation of ectopic bone in soft tissue following severe burns or trauma. Because previous studies have shown that genetic variants of HO, such as fibrodysplasia ossificans progressiva (FOP), are caused by hyperactivating mutations of the type I bone morphogenetic protein receptor (T1-BMPR) ACVR1/ALK2, studies evaluating therapies for HO have been directed primarily toward drugs for this specific receptor. However, patients with tHO do not carry known T1-BMPR mutations. Here we show that, although BMP signaling is required for tHO, no single T1-BMPR (ACVR1/ALK2, BMPR1a/ALK3, or BMPR1b/ALK6) alone is necessary for this disease, suggesting that these receptors have functional redundancy in the setting of tHO. By utilizing two different classes of BMP signaling inhibitors, we developed a translational approach to treatment, integrating treatment choice with existing diagnostic options. Our treatment paradigm balances either immediate therapy with reduced risk for adverse effects (Alk3-Fc) or delayed therapy with improved patient selection but greater risk for adverse effects (LDN-212854).
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Abstract
Burns and trauma cause superficial and deep soft tissue wounds that cannot heal to the preinjury state. Healing requires cell proliferation and differentiation into the injured tissue type, laying down extracellular matrix, often as collagens. Heterotopic ossification causes severe pain, nonhealing wounds, and restricted range of motion. Treatment includes radiation therapy, nonsteroidal anti-inflammatory drugs, bisphosphonates, and possibly surgical excision and prophylactic measures. Hypertrophic scars, nonosseous lesions caused by excessive collagen deposition, are often painful, functionally limiting, and aesthetically displeasing. Treatment includes CO2 laser application, steroid injections, and excision with skin grafting. This article reviews the management of these pathologic wounds.
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Affiliation(s)
- Shailesh Agarwal
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Burn/Wound and Regenerative Medicine Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Burn/Wound and Regenerative Medicine Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin Levi
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Burn/Wound and Regenerative Medicine Laboratory, University of Michigan, Ann Arbor, MI, USA.
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36
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Abstract
Heterotopic ossification (HO) presents a substantial barrier to rehabilitation for patients with severe burns or trauma. Although surgical excision is a mainstay of management for this condition, this is unable to address the chronic sequelae of HO, including chronic pain, joint contractures, nerve dysfunction, and open wounds. Current therapeutic modalities are aimed at excision and the prevention of recurrence using nonsteroidal antiinflammatory drugs (NSAIDs) or radiation therapy. Research is now focused on identifying alternative strategies to prevent the initial occurrence of HO through NSAIDs and novel inhibitors of the bone morphogenetic protein signaling pathway.
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37
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Discussion: Regeneration of Vascularized Corticocancellous Bone and Diploic Space Using Muscle-Derived Stem Cells: A Translational Biologic Alternative for Healing Critical Bone Defects. Plast Reconstr Surg 2017; 139:906-907. [PMID: 28350669 DOI: 10.1097/prs.0000000000003210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sowoidnich K, Churchwell JH, Buckley K, Goodship AE, Parker AW, Matousek P. Spatially offset Raman spectroscopy for photon migration studies in bones with different mineralization levels. Analyst 2017; 142:3219-3226. [DOI: 10.1039/c7an00408g] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study provides a deeper understanding of bone's optical properties which is essential to the development of SORS-based diagnostic tools.
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Affiliation(s)
- Kay Sowoidnich
- Central Laser Facility
- Research Complex at Harwell
- STFC Rutherford Appleton Laboratory
- Didcot OX11 0QX
- UK
| | - John H. Churchwell
- UCL Institute of Orthopaedics and Musculoskeletal Science
- Royal National Orthopaedic Hospital
- London HA7 4LP
- UK
| | - Kevin Buckley
- Central Laser Facility
- Research Complex at Harwell
- STFC Rutherford Appleton Laboratory
- Didcot OX11 0QX
- UK
| | - Allen E. Goodship
- UCL Institute of Orthopaedics and Musculoskeletal Science
- Royal National Orthopaedic Hospital
- London HA7 4LP
- UK
| | - Anthony W. Parker
- Central Laser Facility
- Research Complex at Harwell
- STFC Rutherford Appleton Laboratory
- Didcot OX11 0QX
- UK
| | - Pavel Matousek
- Central Laser Facility
- Research Complex at Harwell
- STFC Rutherford Appleton Laboratory
- Didcot OX11 0QX
- UK
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Agarwal S, Cholok D, Loder S, Li J, Breuler C, Chung MT, Sung HH, Ranganathan K, Habbouche J, Drake J, Peterson J, Priest C, Li S, Mishina Y, Levi B. mTOR inhibition and BMP signaling act synergistically to reduce muscle fibrosis and improve myofiber regeneration. JCI Insight 2016; 1:e89805. [PMID: 27942591 DOI: 10.1172/jci.insight.89805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Muscle trauma is highly morbid due to intramuscular scarring, or fibrosis, and muscle atrophy. Studies have shown that bone morphogenetic proteins (BMPs) reduce muscle atrophy. However, increased BMP signaling at muscle injury sites causes heterotopic ossification, as seen in patients with fibrodysplasia ossificans progressiva (FOP), or patients with surgically placed BMP implants for bone healing. We use a genetic mouse model of hyperactive BMP signaling to show the development of intramuscular fibrosis surrounding areas of ectopic bone following muscle injury. Rapamycin, which we have previously shown to eliminate ectopic ossification in this model, also eliminates fibrosis without reducing osteogenic differentiation, suggesting clinical value for patients with FOP and with BMP implants. Finally, we use reporter mice to show that BMP signaling is positively associated with myofiber cross-sectional area. These findings underscore an approach in which 2 therapeutics (rapamycin and BMP ligand) can offset each other, leading to an improved outcome.
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Affiliation(s)
- Shailesh Agarwal
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - David Cholok
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Shawn Loder
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - John Li
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Christopher Breuler
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Michael T Chung
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Hsiao Hsin Sung
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kavitha Ranganathan
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joe Habbouche
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - James Drake
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joshua Peterson
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Caitlin Priest
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Shuli Li
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Yuji Mishina
- School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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Agarwal S, Loder S, Cholok D, Li J, Breuler C, Drake J, Brownley C, Peterson J, Li S, Levi B. Surgical Excision of Heterotopic Ossification Leads to Re-Emergence of Mesenchymal Stem Cell Populations Responsible for Recurrence. Stem Cells Transl Med 2016; 6:799-806. [PMID: 28297577 PMCID: PMC5442786 DOI: 10.5966/sctm.2015-0365] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 08/29/2016] [Indexed: 01/04/2023] Open
Abstract
Trauma‐induced heterotopic ossification (HO) occurs after severe musculoskeletal injuries and burns, and presents a significant barrier to patient rehabilitation. Interestingly, the incidence of HO significantly increases with repeated operations and after resection of previous HO. Treatment of established heterotopic ossification is challenging because surgical excision is often incomplete, with evidence of persistent heterotopic bone. As a result, patients may continue to report the signs or symptoms of HO, including chronic pain, nonhealing wounds, and joint restriction. In this study, we designed a model of recurrent HO that occurs after surgical excision of mature HO in a mouse model of hind‐limb Achilles’ tendon transection with dorsal burn injury. We first demonstrated that key signaling mediators of HO, including bone morphogenetic protein signaling, are diminished in mature bone. However, upon surgical excision, we have noted upregulation of downstream mediators of osteogenic differentiation, including pSMAD 1/5. Additionally, surgical excision resulted in re‐emergence of a mesenchymal cell population marked by expression of platelet‐derived growth factor receptor‐α (PDGFRα) and present in the initial developing HO lesion but absent in mature HO. In the recurrent lesion, these PDGFRα+ mesenchymal cells are also highly proliferative, similar to the initial developing HO lesion. These findings indicate that surgical excision of HO results in recurrence through similar mesenchymal cell populations and signaling mechanisms that are present in the initial developing HO lesion. These results are consistent with findings in patients that new foci of ectopic bone can develop in excision sites and are likely related to de novo formation rather than extension of unresected bone. Stem Cells Translational Medicine2017;6:799–806
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Affiliation(s)
- Shailesh Agarwal
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Shawn Loder
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - David Cholok
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - John Li
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Chris Breuler
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - James Drake
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cameron Brownley
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joshua Peterson
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Shuli Li
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Levi
- Burn/Wound and Regenerative Medicine Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Pavey GJ, Qureshi AT, Tomasino AM, Honnold CL, Bishop DK, Agarwal S, Loder S, Levi B, Pacifici M, Iwamoto M, Potter BK, Davis TA, Forsberg JA. Targeted stimulation of retinoic acid receptor-γ mitigates the formation of heterotopic ossification in an established blast-related traumatic injury model. Bone 2016; 90:159-67. [PMID: 27368930 PMCID: PMC5546218 DOI: 10.1016/j.bone.2016.06.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/24/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
Heterotopic ossification (HO) involves formation of endochondral bone at non-skeletal sites, is prevalent in severely wounded service members, and causes significant complications and delayed rehabilitation. As common prophylactic treatments such as anti-inflammatory drugs and irradiation cannot be used after multi-system combat trauma, there is an urgent need for new remedies. Previously, we showed that the retinoic acid receptor γ agonist Palovarotene inhibited subcutaneous and intramuscular HO in mice, but those models do not mimic complex combat injury. Thus, we tested Palovarotene in our validated rat trauma-induced HO model that involves blast-related limb injury, femoral fracture, quadriceps crush injury, amputation and infection with methicillin-resistant Staphylococcus aureus from combat wound infections. Palovarotene was given orally for 14days at 1mg/kg/day starting on post-operative day (POD) 1 or POD-5, and HO amount, wound dehiscence and related processes were monitored for up to 84days post injury. Compared to vehicle-control animals, Palovarotene significantly decreased HO by 50 to 60% regardless of when the treatment started and if infection was present. Histological analyses showed that Palovarotene reduced ectopic chondrogenesis, osteogenesis and angiogenesis forming at the injury site over time, while fibrotic tissue was often present in place of ectopic bone. Custom gene array data verified that while expression of key chondrogenic and osteogenic genes was decreased within soft tissues of residual limb in Palovarotene-treated rats, expression of cartilage catabolic genes was increased, including matrix metalloproteinase-9. Importantly, Palovarotene seemed to exert moderate inhibitory effects on wound healing, raising potential safety concerns related to dosing and timing. Our data show for the first time that Palovarotene significantly inhibits HO triggered by blast injury and associated complications, strongly indicating that it may prevent HO in patients at high risk such as those sustaining combat injuries and other forms of blast trauma.
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Affiliation(s)
- Gabriel J Pavey
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States; USU-Walter Reed Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Ammar T Qureshi
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States
| | - Allison M Tomasino
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States
| | - Cary L Honnold
- Department of Pathology, Naval Medical Research Center, Silver Spring, MD, United States
| | - Danett K Bishop
- Department of Wound Infections, Naval Medical Research Center, Silver Spring, MD, United States
| | - Shailesh Agarwal
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Shawn Loder
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Benjamin Levi
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Maurizio Pacifici
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, PA, United States
| | - Masahiro Iwamoto
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, PA, United States
| | - Benjamin K Potter
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States; USU-Walter Reed Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Thomas A Davis
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States; USU-Walter Reed Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States.
| | - Jonathan A Forsberg
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States; USU-Walter Reed Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
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Agarwal S, Drake J, Qureshi AT, Loder S, Li S, Shigemori K, Peterson J, Cholok D, Forsberg JA, Mishina Y, Davis TA, Levi B. Characterization of Cells Isolated from Genetic and Trauma-Induced Heterotopic Ossification. PLoS One 2016; 11:e0156253. [PMID: 27494521 PMCID: PMC4975503 DOI: 10.1371/journal.pone.0156253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/11/2016] [Indexed: 12/13/2022] Open
Abstract
Heterotopic ossification (HO) is the pathologic formation of bone separate from the normal skeleton. Although several models exist for studying HO, an understanding of the common in vitro properties of cells isolated from these models is lacking. We studied three separate animal models of HO including two models of trauma-induced HO and one model of genetic HO, and human HO specimens, to characterize the properties of cells derived from tissue containing pre-and mature ectopic bone in relation to analogous mesenchymal cell populations or osteoblasts obtained from normal muscle tissue. We found that when cultured in vitro, cells isolated from the trauma sites in two distinct models exhibited increased osteogenic differentiation when compared to cells isolated from uninjured controls. Furthermore, osteoblasts isolated from heterotopic bone in a genetic model of HO also exhibited increased osteogenic differentiation when compared with normal osteoblasts. Finally, osteoblasts derived from mature heterotopic bone obtained from human patients exhibited increased osteogenic differentiation when compared with normal bone from the same patients. These findings demonstrate that across models, cells derived from tissues forming heterotopic ossification exhibit increased osteogenic differentiation when compared with either normal tissues or osteoblasts. These cell types can be used in the future for in vitro investigations for drug screening purposes.
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Affiliation(s)
- Shailesh Agarwal
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, 48109, United States of America
| | - James Drake
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, 48109, United States of America
| | - Ammar T Qureshi
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD, 20910, United States of America
| | - Shawn Loder
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, 48109, United States of America
| | - Shuli Li
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, 48109, United States of America
| | - Kay Shigemori
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, 48109, United States of America
| | - Jonathan Peterson
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, 48109, United States of America
| | - David Cholok
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, 48109, United States of America
| | - Jonathan A Forsberg
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD, 20910, United States of America
| | - Yuji Mishina
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, 48109, United States of America
| | - Thomas A Davis
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD, 20910, United States of America
| | - Benjamin Levi
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, 48109, United States of America
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Peterson JR, De La Rosa S, Eboda O, Cilwa KE, Agarwal S, Buchman SR, Cederna PS, Xi C, Morris MD, Herndon DN, Xiao W, Tompkins RG, Krebsbach PH, Wang SC, Levi B. Treatment of heterotopic ossification through remote ATP hydrolysis. Sci Transl Med 2016; 6:255ra132. [PMID: 25253675 DOI: 10.1126/scitranslmed.3008810] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Heterotopic ossification (HO) is the pathologic development of ectopic bone in soft tissues because of a local or systemic inflammatory insult, such as burn injury or trauma. In HO, mesenchymal stem cells (MSCs) are inappropriately activated to undergo osteogenic differentiation. Through the correlation of in vitro assays and in vivo studies (dorsal scald burn with Achilles tenotomy), we have shown that burn injury enhances the osteogenic potential of MSCs and causes ectopic endochondral heterotopic bone formation and functional contractures through bone morphogenetic protein-mediated canonical SMAD signaling. We further demonstrated a prevention strategy for HO through adenosine triphosphate (ATP) hydrolysis at the burn site using apyrase. Burn site apyrase treatment decreased ATP, increased adenosine 3',5'-monophosphate, and decreased phosphorylation of SMAD1/5/8 in MSCs in vitro. This ATP hydrolysis also decreased HO formation and mitigated functional impairment in vivo. Similarly, selective inhibition of SMAD1/5/8 phosphorylation with LDN-193189 decreased HO formation and increased range of motion at the injury site in our burn model in vivo. Our results suggest that burn injury-exacerbated HO formation can be treated through therapeutics that target burn site ATP hydrolysis and modulation of SMAD1/5/8 phosphorylation.
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Affiliation(s)
- Jonathan R Peterson
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Sara De La Rosa
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Oluwatobi Eboda
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Katherine E Cilwa
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD 20910, USA
| | - Shailesh Agarwal
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Steven R Buchman
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Paul S Cederna
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA. Section of Plastic Surgery, Department of Biomedical Engineering, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Chuanwu Xi
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Michael D Morris
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch at Galveston, and Shriners Hospitals for Children, Galveston, TX 77550, USA
| | - Wenzhong Xiao
- Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ronald G Tompkins
- Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Paul H Krebsbach
- Department of Biologic and Material Sciences, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Stewart C Wang
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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Risk factors for the development of heterotopic ossification in seriously burned adults: A National Institute on Disability, Independent Living and Rehabilitation Research burn model system database analysis. J Trauma Acute Care Surg 2016; 79:870-6. [PMID: 26496115 DOI: 10.1097/ta.0000000000000838] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study, we use a multicenter database of adults with burn injuries to identify and analyze clinical factors that predict HO formation. METHODS Data from six high-volume burn centers, in the Burn Injury Model System Database, were analyzed. Univariate logistic regression models were used for model selection. Cluster-adjusted multivariate logistic regression was then used to evaluate the relationship between clinical and demographic data and the development of HO. RESULTS Of 2,979 patients in the database with information on HO that addressed risk factors for development of HO, 98 (3.5%) developed HO. Of these 98 patients, 97 had arm burns, and 96 had arm grafts. When controlling for age and sex in a multivariate model, patients with greater than 30% total body surface area burn had 11.5 times higher odds of developing HO (p < 0.001), and those with arm burns that required skin grafting had 96.4 times higher odds of developing HO (p = 0.04). For each additional time a patient went to the operating room, odds of HO increased by 30% (odds ratio, 1.32; p < 0.001), and each additional ventilator day increased odds by 3.5% (odds ratio, 1.035; p < 0.001). Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO. CONCLUSION Risk factors for HO development include greater than 30% total body surface area burn, arm burns, arm grafts, ventilator days, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments. LEVEL OF EVIDENCE Prognostic study, level III.
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45
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Eisenstein NM, Cox SC, Williams RL, Stapley SA, Grover LM. Bedside, Benchtop, and Bioengineering: Physicochemical Imaging Techniques in Biomineralization. Adv Healthc Mater 2016; 5:507-28. [PMID: 26789418 DOI: 10.1002/adhm.201500617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/10/2015] [Indexed: 01/10/2023]
Abstract
The need to quantify physicochemical properties of mineralization spans many fields. Clinicians, mineralization researchers, and bone tissue bioengineers need to be able to measure the distribution, quantity, and the mechanical and chemical properties of mineralization within a wide variety of substrates from injured muscle to electrospun polymer scaffolds and everything in between. The techniques available to measure these properties are highly diverse in terms of their complexity and utility. Therefore it is of the utmost importance that those who intend to use them have a clear understanding of the advantages and disadvantages of each technique and its appropriateness to their specific application. This review provides all of this information for each technique and uses heterotopic ossification and engineered bone substitutes as examples to illustrate how these techniques have been applied. In addition, we provide novel data using advanced techniques to analyze human samples of combat related heterotopic ossification.
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Affiliation(s)
- Neil M. Eisenstein
- Chemical Engineering; University of Birmingham; Edgbaston B15 2TT UK
- Royal Centre for Defence Medicine; ICT Centre; Vincent Drive; Edgbaston B15 2SQ UK
| | - Sophie C. Cox
- Chemical Engineering; University of Birmingham; Edgbaston B15 2TT UK
| | | | - Sarah A. Stapley
- Royal Centre for Defence Medicine; ICT Centre; Vincent Drive; Edgbaston B15 2SQ UK
| | - Liam M. Grover
- Chemical Engineering; University of Birmingham; Edgbaston B15 2TT UK
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46
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Sun Y, Cai J, Yu S, Chen S, Li F, Fan C. MiR-630 Inhibits Endothelial-Mesenchymal Transition by Targeting Slug in Traumatic Heterotopic Ossification. Sci Rep 2016; 6:22729. [PMID: 26940839 PMCID: PMC4778133 DOI: 10.1038/srep22729] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/18/2016] [Indexed: 12/16/2022] Open
Abstract
Heterotopic ossification (HO) is the abnormal formation of mature bone in extraskeletal soft tissues that occurs as a result of inflammation caused by traumatic injury or associated with genetic mutation. Despite extensive research to identify the source of osteogenic progenitors, the cellular origins of HO are controversial and the underlying mechanisms, which are important for the early detection of HO, remain unclear. Here, we used in vitro and in vivo models of BMP4 and TGF-β2-induced HO to identify the cellular origin and the mechanisms mediating the formation of ectopic bone in traumatic HO. Our results suggest an endothelial origin of ectopic bone in early phase of traumatic HO and indicate that the inhibition of endothelial-mesenchymal transition by miR-630 targeting Slug plays a role in the formation of ectopic bone in HO. A matched case-control study showed that miR-630 is specifically downregulated during the early stages of HO and can be used to distinguish HO from other processes leading to bone formation. Our findings suggest a potential mechanism of post-traumatic ectopic bone formation and identify miR-630 as a potential early indicator of HO.
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Affiliation(s)
- Yangbai Sun
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jiangyu Cai
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Shiyang Yu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Shuai Chen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Fengfeng Li
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Cunyi Fan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
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47
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Matousek P, Stone N. Development of deep subsurface Raman spectroscopy for medical diagnosis and disease monitoring. Chem Soc Rev 2016; 45:1794-802. [DOI: 10.1039/c5cs00466g] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The advent of non-invasive deep Raman techniques heralds the emergence of novel diagnostic and disease monitoring methods.
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Affiliation(s)
- Pavel Matousek
- Central Laser Facility
- Research Complex at Harwell
- STFC Rutherford Appleton Laboratory
- Harwell Oxford
- UK
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48
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Brownley RC, Agarwal S, Loder S, Eboda O, Li J, Peterson J, Hwang C, Breuler C, Kaartinen V, Zhou B, Mishina Y, Levi B. Characterization of Heterotopic Ossification Using Radiographic Imaging: Evidence for a Paradigm Shift. PLoS One 2015; 10:e0141432. [PMID: 26544555 PMCID: PMC4636348 DOI: 10.1371/journal.pone.0141432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022] Open
Abstract
Heterotopic ossification (HO) is the growth of extra-skeletal bone which occurs following trauma, burns, and in patients with genetic bone morphogenetic protein (BMP) receptor mutations. The clinical and laboratory evaluation of HO is dependent on radiographic imaging to identify and characterize these lesions. Here we show that despite its inadequacies, plain film radiography and single modality microCT continue to serve as a primary method of HO imaging in nearly 30% of published in vivo literature. Furthermore, we demonstrate that detailed microCT analysis is superior to plain film and single modality microCT radiography specifically in the evaluation of HO formed through three representative models due to its ability to 1) define structural relationships between growing extra-skeletal bone and normal, anatomic bone, 2) provide accurate quantification and growth rate based on volume of the space-occupying lesion, thereby facilitating assessments of therapeutic intervention, 3) identify HO at earlier times allowing for evaluation of early intervention, and 4) characterization of metrics of bone physiology including porosity, tissue mineral density, and cortical and trabecular volume. Examination of our trauma model using microCT demonstrated two separate areas of HO based on anatomic location and relationship with surrounding, normal bone structures. Additionally, microCT allows HO growth rate to be evaluated to characterize HO progression. Taken together, these data demonstrate the need for a paradigm shift in the evaluation of HO towards microCT as a standard tool for imaging.
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Affiliation(s)
- R. Cameron Brownley
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Shailesh Agarwal
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Shawn Loder
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Oluwatobi Eboda
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - John Li
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Joshua Peterson
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Charles Hwang
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Christopher Breuler
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Vesa Kaartinen
- School of Dentistry, University of Michigan, Ann Arbor, MI, United States of America
| | - Bin Zhou
- Albert Einstein School of Medicine, New York, NY, United States of America
| | - Yuji Mishina
- School of Dentistry, University of Michigan, Ann Arbor, MI, United States of America
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
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49
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Davies OG, Grover LM, Eisenstein N, Lewis MP, Liu Y. Identifying the Cellular Mechanisms Leading to Heterotopic Ossification. Calcif Tissue Int 2015; 97:432-44. [PMID: 26163233 DOI: 10.1007/s00223-015-0034-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/02/2015] [Indexed: 12/19/2022]
Abstract
Heterotopic ossification (HO) is a debilitating condition defined by the de novo development of bone within non-osseous soft tissues, and can be either hereditary or acquired. The hereditary condition, fibrodysplasia ossificans progressiva is rare but life threatening. Acquired HO is more common and results from a severe trauma that produces an environment conducive for the formation of ectopic endochondral bone. Despite continued efforts to identify the cellular and molecular events that lead to HO, the mechanisms of pathogenesis remain elusive. It has been proposed that the formation of ectopic bone requires an osteochondrogenic cell type, the presence of inductive agent(s) and a permissive local environment. To date several lineage-tracing studies have identified potential contributory populations. However, difficulties identifying cells in vivo based on the limitations of phenotypic markers, along with the absence of established in vitro HO models have made the results difficult to interpret. The purpose of this review is to critically evaluate current literature within the field in an attempt identify the cellular mechanisms required for ectopic bone formation. The major aim is to collate all current data on cell populations that have been shown to possess an osteochondrogenic potential and identify environmental conditions that may contribute to a permissive local environment. This review outlines the pathology of endochondral ossification, which is important for the development of potential HO therapies and to further our understanding of the mechanisms governing bone formation.
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Affiliation(s)
- O G Davies
- School of Mechanical and Manufacturing Engineering, Loughborough University, Ashby Road, Loughborough, LE11 3TU, UK.
- Centre for Biological Engineering, Loughborough University, Loughborough, LE11 3TU, UK.
| | - L M Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - N Eisenstein
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - M P Lewis
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Y Liu
- School of Mechanical and Manufacturing Engineering, Loughborough University, Ashby Road, Loughborough, LE11 3TU, UK
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50
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Agarwal S, Loder S, Li J, Brownley C, Peterson JR, Oluwatobi E, Drake J, Cholok D, Ranganathan K, Sung HH, Goulet J, Li S, Levi B. Diminished Chondrogenesis and Enhanced Osteoclastogenesis in Leptin-Deficient Diabetic Mice (ob/ob) Impair Pathologic, Trauma-Induced Heterotopic Ossification. Stem Cells Dev 2015; 24:2864-72. [PMID: 26413838 DOI: 10.1089/scd.2015.0135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Diabetic trauma patients exhibit delayed postsurgical wound, bony healing, and dysregulated bone development. However, the impact of diabetes on the pathologic development of ectopic bone or heterotopic ossification (HO) following trauma is unknown. In this study, we use leptin-deficient mice as a model for type 2 diabetes to understand how post-traumatic HO development may be affected by this disease process. Male leptin-deficient (ob/ob) or wild-type (C57BL/6 background) mice aged 6-8 weeks underwent 30% total body surface area burn injury with left hind limb Achilles tenotomy. Micro-CT (μCT) imaging showed significantly lower HO volumes in diabetic mice compared with wild-type controls (0.70 vs. 7.02 mm(3), P < 0.01) 9 weeks after trauma. Ob/ob mice showed evidence of HO resorption between weeks 5 and 9. Quantitative real time PCR (qRT-PCR) demonstrated high Vegfa levels in ob/ob mice, which was followed by disorganized vessel growth at 7 weeks. We noted diminished chondrogenic gene expression (SOX9) and diminished cartilage formation at 5 days and 3 weeks, respectively. Tartrate-resistant acid phosphatase stain showed increased osteoclast presence in normal native bone and pathologic ectopic bone in ob/ob mice. Our findings suggest that early diminished HO in ob/ob mice is related to diminished chondrogenic differentiation, while later bone resorption is related to osteoclast presence.
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Affiliation(s)
- Shailesh Agarwal
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - Shawn Loder
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - John Li
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - Cameron Brownley
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - Jonathan R Peterson
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - Eboda Oluwatobi
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - James Drake
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - David Cholok
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - Kavitha Ranganathan
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - Hsiao Hsin Sung
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - James Goulet
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - Shuli Li
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
| | - Benjamin Levi
- Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
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